Evaluating awareness of oral cancer and attitudes towards its screening practice in Vidarbha: A cross-sectional study

Sweza Bhaisare; Gaurav Mude

doi:10.12688/f1000research.135122.1

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Study Protocol

Evaluating awareness of oral cancer and attitudes towards its screening practice in Vidarbha: A cross-sectional study

[version 1; peer review: 2 not approved]

Sweza Bhaisare ¹, Gaurav Mude²

PUBLISHED 22 Sep 2023

Author details Author details

¹ Clinical Research, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
² Pharmacology, Datta Meghe College of Pharmacy, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India

Sweza Bhaisare
Roles: Conceptualization, Writing – Original Draft Preparation

Gaurav Mude
Roles: Validation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Datta Meghe Institute of Higher Education and Research collection.

Abstract

Background: In various parts of the country, oral cancer is a serious and rapidly growing issue. India has an elevated number of mouth cancer and is growing year after year. mouth cancer is a disease that can be avoided and is mostly affected by lifestyle habits such as chewing tobacco and smoking. Awareness concerning the risk factors, signs, and symptoms of mouth cancer may assist in the early detection and therapy of the condition, which will help in increasing the survival rate of the population. The purpose of this investigation is to estimate mouth cancer awareness in terms of symptoms, signs and causal factors, and information sources. Methods: A cross-sectional population-based questionnaire survey of randomly selected participants will be conducted among 381 participants however we will try to include a larger sample size in order to improve the precision in the Wardha district. The results will be analysed using appropriate statistical methods and a conclusion will be drawn on the basis of observation. This is a research protocol and this study aims to evaluate the awareness about oral cancer and attitude towards dental screening of oral cancer.

Keywords

Oral Cancer, Awareness, dental screening, knowledge, Attitude, condition, detection, educating

Corresponding author: Sweza Bhaisare

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2023 Bhaisare S and Mude G. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Bhaisare S and Mude G. Evaluating awareness of oral cancer and attitudes towards its screening practice in Vidarbha: A cross-sectional study [version 1; peer review: 2 not approved]. F1000Research 2023, 12:1190 (https://doi.org/10.12688/f1000research.135122.1) First published: 22 Sep 2023, 12:1190 (https://doi.org/10.12688/f1000research.135122.1) Latest published: 22 Sep 2023, 12:1190 (https://doi.org/10.12688/f1000research.135122.1)

Introduction

Cancer is a scientific term for a large group of diseases that can affect any part of the body.¹ The other term which can be used for it is malignant tumors and neoplasms. It can influence the different areas of the mouth such as the lips, mouth, and oral cavity. Cancer is the growth of abnormal cells throughout the body which can affect neighboring parts of the body and can develop into various organs which is referred to as metastasis. The prime source of death is widespread metastasis. In 2020, 10 million deaths have been reported, the most common were breast (2.26 million cases), lung (2.21 million cases), colon and rectum (1.93 million cases), prostate (1.41 million cases), and stomach cancer (1.09 million cases).¹

Oral cancer is described as squamous cell carcinoma of the oropharynx, oral cavity, and lip. It is a major issue and particularly for dental surgeons. Each year 400,000 cases of mouth cancer are reported and most of them developed in Asian nations, such as Indonesia, Bangladesh, Pakistan, Sri Lanka, and India. Oral cavity and lip cancer was common in 2020 and has reported more than 377,700 cases and is the sixteenth most common cancer, the eleventh most common cancer in males, and the eighteenth usual cancer in females. The mouth cancer occurrence rate in 2020 in India was 219,722 and ASR (age-standardized rates) = 16.0 followed by women 45,347 and ASR of 6.7. Mouth and oral cancer mortality in 2020 were 121.096 and ASR = 8.9. followed by women at 26,399 and ASR = 3.9.²

Oral cancer is a life-threatening disease all over the world and has a very poor prognosis with a five-year survival rate. Its survival rate can improve by 80% if identified within early tiers (1 and 2 stages).³ 50% of patients with oral cancer are diagnosed at the last stage (stages 3 and 4) as most patients do not seek medical attention until they discover signs such as bleeding, pain, or tumors in the oral area.⁴ Radiotherapy or concurrent chemotherapy is still a conventional treatment in oral cancer but has effects on the daily functionality of the oral cavity.⁵ When there is a diagnostic delay the chance of having last-stage oral cancer is remarkably higher.⁶ And the diagnostic delay is linked to low awareness of oral cancer among people and its symptoms and risk factors.⁷

Poor compliance (25.7%) to oral cancer screening after the invitation has been linked to a possible lack of public awareness of this disease.⁸ So, the first step in which we can contribute in decreasing the occurrence of mouth cancer is by informing and educating the population on troubles relating to the known risk factors and dental screening. As the awareness about oral cancer study had not been concluded previously in our Wardha District. so here is our aim to appraise the awareness of oral cancer and attitudes toward screening practices for oral cancer among the rural and semi-urban population in district Wardha. With the help of its outcome, the health professional will try to educate and inform people about oral cancer which will help in reducing the incidence of mouth cancer in Wardha district (India).

