Awareness and perception of oral cancer among the general population

INTRODUCTION

Oral cancer represents an important global health concern, especially in South Asian countries like India, which has one of the world’s highest incidences of oral malignancy.^[1] Major risk factors associated with oral cancer include tobacco use (smoked or smokeless), excessive alcohol consumption, poor oral hygiene, and human papillomavirus (HPV) infection.^[2,3] Despite advancements in diagnosis and treatment, low survival rates persist, primarily due to delayed presentation and diagnosis resulting from inadequate screening practices and low public awareness.^[4] Preventive strategies must include public education, routine dental examinations, and behavioral change interventions.^[5] This study employed a structured questionnaire survey to assess oral cancer awareness, risk perception, and preventive behaviors among adults, thereby identifying existing gaps and promoting timely preventive action.^[6]

MATERIALS AND METHODS

The primary objective of this study was to assess adult awareness of oral cancer symptoms and risk factors. This cross-sectional study was conducted among adults residing in both urban and rural areas of Jabalpur in May 2025 and the study was carried out in community centers, educational institutions, and public healthcare facilities. The study included individuals aged 18 years and above from both urban and rural areas. Participants were selected based on their willingness to participate and ability to understand the questionnaire content. Individuals with cognitive impairments or language barriers were excluded to ensure accurate responses.

The sample size was calculated using the formula for cross-sectional studies:

n = (Z² × p × q)/d²

Where:

Z = 1.96 (for 95% confidence interval)

p = Expected prevalence of oral cancer awareness (assumed 50% for maximum sample size)

q = 1 − p = 0.50

d = Margin of error (5% or 0.05)

Based on this calculation, the minimum required sample size was 384 participants. However, due to time and resource constraints during the study, only 52 participants were recruited using convenience sampling. This limitation is acknowledged and discussed in the limitations section. Data were collected through a structured and pre-validated questionnaire (Cronbach’s alpha = 0.78)^[6] distributed in both physical and digital formats. The questionnaire was originally designed in English and translated into the local language where needed. It included multiple-choice and yes/no questions covering demographic details (age, gender), personal habits (tobacco and alcohol use), dental visit frequency, awareness of oral cancer signs and risk factors, and attitudes toward screening and prevention. Informed consent was obtained from all participants before data collection. A non-probability convenience sampling method was adopted due to time and resource constraints. This approach enabled quick and efficient access to a diverse range of participants; however, it may affect the generalizability of the findings to the broader population.

Responses were compiled in Microsoft Excel and analyzed using Statistical Package for the Social Sciences software, version 26.0. Descriptive statistics, including frequencies and percentages, were used to summarize participant characteristics and awareness levels. Chi-square tests were employed to examine associations between awareness and behavioral factors, such as tobacco use, alcohol consumption, and dental visit frequency. Statistical significance was set at ρ < 0.05. Participation was entirely voluntary, and written informed consent was obtained from all participants. Anonymity and confidentiality were maintained throughout the data collection and analysis process. Ethical Committee clearance was waived due to the nature of the study. This study had several limitations. The use of convenience sampling and the small sample size (n = 52, below the calculated requirement of 384) may introduce selection bias, limiting the generalizability of the results to the broader population. Self-reported responses may be affected by social desirability or recall bias. In addition, the closed-ended nature of the questionnaire may not capture the depth of knowledge and attitudes related to oral cancer.

RESULTS

A total of 52 participants were included in the study, with ages ranging from 17 to 61 years. The mean age was 22.44 years (SD = 6.83), indicating a predominantly young sample with few older individuals. The most frequently reported age was 19 years (n = 10, 19.2%), followed by 24 years (n = 6, 11.5%) and 25 years (n = 4, 7.7%). A significant majority of participants (84.6%) were between 17 and 25 years of age, suggesting that the study population primarily consisted of adolescents and young adults. Only 5.8% of participants were aged above 40 years, indicating low representation of older individuals. Overall, the age distribution reflects a youthful demographic, which may influence the generalizability of findings to older populations. Regarding gender distribution, 36 (69.2%) participants identified as male, while 16 (30.8%) participants identified as female [Figure 1]. This gender imbalance suggests that study findings may be more reflective of male perspectives, and caution should be exercised when generalizing results across genders. Among the 52 participants, 49 (94.2%) reported not using tobacco products, including cigarettes and chewing tobacco, while only 3 (5.8%) admitted to using them. This indicates a very low prevalence of tobacco use within the study population. Regarding alcohol consumption, 47 (90.4%) participants reported abstaining from alcohol, while only 5 (9.6%) admitted to alcohol use. These findings reflect a predominantly healthy behavioral trend among participants regarding substance use. When asked about awareness of oral cancer, 49 (94.2%) participants reported having heard about the disease, while only 3 (5.8%) had not [Figure 2]. This demonstrates a high level of awareness about oral cancer among the study population.

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Figure 1: Gender distribution of study participants (n = 52).

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Figure 2: Awareness about oral cancer among participants (n = 52).

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The majority of participants identified tobacco use as the primary risk factor for oral cancer (n = 47, 90.4%), 3 (5.8%) participants identified poor oral hygiene, while 2 (3.8%) recognized alcohol consumption as a contributing factor. These findings reflect strong awareness of tobacco as a major risk factor, although awareness of other contributing factors was notably lower. Forty-seven participants (90.4%) were aware that regular dental check-ups can aid in early detection of oral cancer, while 5 (9.6%) were not aware. Regarding symptoms, 35 (67.3%) participants reported familiarity with oral cancer symptoms, including persistent mouth sores, unexplained bleeding, difficulty chewing or swallowing, and lumps in the neck or oral cavity. The remaining 17 (32.7%) participants were not familiar with these symptoms [Figure 3]. Six participants (11.5%) reported experiencing unusual symptoms in the mouth, such as sores, lumps, or discomfort lasting longer than 2 weeks, while 46 (88.5%) participants did not report such symptoms. Analysis of dental visit patterns revealed that 21 (40.4%) participants never visit a dentist for routine check-ups, 15 (28.8%) participants visit less than once a year, 7 (13.5%) participants visit once a year, and only 9 (17.3%) participants follow the recommended routine of visiting every 6 months.

