Kamal Ghorui
NEW DELHI: Nearly one in ten adults from the Nicobarese tribal community living on Car Nicobar Island shows signs of oral lesions that could potentially turn cancerous, a large community-based study has found, underlining the heavy health toll of smokeless tobacco and alcohol use in a remote island population.The study, conducted by the ICMR–Regional Medical Research Centre and published on Springer Nature Link, examined over 2,600 adults across 10 villages on the island. Researchers found that 9.92% of those screened had oral potentially malignant disorders (OPMDs), while 0.19% were already diagnosed with oral cancer.OPMDs are conditions associated with an increased risk of cancers of the lip and oral cavity. While some national studies have reported OPMD prevalence as high as 13–14%, oncologists say such figures are far more worrying when concentrated within a single, relatively small community.“Even though some national studies have reported oral potentially malignant disorders in up to 13–14% of the population, finding such high prevalence within a single community is particularly alarming. It reflects concentrated exposure to smokeless tobacco and signals a disproportionately high future burden of oral cancer unless urgent preventive action is taken,” said Dr Amit Upadhyay, senior consultant haematologist and oncologist at PSRI Hospital.Using door-to-door screening and clinical examinations based on World Health Organisation guidelines, the study documented a strong association with tobacco use. Of the 274 individuals identified with oral lesions, 271—nearly 99%—were users of smokeless tobacco. The most common condition was smokeless tobacco keratosis, affecting over 7% of the population. Leukoplakia and oral submucous fibrosis, both known precursors to oral cancer, were also detected, along with two biopsy-confirmed cases of squamous cell carcinoma.Researchers were particularly concerned by the age profile of those affected. Most lesions were found among young and middle-aged adults aged 26–45 years, with men disproportionately impacted, indicating that cancer risk is setting in early. More than 80% of participants reported using smokeless tobacco, often local preparations such as sukka—dried tobacco mixed with slaked lime—while nearly 58% consumed alcohol regularly, including local brews.Experts say the findings also expose deeper structural barriers to early detection in remote tribal settings. Dr Ajoy Roychoudhury, professor and head of the department of oral & maxillofacial surgery, pointed out that geography and health-system gaps are compounding the risk. “Geographic isolation, weak healthcare access, and cultural practices are delaying early detection of tobacco-related oral precancers among Nicobarese communities, making urgent, targeted screening, cessation support, and local awareness programmes critical to prevent avoidable oral cancer burden,” he said.Car Nicobar Island, part of India’s Andaman and Nicobar Islands, has a population of around 20,000, with the Nicobarese comprising nearly 98% of residents. Limited access to specialised healthcare facilities makes early detection and prevention particularly challenging—and all the more necessary.The authors describe the study as the first population-level evidence documenting oral malignant and potentially malignant lesions among the Nicobarese in India. They call for urgent community-based oral screening, culturally sensitive tobacco-cessation initiatives, and sustained local health education to prevent precancerous lesions from progressing to cancer.Public-health experts warn that without swift, targeted intervention, a largely preventable risk could translate into a long-term cancer burden for India’s tribal and island communities.