Objectives

• To assess the awareness of mouth cancer and attitudes towards its screening practice for oral cancer among the ruler and semi-urban population in district Wardha.
• To match their level of knowledge and attitude related to oral cancer based on their age, gender, and level of education.

Protocol

The population used in this study is part of a larger population that can also be found in the upcoming article ‘Awareness regarding breast cancer among the female population in Wardha District’ (Shraddha Banmare, Gaurav Mude).

Methods

Study design: The observational cross-sectional study of awareness and attitude towards screening will be done by using a standardized questionnaire. A conceptual study of oral cancer and its awareness will be done. The study will be completed over a period of 4 months. Prior ethics committee permission has been obtained from the institutional Ethics Committee of Datta Meghe Institute of Higher Education and Research. The standardized questionnaire is derived from previously published articles. After explaining the objectives of the study informed consent will be obtained from the volunteers who are willing to participate. The subject will complete the standardized questionnaire²⁴ which includes a list of questions that will help in assessing the awareness of mouth cancer and attitudes toward its screening practice for oral cancer. The primary outcome will be assessing the awareness of mouth cancer and attitudes toward its screening practice in the Wardha district. The secondary outcome will be to match their level of knowledge and attitude related to oral cancer based on their age, gender, and level of education. The gathered information using a standardized questionnaire will be compiled and examined.

Sample size

Cochran Formula for sample size:

N = \frac{Z_{1 - α / 2}^{2} * p * (1 - p)}{E^{2}}

Where,

Z₁² – α/2 = is the level of significance at 5% i.e., 95%

P = Where aware of oral cancer = 55% = 0.55

Confidence interval = 1.96

E = 5% will be Error of Margin = 0.05

n = \frac{{1.96}^{2} \times 0.55 \times (1 - 0.55)}{{0.05}^{2}}

n = 381.24

n = 390 participants needed in the sample.

The study will however try to include a larger sample in order to improve its precision.

Ref. 9.

Techniques of sampling: Simple random sampling will be used.

Selection of subjects

Inclusion criteria

Age range

• Subjects aged above 18 to 65.

Gender

• Both male and female subjects will be included randomly.
• Participants who are willing to participate after explaining the protocol.

Exclusion criteria

• Participants who are not willing to participate after explaining the protocol.

Sources of participants

Participants will be randomly assigned from the rural, semi-urban, and urban residential areas of Wardha district. Subjects will be recruited from various locations like hospitals, local institutions, homes, and from the campaigns in public spaces.

Method of data collection

• Instrument: the researchers prepared a structured questionnaire consisting of MCQs.

Steps of data collection

Step 1: Permission is obtained prior from the ethics committee for the data collection.

Step 2: Introduction between the participants and the researcher.

Step 3: The participants will be assigned by using a random sampling method.

Step 4: ICF²⁵ will be taken from the participants who are willing to participate, after explaining the study purpose.

Step 5: A standardized questionnaire will be filled out by the subjects with the help of face-to-face interaction.

Expected dates of data collection

The data will be collected from May 2023 to August 2023.

Expected dates of recruitment

The first subject was recruited on the 1^st of May and 390 participants will be recruited by the end of August 2023

Data analysis and statistical plan

The data will be analyzed according to socio-demographic and geographic factors and attitudes toward dental screening. Frequency percentage, mean, and SD will be calculated and, to understand the relationship between various demographic variables and knowledge, the chi-square test will be used. All the statistical analysis will be performed using SPSS Software, version 27.0 p < 0.05.

Dissemination

Once the study is completed it will be published in an indexed journal.

Study status

The study has started. The study has not been completed and no data analysis has been performed.