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Figure 3: Awareness of oral cancer symptoms among participants (n = 52).

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Regarding preventability, 47 (90.4%) participants believed that oral cancer is preventable, while 5 (9.6%) participants did not share this belief [Figure 4]. When asked about willingness to undergo regular screenings, 33 (63.5%) participants expressed willingness, while 19 (36.5%) were not willing. Notably, all 52 (100%) participants agreed that oral cancer awareness programs are necessary in their community. Nine participants (17.3%) reported having a family history of oral cancer or other forms of cancer, while 43 (82.7%) participants did not. Chi-square tests were performed to examine associations between awareness levels and demographic or behavioral factors. The association between tobacco use and awareness of oral cancer risk factors which is presented in Table 1 was statistically significant (χ² = 8.42, df = 1, ρ= 0.004), indicating that tobacco users were more likely to be aware of tobacco as a risk factor. However, no significant association was found between gender and overall oral cancer awareness (χ² = 1.23, df = 1, ρ = 0.267) or between age group and willingness to undergo screening (χ² = 2.45, df = 1, ρ = 0.118). The association between frequency of dental visits and familiarity with oral cancer symptoms was statistically significant (χ² = 12.67, df = 1, ρ = 0.002), suggesting that individuals who visit dentists regularly are more knowledgeable about symptoms.

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Figure 4: Perception of oral cancer preventability among participants (n = 52).

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DISCUSSION

The present study reveals high awareness of oral cancer among young adults, with 94.2% of participants knowing of the disease and 67.3% recognizing major symptoms such as persistent lumps and sores. Most of the participants identified tobacco use as the central risk factor (90.4%), while fewer were aware of other contributors, including poor oral hygiene and alcohol consumption. These findings align with research from India and South Asia, where population surveys report widespread recognition of tobacco as the leading risk factor, though knowledge of other risk factors and symptoms is often incomplete.^[7-9] However, awareness levels can be substantially lower in rural settings and among certain demographic groups, contrasting with the high awareness observed in our predominantly young, urban sample.^[9]

The study reveals a significant gap between knowledge and preventive practices despite good awareness. Only 17.3% of participants reported visiting the dentist every 6 months, while 40.4% never sought regular check-ups. This finding is consistent with research from both local and global settings, which observes that preventive health behaviors often lag behind knowledge due to motivational and socioeconomic barriers.^[9,10] The statistically significant association between regular dental visits and symptom knowledge (ρ = 0.002) further emphasizes the importance of routine dental care in promoting oral cancer awareness.

The willingness to participate in oral cancer screening (63.5%) appears fairly hopeful, though some resistance persists, indicating continuing attitudinal barriers similar to those observed in earlier work.^[9] The unanimous agreement (100%) regarding the need for oral cancer awareness programs reinforces strong community interest in targeted education and outreach. The presence of family cancer history among 17.3% of participants highlights the importance of prevention strategies tailored for high-risk groups, a point raised repeatedly in scientific literature.^[7,10] While our findings generally align with previous research, the small sample size and convenience sampling method limit the generalizability of results. The predominantly young sample (mean age 22.44 years) may not represent the broader population at higher risk for oral cancer, typically individuals over 40 years of age.^[11] In addition, the low prevalence of tobacco (5.8%) and alcohol use (9.6%) in our sample differs markedly from national statistics, suggesting potential selection bias or underreporting.

The significant association between tobacco use and awareness of risk factors (p = 0.004) suggests that individuals engaging in risky behaviors may be more conscious of associated health consequences, possibly due to targeted health campaigns. However, this awareness has not necessarily translated into behavior modification, underscoring the need for interventions that go beyond information dissemination to address psychological, social, and economic factors influencing health behaviors. Overall, these results indicate the need for comprehensive public health interventions that promote not only awareness but also active behavioral change.^[10,11] Future strategies must prioritize oral cancer education, routine screening to improve early detection, and reduction of tobacco and alcohol use to lower disease burden in India and similar high-risk regions.^[9,11] Community-based programs targeting diverse age groups and socioeconomic backgrounds, along with the integration of oral cancer screening into primary healthcare services, could help bridge the gap between knowledge and practice.

CONCLUSION

This study demonstrates that while participants exhibit high awareness of oral cancer, with most recognizing key symptoms and understanding its preventability, significant gaps exist between knowledge and preventive behavior. Despite high awareness, tobacco and alcohol use persist in the community, and regular dental check-ups, vital for early detection, are underutilized, with only 17.3% of respondents following recommended screening intervals. The findings regarding awareness of risk factors and willingness toward screening are encouraging and align with previous research from India and globally. However, the small sample size, convenience sampling method, and predominantly young demographic limit the generalizability of these findings to the broader population, particularly older adults at higher risk for oral cancer. Public health efforts must now focus on translating awareness into action through behavioral change interventions, increased accessibility to dental care, and targeted programs for high-risk groups. Community-based oral cancer awareness programs, supported by all participants in this study, represent a promising avenue for addressing these gaps. Future research with larger, more representative samples and longitudinal designs is needed to better understand barriers to preventive behaviors and evaluate the effectiveness of intervention strategies in reducing oral cancer burden in India and similar high-risk regions.