Introduction

Oral cancer is the tenth most prevalent cancer globally, and its incidence is increasing, especially in developing nations.1 In Asia, it poses a significant health burden, with Southeast Asia reporting the highest incidence at 6.4 cases per 100,000 individual.2 Afghanistan notably faces a substantial incidence of lip and oral cavity cancer, with 22,817 cases reported in 2020. It ranks sixth in terms of cancer incidence.3

Research has identified smoking, alcohol consumption, and the use of smokeless tobacco products as primary risk factors for oral cancer, particularly among younger individuals.4 Detecting oral cancer at an early stage remains a challenge because delayed diagnosis often leads to poorer treatment outcomes.5 Despite oral malignancies typically manifesting as visible lesions, there is a concerning lack of awareness about their presentation and associated risk factors, which contributes to delayed diagnosis and increased morbidity and mortality rates.

Studies have emphasized the importance of timely diagnosis in improving patient outcomes, with potential 5-year survival rate enhancements from 50% to 80% when lesions are detected early.6 This not only offers patients a better chance of a cure but also reduces treatment expenses and enhances their quality of life.

Dental practitioners play a vital role in oral cancer diagnosis; however, reports indicate that many lack the necessary skills and knowledge for early detection, highlighting the need for more comprehensive screening protocols.7–9 Educating young students, especially dental students, about oral cancer and its risk factors can significantly contribute to prevention and early detection efforts.

Oral cancer poses a significant global health challenge, particularly in developing countries such as Afghanistan, where access to healthcare services may be limited. In Afghanistan, the incidence of oral cancer is notably high, with significant implications for public health. Despite its prevalence, there is a concerning lack of awareness about oral cancer among the population, including dental students and interns who play a crucial role in early detection and prevention efforts. To the best of our knowledge, no similar study has been conducted in Afghanistan. Our study aimed to address the critical need for improved oral cancer awareness and education among dental students and interns in Kabul, Afghanistan. By assessing their level of awareness of oral cancer, we can identify gaps in awareness and develop targeted educational interventions to enhance prevention and early detection efforts.

Materials and Methods Ethical Considerations

Ethical approval for the study protocol was obtained from the Research Ethics Committee of Khatam-Al-Nabieen University (AF, knu.edu.af.rec 03, 15-June-2022), ensuring adherence to the principles outlined in the Declaration of Helsinki (1964 and its subsequent revisions). A consent form providing detailed information was included alongside the questionnaire. We explicitly informed the students and interns that their participation in the study was voluntary. Subjects who agreed to complete the questionnaire were asked to sign consent form to participate in the study. We assured the participants that their anonymized data would be utilized solely in research and that confidentiality would be maintained.

Study Design

This study was a cross-sectional survey based on questionnaires.

Study Setting and Data

This research was conducted at the Faculty of Dentistry at Khatam Al Nabieen University in Kabul, Afghanistan, from July to November 2022. The sample size comprised 453 participants, including third-, fourth-, and fifth-year dental students, as well as dental interns.

Inclusion Criteria

Third-, fourth-, and fifth-year dental students, dental interns, and participants who consented to complete the questionnaire.

Exclusion Criteria

First- and second-year dental students, individuals who declined participation, individuals who provided incomplete responses, and non-dental students.

Study Instrument

The current study used a prevalidated questionnaire adapted from a previous study comprising 14 closed-ended questions.10 The questionnaire was translated into Dari by a specialist, after which it was distributed in person to students during their class sessions and to dental interns in dental settings. It typically took approximately 10 min to completethe first two questions pertained to gender and year of study, whereas the second part comprised 13 questions related to knowledge of oral cancer.

Data Collection

Following ethical approval, the investigators collected the participants’ data in person during their class sessions. A convenient, nonprobability sampling method was employed to recruit participants.

Statistical Analysis

The data were analyzed using descriptive statistical methods, and a bivariate analysis was conducted. A p value ≤0.05 was considered to indicate statistical significance. IBM SPSS version 25 was used for statistical analysis.

Results

Table 1 displays participant information regarding gender, year of study, and awareness of oral cancer. This study incorporated a bivariate analysis to investigate the potential association between respondents’ awareness of oral cancer and their gender. Of the 453 participants, 178 (39.3%) were male, and 275 (60.7%) were female.

Table 1 Demographic Characteristics and Knowledge of Oral Cancer

The first column of the table outlines the variables used to gauge awareness of oral cancer. The second column lists the anticipated responses, and the subsequent columns illustrate the responses categorized by gender. The remaining columns demonstrate the bivariate analysis, specifically the chi-square and p values.

The largest proportion of participants, constituting 42.9% (193 out of 453), were in their fifth year of education. A total of 88.07% (399 out of 453) of the participants had heard about oral cancer. All subsequent calculations used 399 as the denominator.