Discussion

Oral cancer can build at the lips, salivary glands, tongue, lining of the mouth, buccal area, and other locations. Many different habits such as drinking, smoking, chewing tobacco, Paan, and flavouring agents are used in high amounts in different parts of the country.¹⁰ Tobacco use is widespread among the residents and the community.¹¹ Consuming alcohol and use of tobacco are regarded as the primary factor for the occurrence of mouth cancer.¹² Snuff is the most widely used smokeless tobacco in Pakistan and sun and heat dried tobacco leaves, slaked lime, tree bark ash, and flavouring and colouring agents are used to make it.¹³ 50% of oral cancers are thought to be caused by precursor lesions.¹⁴ Changes in the concentration of intrinsic fluorophores such as collagen, nicotinamide adenine dinucleotide (NADH), flavin adenine dinucleotide (FAD), and porphyrin in human oral tissue mark the progression of oral mucosal lesions.¹⁵ Therefore, it’s important to do proper management and early detection of malignant lesions which helps in prevention.¹⁶

Genetics also plays a crucial part in the development of cancer and a high chance of developing buccal mucosa and tongue cancer.¹⁷ However, it’s hard to link genetics or family with oral cancer as there is the existence of other causal factors such as chewing tobacco, etc. Some researchers believe that some people are vulnerable to developing oral cancer those who are born with the inability to metabolize carcinogens are unable to restore DNA damage.¹⁸ Chronic inflammation is also one of the vital parts in the occurrence of cancers such as the mouth and pharyngeal neoplasm. The main viruses involved in the growth of mouth cancer are HPV infection and human immunodeficiency virus (HIV). Human papillomavirus is a tiny virus with a circular double-stranded DNA genome of approximately 8 kb in size. HPV infection is the main causal factor for oropharyngeal squamous cell carcinoma caused by sexual activity. The prevalence peak was found in older people, especially in men showing a longer duration of infection at older ages.¹⁹

Having knowledge about the prior detection and sign and symptoms of oral cancer will assist human beings to diagnose early before getting to the higher stage of oral cancer. However, more than 30% of patients delay for extra three months prior to seeking medical attention for the signs and symptoms of oral cancer.²⁰ The prevalent reason for the delay in seeking medical treatment for signs and symptoms of oral cancer has been reported as a lack of awareness about mouth cancer which leads to the misattribution of symptoms.²¹ Warnakalasuriya reported a need for awareness about oral cancer in the United Kingdom, as well as a lack of awareness about the prior signs and symptoms of the disease.²² In India Gorakhpur, the highest rate of awareness was observed among high school graduates and was low among the illiterates which pointed to further knowledge among Indian people about oral cancer.²³

Opportunistic screening for signs and symptoms among patients who receive dental routine care settings could aid in the early detection of oral cancer. Informing the patient that they are being screened for the early detection of oral cancer, especially the people who are at high risk could be an opportunity for the clinician to provide people with details about the existence, risk factors, sign and symptoms, and prevention of mouth cancer. The British Dental Association (BDA) recommends the patient must be informed that mouth cancer screening is being performed.⁸

Bias

Minimum bias will occur as patients will be randomly selected based on the exclusion and inclusion criteria.

Ethical considerations

The studies involving human participants were reviewed and approved by the institutional Ethics Committee of Datta Meghe Institute of Higher Education and Research (Deemed to be University) Wardha – 442107, Maharashtra, India.

Ref. No. DMIHER (DU)/IEC/2023/593.

The study protocol will be explained to the participating subjects.

Further, a written informed consent form will be obtained from the participants.

Data availability

Underlying data

No data are associated with this article.

Extended data

Zenodo: questionary for oral cancer awareness, https://zenodo.org/record/8005341.²⁴

Zenodo: English ICF and consent form, https://zenodo.org/record/8229957.²⁵

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgments

The author would like to acknowledge the support from the Department of Clinical Research, DMIHER, AVBRH, Sawangi, Wardha, India.

