Dear Editor,
Oral submucous fibrosis (OSMF) is a chronic, progressive and debilitating disease that affects the oral cavity, specifically the mucosa and submucosa. It has casually been linked to chewing gutkha, a tobacco and areca nut preparation.[1] It is considered a pre-cancerous disease that affects the oral cavity and can lead to the development of oral cancer if left untreated. Unfortunately, it is a condition that is often neglected and receives little attention from both national and international organizations, as well as government and non-government health sectors. This lack of attention results in a lack of awareness, a lack of treatment protocols, and a lack of resources to treat patients who suffer from this condition.[1]
OSMF is particularly prevalent in Asian countries, where it is popularly known as an Asian disease that affects people from low socioeconomic backgrounds.[2,3] Some research suggests that diet and drinking water play a role in the development of this condition, and it is therefore also associated with a lack of awareness and negligence.[3] This can result in OSMF progressing to a more serious stage, such as oral cancer.
The condition can create physical, mental, and social inhibitions in patients who suffer from it. Patients often complain of stiff oral mucosa, burning oral mucosal tissue, and occasionally ulcers that can hinder eating and drinking. This can lead to malnutrition and weight loss, and can negatively impact a patient’s overall quality of life.[2,3]
In addition to physical difficulties, many patients also suffer from cancerphobia, which is a fear of cancer. This fear often leads to self-medication, as well as severe mental stress and behavioural problems. This only exacerbates the challenges that patients face and can further prevent them from seeking proper treatment.
The recent study[4] on tobacco pattern chewing highlights the importance of targeting efforts to reduce tobacco related products use, particularly in low and middle-income countries, which serves as a benchmark for monitoring progress towards reducing tobacco-related diseases. By addressing the root cause of the problem, such as the availability of tobacco products, governments can work to reduce the number of OSMF patients and prevent the disease from becoming more widespread. It is imperative for healthcare sectors to prioritize the care and treatment of OSMF patients, especially on the occasion of World Cancer Day, as the government should focus on closing the care gap for OSMF patients and preventing the disease from progressing to a malignant state. Policy changes regarding causative factors, such as gutkha, which has been banned in India but still available in a two-sachet form, should also be considered to address the inequities in care protocols between OSMF and cancer.
In conclusion, OSMF is a condition that requires more attention, resources, and support from healthcare sectors, both nationally and internationally. Patients suffering from OSMF need access to proper treatment and support to help manage their condition, prevent progression to oral cancer, and improve their quality of life. On World Cancer Day, let us all come together to raise awareness about this condition, provide support to patients, and work towards closing the OSMF care gap.
Gururaj Arakeri, [1,2] Vishal Rao, [1] Shekar Patil, [3] Peter A Brennan [4]
1 Department of Head and Neck Oncology, HCG Cancer Center, Bengaluru, Karnataka, India
2 Department of Oral and Maxillofacial Surgery, HKDET Dental College and Hospital, Humnabad, Karnataka, India
3 Department of Medical Oncology, HCG Cancer Center, Bengaluru, Karnataka, India
4 Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
Conflict of interest
None
Funding
None
References:
1. Brennan PA, Arakeri G. Oral submucous fibrosis-an increasing global healthcare problem. J Oral Pathol Med. 2017 Jul;46(6):405. doi: 10.1111/jop.12580. PMID: 28672092.
2. Arakeri G, Patil SG, Aljabab AS, Lin KC, Merkx MAW, Gao S, Brennan PA. Oral submucous fibrosis: An update on pathophysiology of malignant transformation. J Oral Pathol Med. 2017 Jul;46(6):413-417. doi: 10.1111/jop.12582. Epub 2017 May 6. PMID: 28391621.
3. Arakeri G, Rai KK, Hunasgi S, Merkx MAW, Gao S, Brennan PA. Oral submucous fibrosis: An update on current theories of pathogenesis. J Oral Pathol Med. 2017 Jul;46(6):406-412. doi: 10.1111/jop.12581. Epub 2017 May 4. PMID: 28391620.
4. Theilmann M, Lemp JM, Winkler V, et al. Patterns of tobacco use in low and middle income countries by tobacco product and sociodemographic characteristics: nationally representative survey data from 82 countries. BMJ. 2022 Aug 30;378:e067582. doi: 10.1136/bmj-2021-067582. PMID: 36041745.
Closing the Gap: Addressing the Challenges of Oral Submucous Fibrosis on World Cancer Day