A total of 74.6% of the respondents, specifically 298 out of 399, accurately recognized habits (smoking and tobacco chewing) as potential causes of oral cancer. Approximately three-quarters of the respondents (74.9%, 299 out of 399) correctly indicated that oral cancer does not spread from person to person through touch or speaking. In total, 35.1% of the respondents, totaling 140 out of 399, believed that sharing clothes and utensils with an oral cancer patient could lead to the spread of the disease. In addition, 48.9% of respondents, 195 out of 399, believed that oral cancer is primarily observed in AIDS patients. A total of 19.7% of the respondents, equivalent to 79 out of 399, had come across someone with oral cancer. Among these individuals, 74.6% (20 out of 79) tried to avoid them or felt afraid of them. In addition, 11.7% of the respondents, 47 out of 399, reported having a family member either diagnosed with oral cancer or who had passed away due to the disease. Moreover, 60.9% of the respondents, or 243 out of 399, held the belief that oral cancer can be cured. Only 4.2% (17 out of 399) accurately identified all the treatment options for oral cancer: surgery, radiotherapy, chemotherapy, immunotherapy, targeted therapy, and combination therapy.

A total of 90.5% (361 out of 399) accurately identified the appropriate response for helping oral cancer patients: providing treatment support, being friendly, and offering help. Furthermore, 76.1% of respondents, or 304 out of 399, felt that the current survey increased awareness about oral cancer.

The mean percentage of knowledge was greater among males (62.7%) than among females (58.4%). A significantly greater number of males than females reported having heard about oral cancer. Bivariate analysis did not reveal a significant difference in awareness levels between males and females regarding oral cancer.

Discussion

Because of the extensive occurrence of oral cancer in Afghanistan and Southeast Asia, it is essential to ensure sufficient awareness regarding the risk factors, symptoms, and available treatments associated with this disease. This study evaluated the awareness of oral cancer among students at Khatam Al Nabieen University in Kabul, Afghanistan. The goal of this study was to identify areas where their knowledge might be insufficient and advocate for enhanced educational efforts within the university to promote preventive measures and safety concerning oral cancer. In addition, this study sought to investigate potential differences in awareness levels of oral cancer between male and female university students by assessing variations in exposure to general education on the subject among both groups.

The survey, comprising 12 questions focused on assessing university students’ awareness of oral cancer, includes inquiries about the nature of the disease, its contagiousness, risk factors, curability, and student acquaintances with oral cancer patients. A significant proportion of the students had heard of oral cancer, indicating considerable awareness of the disease among the student population. However, most respondents were aware of smoking and tobacco chewing as common risk factors, demonstrating their awareness of potential causes. This finding aligns with research conducted among medical students in Pakistan, which showed that more than half of students believed that smoking and tobacco chewing are the main risk factors for oral cancer.10 Moreover, research conducted in Malaysia revealed that a higher percentage (>90%) of students were aware of smoking and tobacco chewing as primary risk factors contributing to the development of oral cancer.11

Regarding the transmission of oral cancer among individuals, a majority demonstrated adequate understanding of non-contagious nature of oral cancer. Compared with the previous inquiry, a lower proportion of participants denied the notion that sharing utensils and clothes with a cancer patient can lead to the spread of the disease. However, half of the respondents believed that oral cancer was not necessarily observed in patients with AIDS. These findings align with those from a study conducted among university students in Karachi, Pakistan, where one quarter held the misconception that oral cancer is contagious.10

Although a study conducted in Malaysia indicated significant variations in knowledge about oral cancer based on age and educational level, the misconception that this type of cancer can spread through casual physical contact should not exist among university students.12 This finding partly indicates a deficiency in distinguishing between cancers and typical oral infections and partly signifies the inadequacy of current educational campaigns addressing this issue. Although oral cancer is not considered an AIDS-defining malignancy, individuals with AIDS have a greater probability of being diagnosed with it.13 Forty-nine percent of the participants believed that oral cancer is primarily observed in patients with AIDS, which could be attributed to some respondents considering the increased likelihood of oral cancer due to a weakened immune response associated with AIDS.14

The current study, only 4.2% of the respondents accurately identified all the treatment options for oral cancer, including surgery, radiotherapy, chemotherapy, immunotherapy, targeted therapy, and combination therapy. The current findings align with those of a study conducted among university students in Karachi, Pakistan, which reported that 3% of respondents were aware of treatment options for oral cancer.10

Correct answers were stratified between male and female participants. The results indicate that males exhibited a greater level of knowledge than females; however, no significant difference was observed. A study conducted among medical students in Himachal Pradesh, India, by Fotedar V et al showed that females had a better understanding of the subject matter than males, although the difference was not statistically significant.15

Limitations of the Study

This study was conducted among dental students and interns at Khatam Al Nabieen University in Kabul. While the findings provide valuable insights, they may not fully represent the awareness levels of all dental students across Kabul or Afghanistan. Future studies with a broader and more diverse sample are recommended to validate these results. Additionally, exploring how cultural and socioeconomic factors influence oral cancer awareness and behavior could further enhance the breadth and applicability of findings from such studies.

