Global Health Nexus, Winter 2004

Creating Oral Cancer Interventions Among Immigrant Populations: A Focus on South Asian Immigrants

A. Ross Kerr, DDS, MSD
Assistant Professor of Oral Medicine and Director of Special Patient Care and Hospital Dentistry

In July 2003, I traveled to Mumbai (formerly Bombay), India, for 10 days on behalf of NYU’s Oral Cancer RAAHP Center to collaborate with Dr. Jyotsna Changrani, who had organized the trip, and Dr. Francesca Gany, both of the NYU School of Medicine’s Center for Immigrant Health, on its Smokeless Tobacco, Oral Pathology Prevention, and Awareness Network (STOP PANN) project. We were joined by Dr. Hetal Marfatia-Patel of the Mumbai-based Seth G.S. Medical College’s Department of Otolaryngology. Our objective was to train four medical students (two from the NYU School of Medicine and two from Seth G.S. Medical College) to conduct oral cancer examinations and to oversee the piloting of a survey instrument to be used to assess the demographics, knowledge, attitudes, and practices of South Asian immigrant populations in New York City with respect to their use of paan and gutkha, both forms of smokeless tobacco whose consumption is a deeply rooted cultural tradition in South Asia.

Paan, a form of betel quid, is a mixture of areca nut, slaked lime, spices, seeds, and tobacco wrapped in a betel leaf. Over the past decade, gutkha, a powdered or granulated mixture of tobacco, areca nut, limes, and spices, available in handy foil sachets, has also become immensely popular with both men and women across all socioeconomic levels. Importantly, the use of paan and gutkha has been clearly documented as a risk factor for oral cancer and precancer and both tobacco and areca nut have been shown to be independent risk factors for oral cancer and precancer. Since New York City is a magnet for the 1.67 million Asian Indians, primarily Indians, Bangladeshi, and Pakistanis, who have made the United States their home, the need for public health interventions is critical.

I was also responsible for overseeing an oral cancer screening at the general out-patient medical clinic at the government-run King Edward VII Memorial Hospital. We met with high-level health-care administrators, head and neck surgeons, oral cancer epidemiologists, preventive oncologists, and oral medicine specialists in Mumbai. As a result of this visit:

• Approximately 200 subjects were surveyed and the data is being analyzed to help us learn more about the smokeless tobacco chewing habits of New York City's South Asian immigrant populations, and to refine the surveys to be conducted among this population,
• Medical students learned both how to conduct a survey and how to perform oral cancer screenings, an important examination technique rarely taught in medical school curricula. The medical students subsequently chose the topic of oral cancer screening for their research reports,
• My colleagues and I learned about the Indian oral cancer scene, and ideas for future research collaborations were born, including possible risk-factor intervention studies, surveys to assess the systemic effects of areca/tobacco chewing habits, and studies to test emerging technology for the early detection of oral cancer and precancer.

In short, the collaboration between medicine and dentistry on this project was extremely fruitful and will very likely lead to future joint efforts involving information-sharing and problem-solving to reduce the incidence of oral cancer and precancer in South Asian populations both in their homelands and in the U.S.