Chewable risk factors - Threatened oral cancer HPV’s Looming Epidemic in Pakistan

Background: In Pakistan oropharyngeal cancer is the second leading malignancy after breast cancer, attributed to extensive use of several precarious chewable tobacco formulations. The human papillomavirus (HPV), as proven, plays a pivotal role in oropharyngeal cancer. This study was designed to investigate the relationship between chewable tobacco usage with HPV and its oncogenic strains in this population. Methods: Oral samples were collected from camps during awareness campaigns on oral hygiene/hazards of chewable tobacco. Subjects addicted to chewable tobacco formulations such as naswar, gutka, and pan, areca nut with or without oral lesions, having no febrile conditions were included. DNA was extracted and PCR were performed. SPSS version 20.0 was used for analysis. Frequencies and percentages were calculated for qualitative and mean & standard deviation for numerical variables. Pearson chi-square with 95% confidence level was used, p-value less than 0.05 was taken as significant. Results: A total of 1000 subjects and 450 controls (age 28.90±12.163) were included in this study. Out of 1000 (831 males and 169 females), 204(20%) were HPV positive whereas, 13, 6 and 6 subjects were positive for HPV16, HPV18 and both HPV16&18 respectively, compared to only 14 (6.42%) in the controls. Overall 631 were chewing a single and 369 multiple forms. Significant association was found between different forms of chewable tobacco with Leukoplakia, Erythroplakia, Rough mucosa and Trismus. Conclusions: Usage of chewable tobacco formulations is associated with high frequency of HPV infection OR= 7.981 (CI 4.587-13.89), which is a threat for an epidemic of oropharyngeal cancer.