Conclusion

This study reveals a significant gap in oral cancer awareness among university students in Kabul, emphasizing the need for enhanced educational initiatives. Targeted efforts to improve knowledge on prevention and early detection, particularly among dental students and interns, are essential to reduce disparities and improve patient outcomes.

Data Sharing Statement

Data are available from the corresponding author upon request.

Disclosure

The authors report no conflicts of interest in this work.

References

1. Almutairi FJ. Oral cancer: updated review of literature. Saudi J Oral Dent Res. 2022;7(9):238–245. doi:10.31557/APJCB.2023.8.4.379

2. Patil S, Sarode SC, Baeshen HA, et al. Bibliographic analysis of oral precancer and cancer research papers from Saudi Arabia. Asian Pac J Cancer Prev. 2020;21(1):13. doi:10.31557/APJCP.2020.21.1.13

3. Rahyab R, Niazi U, Pachakhan ST, Barakzai AM. The THE DEMOGRAPHIC OF LIPS AND ORAL CAVITY CANCER. Int J Dental Clin Study. 2022;3(4):01–11.

4. Almubarak H, Alqahtani WM, Shamsudeen SM, et al. Prevalence and risk factors of oral cancer among Saudi women: a systematic review. World. 2022;13(3):290. doi:10.5005/jp-journals-10015-1917

5. Parakh MK, Ulaganambi S, Ashifa N, Premkumar R, Jain AL. Oral potentially malignant disorders: clinical diagnosis and current screening aids: a narrative review. Eur J Cancer Prev. 2020;29(1):65–72. doi:10.1097/CEJ.0000000000000510

6. Su Y-F, Chen Y-J, Tsai F-T, et al. Current insights into oral cancer diagnostics. Diagnostics. 2021;11(7):1287. doi:10.3390/diagnostics11071287

7. Shadid RM, Abu Ali MA, Kujan O. Knowledge, attitudes, and practices of oral cancer prevention among dental students and interns: an online cross‑sectional questionnaire in Palestine. BMC Oral Health. 2022;22(1):381. doi:10.1186/s12903-022-02415-8

8. Shubayr MA, Bokhari AM, Essa AA, Nammazi AM, Al Agili DE. Knowledge, attitudes, and practices of oral cancer prevention among students, interns, and faculty members at the college of dentistry of Jazan University. BMC Oral Health. 2021;21:1–7.

9. Gaballah K, Faden A, Fakih FJ, Alsaadi AY, Noshi NF, Kujan O. In Diagnostic Accuracy of Oral Cancer and suspicious Malignant Mucosal Changes Among Future Dentists. Healthcare, MDPI;2021:263. doi:10.3390/healthcare9030263

10. Limaye D, Ziesenis P, Limaye V, et al. Oral cancer awareness among university students from Karachi, Pakistan. Int J Adv Med. 2019;6(1):40. doi:10.18203/2349-3933.ijam20190002

11. Chan Z-W, Phuan Y-F, Ooi P-Y, et al. An assessment of oral cancer knowledge, attitudes, and practices among undergraduate students in Malaysian dental schools. BMC Oral Health. 2023;23(1):617. doi:10.1186/s12903-023-03354-8

12. Kassim NK, Adnan MM, Wern CW, Ru LZ, Hanafi MH, Yusoff A. Awareness and knowledge of oral cancer among siamese ethnic group in Tumpat, Kelantan. Malays J Med Sci. 2017;24(4):47. doi:10.21315/mjms2017.24.4.6

13. Wang C-CJ, Silverberg MJ, Abrams DI. Non-AIDS-defining malignancies in the HIV-infected population. Curr Infect Dis Rep. 2014;16:1–7. doi:10.1007/s11908-014-0406-0

14. Coelho KR. Challenges of the oral cancer burden in India. J Cancer Epidemiol. 2012;2012:1–17. doi:10.1155/2012/701932

15. FOtedar V, FOtedar S, Gupta M, Manchanda K, Sharma M. Oral cancer knowledge, attitudes and practices: a survey of undergraduate medical students in Himachal Pradesh, India. J Clin Diagn Res. 2015;9(8):XC05–XC08. doi:10.7860/JCDR/2015/12752.6406.