Dr. Ross Kerr, center, with two Seth G.S. Medical College students in Mumbai.
Paan being prepared for chewing.
Indian and U.S. medical students learned how to conduct and perform oral cancer screenings.
Kerr, DDS, MSD
Assistant Professor of Oral Medicine and Director of
Special Patient Care and Hospital Dentistry
In July 2003, I traveled to Mumbai (formerly Bombay), India, for 10
days on behalf of NYU’s Oral Cancer RAAHP Center to collaborate
with Dr. Jyotsna Changrani, who had organized the trip, and Dr. Francesca
Gany, both of the NYU School of Medicine’s Center for Immigrant
Health, on its Smokeless Tobacco, Oral Pathology Prevention, and Awareness
Network (STOP PANN) project. We were joined by Dr. Hetal Marfatia-Patel
of the Mumbai-based Seth G.S. Medical College’s Department of
Otolaryngology. Our objective was to train four medical students (two
from the NYU School of Medicine and two from Seth G.S. Medical College)
to conduct oral cancer examinations and to oversee the piloting of
a survey instrument to be used to assess the demographics, knowledge,
attitudes, and practices of South Asian immigrant populations in New
York City with respect to their use of paan and gutkha, both forms
of smokeless tobacco whose consumption is a deeply rooted cultural
tradition in South Asia.
Paan, a form of betel quid, is a mixture of areca nut, slaked lime,
spices, seeds, and tobacco wrapped in a betel leaf. Over the past
decade, gutkha, a powdered or granulated mixture of tobacco, areca
nut, limes, and spices, available in handy foil sachets, has also
become immensely popular with both men and women across all socioeconomic
levels. Importantly, the use of paan and gutkha has been clearly documented
as a risk factor for oral cancer and precancer and both tobacco and
areca nut have been shown to be independent risk factors for oral
cancer and precancer. Since New York City is a magnet for the 1.67
million Asian Indians, primarily Indians, Bangladeshi, and Pakistanis,
who have made the United States their home, the need for public health
interventions is critical.
I was also responsible for overseeing an oral cancer screening at
the general out-patient medical clinic at the government-run King
Edward VII Memorial Hospital. We met with high-level health-care administrators,
head and neck surgeons, oral cancer epidemiologists, preventive oncologists,
and oral medicine specialists in Mumbai. As a result of this visit:
In short, the collaboration
between medicine and dentistry on this project was extremely fruitful
and will very likely lead to future joint efforts involving information-sharing
and problem-solving to reduce the incidence of oral cancer and precancer
in South Asian populations both in their homelands and in the U.S.
200 subjects were surveyed and the data is being analyzed to help
us learn more about the smokeless tobacco chewing habits of New
York City's South Asian immigrant populations, and to refine the
surveys to be conducted among this population,
- Medical students
learned both how to conduct a survey and how to perform oral cancer
screenings, an important examination technique rarely taught in
medical school curricula. The medical students subsequently chose
the topic of oral cancer screening for their research reports,
- My colleagues
and I learned about the Indian oral cancer scene, and ideas for
future research collaborations were born, including possible risk-factor
intervention studies, surveys to assess the systemic effects of
areca/tobacco chewing habits, and studies to test emerging technology
for the early detection of oral cancer and precancer.