References

1. Cancer: Accessed: August 9, 2023. Reference Source
2. Mouth and oral cancer statistics. Reference Source
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4. Silverman S, Kerr AR, Epstein JB: Oral and Pharyngeal Cancer Control and Early Detection. J. Cancer Educ. 2010; 25: 279–281. PubMed Abstract | Publisher Full Text | Free Full Text .
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10. Gómez I, Seoane J, Varela-Centelles P, et al.: Is diagnostic delay related to advanced-stage oral cancer? A meta-analysis. Eur. J. Oral Sci. 2009; 117: 541–546. PubMed Abstract | Publisher Full Text .
11. Goyal A, Sharma A, Agarwal S, et al.: Determinants of Tobacco Use among Children of a Rural Village in India: An Exploratory Qualitative Study. Asian Pac. J. Cancer Prev. 2020; 21(1): 81–86. PubMed Abstract | Publisher Full Text | Free Full Text .
12. Hamada GS, Bos AJ, Kasuga H, et al.: Comparative epidemiology of oral cancer in Brazil and India. Tokai J. Exp. Clin. Med. 1991; 16: 63–72. PubMed Abstract
13. Zahir R, Khan ZA, Aleem B, et al.: Association of High Immunohistochemical Expression of Minichromosome Maintenance 3 with Human Oral Squamous Cell Carcinoma—A Preliminary Study. Diagnostics. 2023; 13: 13. Publisher Full Text
14. Jensen K, Afroze S, Munshi MK, et al.: Mechanisms for nicotine in the development and progression of gastrointestinal cancers. Transl. Gastroint. Cancer. 2012; 1: 81–87.
15. Sah AN, Kumar P, Pradhan A: In-vivo Testing of Oral Mucosal Lesions with an In-house Developed Portable Imaging Device and Comparison with Spectroscopy Results. J. Fluoresc. 2023; 33: 1375–1383. Publisher Full Text .
16. Sathiasekar AC, Mathew DG, Jaish Lal MS, et al.: Oral field cancerization and its clinical implications in the management in potentially malignant disorders. J. Pharm. Bioallied Sci. 2017; 9(Suppl 1): S23–S25. PubMed Abstract | Publisher Full Text .
17. Irani S: miRNAs signature in head and neck squamous cell carcinoma metastasis: A literature review. J. Dent (Shiraz, Iran). 2016; 17: 71–83.
18. Kim KM, Kim YM, Shim YS, et al.: Epidemiologic survey of head and neck cancers in Korea. J. Korean Med. Sci. 2003; 18: 80–87. Publisher Full Text .
19. Shivappa N, Hebert JR, Rosato V, et al.: Inflammatory potential of diet and risk of oral and pharyngeal cancer in a large case-control study from Italy. Int. J. Cancer. 2017; 141: 471–479. PubMed Abstract | Publisher Full Text | Free Full Text .
20. Shigeishi H, Sugiyama M: Risk factors for oral human papillomavirus infection in healthy individuals: A systematic review and meta-analysis. J. Clin. Med. Res. 2016; 8: 721–729. PubMed Abstract | Publisher Full Text | Free Full Text .
21. Scott SE, Grunfeld EA, Mcgurk M: Patient’s delay in oral cancer: a systematic review. Community Dent. Oral Epidemiol. 2006; 34: 337–343. PubMed Abstract | Publisher Full Text .
22. Speight PM, Palmer S, Moles DR, et al.: The cost-effectiveness of screening for oral cancer in primary care. Health Technol. Assess. 2006; 10: 1–144. Publisher Full Text .
23. Agrawal M, Pandey S, Jain S, et al.: Oral Cancer Awareness of the General Public in Gorakhpur City, India. Asian Pac. J. Cancer Prev. 2012; 13: 5195–5199. PubMed Abstract | Publisher Full Text .
24. Bhaisare S, Mude G: Questionary-Sweza bhaisare (Version V1). Zenodo. 2023. Publisher Full Text
25. Bhaisare SS, Mude G: English Informed consent form (Version V1). Zenodo. 2023. Publisher Full Text

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Version 1

VERSION 1 PUBLISHED 22 Sep 2023

Author details Author details

¹ Clinical Research, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
² Pharmacology, Datta Meghe College of Pharmacy, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India

Sweza Bhaisare
Roles: Conceptualization, Writing – Original Draft Preparation

Gaurav Mude
Roles: Validation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

version 1

Published: 22 Sep 2023, 12:1190

https://doi.org/10.12688/f1000research.135122.1

Copyright

© 2023 Bhaisare S and Mude G. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Bhaisare S and Mude G. Evaluating awareness of oral cancer and attitudes towards its screening practice in Vidarbha: A cross-sectional study [version 1; peer review: 2 not approved]. F1000Research 2023, 12:1190 (https://doi.org/10.12688/f1000research.135122.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Reviewer Report 02 May 2024

Derk Hendrik Jan Jager, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Center, Location Vrije Universiteit, Amsterdam and Academic Center for Dentistry, Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands Antilles

Not Approved

https://doi.org/10.5256/f1000research.148225.r252600

Title:
- Name in which country the research will take place. Readers may not know where Vidarbha is.

