Databases searched include PubMed, EMBASE, CINAHL, Google Scholar using key words tobacco use in India, cigarettes, beedis, smokeless tobacco, tobacco control, and legislation policies, and wide probability of these words was used in a variety of combinations. Reports of Government of India and World Health Organization (WHO), news reports from Web sites, names of individual states in India were used with the above key words to obtain state-specific information. The

This comprehensive review includes large-scale pan-India surveys and regional studies. Every aspect of smokeless tobacco, including variations in social, economic, demographic, gender, and education stratifiers, is presented. This evidence-based presentation thereby provides insight not only to assess the burden but can serve as a base, leading to the development and encouragement of research in closing the existing gaps in knowledge. It can also provide a track to formulate tobacco control strategies as well as to reinforce and potentially guide tobacco control policy aimed at addressing the tailored needs in the Indian context. The recommendations expand the tobacco control spectrum and are the first of their kind in the literature to focus on cessation programs as a paramedical subject to draw the attention of not only policymakers but also to integrate medical and dental educational institutions, health care professionals, and tobacco users to synergistically develop successful tobacco control measures.

PURPOSE Oral cancer (OC) is the leading cancer in 25% of Indian cancer registries, and 80% of OCs are diagnosed in advanced stages. OC screening is a topic of debate. Studies from other countries have used a variety of study designs as OC screening strategies. There are not many studies from India on strategic screening, and there is a need to review the literature to provide insights and knowledge about screening programs. The purpose of this narrative review is to present broad epidemiologic evidence on the OC burden in India, to discuss and summarize the currently available evidence for OC screening strategies, and to highlight a feasible opportunistic screening strategy for addressing OC burden in India. METHODS Medline and EMBASE were used to identify articles. Data from GLOBOCAN and government reports were obtained from websites. As many key concepts and divergent views cannot be addressed with a single research question, a narrative review was considered appropriate, but to ensure a comprehensive literature search, a systematic review search strategy was used. RESULTS OC rates are rising more rapidly in India than projected. Wide variations in OC incidence within India reflect regional diversity of risk factors. Studies abroad have demonstrated the feasibility of opportunistic screening of oral potentially malignant disorders by dentists; however, although recommendations exist in India, no studies of opportunistic screening by dentists have been reported. CONCLUSION The projected major increases in the OC burden necessitate an OC screening program; opportunistic screening of high-risk groups by dentists using oral visual examination is recommended as a cost-effective strategy. As a way forward, a pilot project to assess the feasibility of regional opportunistic screening is in progress.

Oral cancer is a silent crisis in India. Thirty per cent of all cancers are oral cancer, and approximately 17% of all cancers in men and 10.5% of all cancers in women are oral cancer. Approximately 70,000 new cases are reported annually and 46,000 oral cancer-related deaths occur each year in India; furthermore, the number of cases is rapidly increasing. With this crescendo there may be an estimated 100,000 new cases by 2020, which is insurmountable, especially in emerging economies like India. This astronomical increase is a direct result of tobacco usage. The Global Adult Tobacco Survey performed in 2010 (GATS-2010) reported that approximately 274.5 million people in India use tobacco in various forms. Increasing use of smokeless tobacco, especially by women and children, is of major concern. The World Health Organisation has identified tobacco control and oral cancer control measures as a health priority. However, prevention of tobacco use in India is a great challenge owing to low overall literacy rates and to greater prevalence among people in lower socio-economic strata. Addressing this problem requires a multidisciplinary approach. This paper presents a situational analysis of oral cancer in India and the role of tobacco in making it the epicentre of the disease, and focuses on the role of dental care-givers in influencing and promoting tobacco-control programmes and early detection of oral cancer.

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