The gendered face of oral cancer

While tobacco use, particularly smokeless forms such as gutka, khaini, and betel nut continues to drive the majority of cases, emerging shifts in risk profiles point to a more complex picture that public health systems are still struggling to address.

More than 90% of oral cancer cases in the country are linked to tobacco exposure, a habit that remains disproportionately prevalent among men. Cultural normalisation of chewing tobacco, especially in occupational and rural settings, has made early symptoms easy to ignore and difficult to challenge. Alcohol use compounds this risk further, accelerating disease progression and worsening outcomes.

At the same time, clinicians are increasingly encountering oral cancer in women and younger patients with no history of tobacco use. While these cases still represent a minority, the trend complicates traditional screening assumptions that focus almost exclusively on male tobacco users. HPV, long associated with oropharyngeal cancers, is now being flagged as a contributing factor in some younger, non-tobacco patients, underscoring the need for broader risk awareness and more inclusive screening strategies.

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Despite being one of the most visually accessible cancers, oral cancer in India is still diagnosed far too late. Most patients reach specialist care only after months of delay, when the disease has already advanced and treatment becomes more invasive, disfiguring, and less effective. Early lesions are often painless and subtle — a small ulcer, a patch of discoloration, and are frequently dismissed by patients and primary care providers alike.

Screening has proven to be one of the few interventions capable of disrupting this cycle. As Dr. Sultan A. Pradhan has noted, “Screening programs have proven to be a game-changer. Organised oral screening initiatives can reduce mortality by 24–30% by detecting precancerous conditions early.” Mobile screening units and community cancer camps have demonstrated how early identification of high-risk lesions can prevent malignant transformation altogether, particularly in populations with limited access to tertiary care.

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Alongside screening, technology is reshaping how cancer is detected and managed. Advances in molecular diagnostics are pushing oncology beyond traditional imaging, offering the possibility of detecting disease at a far earlier stage. As Dr. Shyam Aggarwal has observed, “We will soon start asking patients, is your ctDNA negative?” His emphasis on deep DNA sequencing and circulating tumour DNA reflects a future in which treatment decisions are guided not only by visible tumours, but by molecular signals that appear long before disease becomes clinically apparent.

Hospitals that integrate early detection pathways with advanced surgical techniques, precision reconstruction, and multidisciplinary care play a critical role in translating early diagnosis into survival. These centres act as bridges between community screening and long-term outcomes, ensuring that patients identified early are not lost in the system.

Oral cancer is one of the few cancers that is largely preventable, readily detectable, and highly curable when caught early. Its unequal impact, shaped by gender, habit, and delayed access to care is not inevitable. The real cost lies not in treatment alone, but in delayed action, missed warning signs, and a failure to adapt screening and technology to those most at risk.