Overall
- Try to adhere to the SPIRIT guidelines and checklist. See here: https://www.equator-network.org/reporting-guidelines/spirit-2013-statement-defining-standard-protocol-items-for-clinical-trials/

... Continue reading

Title:
- Name in which country the research will take place. Readers may not know where Vidarbha is.

Overall
- Try to adhere to the SPIRIT guidelines and checklist. See here: https://www.equator-network.org/reporting-guidelines/spirit-2013-statement-defining-standard-protocol-items-for-clinical-trials/

Abstract:
- Mouth cancer and oral cancer are used both. I would like to recommend using oral cancer.
- Name in which country the Wardha district is located. Furthermore, it is confusing that a different name is used in the title (Vidarbha).

Introduction
- Second paragraph: the definition of Oral cancer is incorrect. Carcinoma of the oropharynx does not fall under oral cancer but under Oropharyngeal squamous cell carcinoma (OPSCC). So it is better to use the following division:
Oral Cancer (OC)/Oral Squamous Cell carcinoma (OSCC): oral cavity and lip
Oropharyngeal squamous cell carcinoma (OPSCC): oropharynx
- It is preferable not to use “mouth cancer” but use OC/OSCC. See above
- A prevalence of 400,000 new cases per year is mentioned. In which countries/region? Does this only concern oral cancer (OC) or also OPSCC? Or even Head and Neck cancer? Please clarify.
- “The mouth cancer occurrence rate in 2020 in India was 219,722 and ASR (age-standardized rates) = 16.0 followed by women 45,347 and ASR of 6.7. Mouth and oral cancer mortality in 2020 were 121,096 and ASR = 8.9. followed by women at 26,399 and ASR = 3.9”. This sentence is unclear. Explain better to the reader what ASR is. Rewrites this sentence. Do not use a “=” sign in the sentence. Why are both “mouth” and “oral” cancer used here? What's the difference?
- “Oral cancer is a life-threatening disease all over the world and has a very poor prognosis with a five-year survival rate.” What is the 5-year survival rate?
- Explain “stages 1 to 4”.
- “As the awareness about oral cancer study had not been concluded previously in our Wardha District. so here is our aim to appreciate the awareness of oral cancer and attitudes toward screening practices for oral cancer among the rural and semi urban population in Wardha district”. Please rewrite this sentence. Furthermore, the objectives are also mentioned in the next paragraph.

Objectives:
- The 2nd objective is not clear to me. Match to what?

Protocol:
- Sample size and selection of subjects: please transform these to a narrative form.
- MCQs: please write this abbreviation in full
- Please use a narrative way of presenting the protocol
- Exclusion: is a history of cancer an exclusion criterion? What are the in/exclusion criteria?

Discussion:
- “oral cancer can build” Please rewrite
- What is Paan?
- Much attention is paid in the Discussion to the possible causes of OC and OPSCC. This has only limited relevance for this study. Nothing is said about possible pitfalls or other complicating matters when conducting the study. Also discuss expected outcomes.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Knowledge and attitudes of oral health students and professionals related to HPV-related oropharyngeal cancer, Sjogren's syndrome, Hyposalivation

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

CITE

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Reviewer Report 26 Feb 2024

Mohammad Daud Ali, Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia

Not Approved

https://doi.org/10.5256/f1000research.148225.r246824

Kindly write the rationale of the study in the last paragraph separately
Kindly align the introduction with the study's primary and secondary objectives.

Kindly add the identification

Kindly write the rationale of the study in the last paragraph separately
Kindly align the introduction with the study's primary and secondary objectives.

Kindly add the identification of the study population.
How survey tools kindly were designed.
Kindly describe the questionnaire/Tools validation description.
Kindly add an ethical approval number under the heading Ethical consideration
Kindly add the study site
Kindly add study participants' inclusion and exclusion criteria
How invited the study participants.
How to minimize study participants' biasing
How is sample size calculated kindly add in the manuscript under methods
Kindly add how data is collected as well as how study participants are enrolled in the study for data collection.
How was the survey conducted through a hard copy of the questionnaire or online?

Others

Kindly add study limitations.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Pharmacy practice and clinical pharmacy.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Version 1 22 Sep 23	read	read

Mohammad Daud Ali, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
Derk Hendrik Jan Jager, Amsterdam University Medical Center, Location Vrije Universiteit, Amsterdam and Academic Center for Dentistry, Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands Antilles

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Reviewer Report

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02 May 2024 | for Version 1

Derk Hendrik Jan Jager, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Center, Location Vrije Universiteit, Amsterdam and Academic Center for Dentistry, Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands Antilles

1 Views Cite this report Responses(0)

Not Approved

Title:
- Name in which country the research will take place. Readers may not know where Vidarbha is.

Overall
- Try to adhere to the SPIRIT guidelines and checklist. See here: https://www.equator-network.org/reporting-guidelines/spirit-2013-statement-defining-standard-protocol-items-for-clinical-trials/

Abstract:
- Mouth cancer and oral cancer are used both. I would like to recommend using oral cancer.
- Name in which country the Wardha district is located. Furthermore, it is confusing that a different name is used in the title (Vidarbha).

Introduction
- Second paragraph: the definition of Oral cancer is incorrect. Carcinoma of the oropharynx does not fall under oral cancer but under Oropharyngeal squamous cell carcinoma (OPSCC). So it is better to use the following division:
Oral Cancer (OC)/Oral Squamous Cell carcinoma (OSCC): oral cavity and lip
Oropharyngeal squamous cell carcinoma (OPSCC): oropharynx
- It is preferable not to use “mouth cancer” but use OC/OSCC. See above
- A prevalence of 400,000 new cases per year is mentioned. In which countries/region? Does this only concern oral cancer (OC) or also OPSCC? Or even Head and Neck cancer? Please clarify.
- “The mouth cancer occurrence rate in 2020 in India was 219,722 and ASR (age-standardized rates) = 16.0 followed by women 45,347 and ASR of 6.7. Mouth and oral cancer mortality in 2020 were 121,096 and ASR = 8.9. followed by women at 26,399 and ASR = 3.9”. This sentence is unclear. Explain better to the reader what ASR is. Rewrites this sentence. Do not use a “=” sign in the sentence. Why are both “mouth” and “oral” cancer used here? What's the difference?
- “Oral cancer is a life-threatening disease all over the world and has a very poor prognosis with a five-year survival rate.” What is the 5-year survival rate?
- Explain “stages 1 to 4”.
- “As the awareness about oral cancer study had not been concluded previously in our Wardha District. so here is our aim to appreciate the awareness of oral cancer and attitudes toward screening practices for oral cancer among the rural and semi urban population in Wardha district”. Please rewrite this sentence. Furthermore, the objectives are also mentioned in the next paragraph.

Objectives:
- The 2nd objective is not clear to me. Match to what?

Protocol:
- Sample size and selection of subjects: please transform these to a narrative form.
- MCQs: please write this abbreviation in full
- Please use a narrative way of presenting the protocol
- Exclusion: is a history of cancer an exclusion criterion? What are the in/exclusion criteria?

Discussion:
- “oral cancer can build” Please rewrite
- What is Paan?
- Much attention is paid in the Discussion to the possible causes of OC and OPSCC. This has only limited relevance for this study. Nothing is said about possible pitfalls or other complicating matters when conducting the study. Also discuss expected outcomes.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Knowledge and attitudes of oral health students and professionals related to HPV-related oropharyngeal cancer, Sjogren's syndrome, Hyposalivation

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Respond to this report

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Reviewer Report

2 Views

26 Feb 2024 | for Version 1

Mohammad Daud Ali, Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia

2 Views Cite this report Responses(0)

Not Approved

Kindly write the rationale of the study in the last paragraph separately
Kindly align the introduction with the study's primary and secondary objectives.

Kindly add the identification of the study population.
How survey tools kindly were designed.
Kindly describe the questionnaire/Tools validation description.
Kindly add an ethical approval number under the heading Ethical consideration
Kindly add the study site
Kindly add study participants' inclusion and exclusion criteria
How invited the study participants.
How to minimize study participants' biasing
How is sample size calculated kindly add in the manuscript under methods
Kindly add how data is collected as well as how study participants are enrolled in the study for data collection.
How was the survey conducted through a hard copy of the questionnaire or online?

Others

Kindly add study limitations.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Pharmacy practice and clinical pharmacy.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Evaluating awareness of oral cancer and attitudes towards its screening practice in Vidarbha: A cross-sectional study

Abstract

Keywords

Introduction

Objectives

Protocol

Methods

Sample size

Selection of subjects

Sources of participants

Method of data collection

Discussion

Bias

Ethical considerations

Data availability

Underlying data

Extended data

Acknowledgments

References

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