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Background and Aim: Less than 50% of oral cancer cases are diagnosed at early stages of the disease and this is in part due to poor awareness and lack of knowledge on the signs and symptoms of oral cancer. This study sought to measure the baseline awareness of oral cancer in Malaysia and aimed to increase public awareness and knowledge of oral cancer using a mass media campaign. Methods: Baseline awareness and impact of the campaign was measured using self-administered questionnaires sent via email to individuals. The campaign was aired on two national television channels and the reach was monitored through an independent programme monitoring system. Results: 78.2% of respondents had heard of oral cancer, and this increased significantly after the campaign. However, the ability to recognize signs and symptoms remains unchanged. We found that the level of awareness differed between the distinct ethnic subgroups and the reach of the campaign was not uniform across all ethnicities. Conclusion: This substantial study to measure the oral cancer awareness in Malaysia provides important baseline data for the planning of public health policies. Despite encouraging evidence that a mass media campaign could increase the awareness of oral cancer, further research is required to address the acceptability, comprehensiveness and effectiveness. Furthermore, different campaign approaches may be required for specific ethnic groups in a multi-ethnic country such as Malaysia.

Health risks stemming from betel-quid (BQ) chewing are frequently overlooked by people. Updated epidemiological data on the increased BQ use among Asian populations using comparable data collection methods have not been widely available. To investigate the prevalence, patterns of practice and associated types of oral preneoplastic disorders, an intercountry Asian Betel-quid Consortium study (the ABC study) was conducted for Taiwan, Mainland China, Malaysia, Indonesia, Nepal and Sri Lanka. A random sample of 8,922 subjects was recruited, and the data were analyzed using survey-data modules adjusted for the complex survey design. Chewing rates among men (10.7-43.6) were significantly higher than women (1.8-34.9) in Taiwan, Mainland China, Nepal and Sri Lanka, while women's rates (29.5-46.8) were higher than that for men (9.8-12.0) in Malaysia and Indonesia. An emerging, higher proportion of new-users were identified for Hunan in Mainland China (11.1-24.7), where Hunan chewers have the unique practice of using the dried husk of areca fruit rather than the solid nut universally used by others. Men in the Eastern and South Asian study communities were deemed likely to combine chewing with smoking and drinking (5.6-13.6). Indonesian women who chewed BQ exhibited the highest prevalence of oral lichen planus, oral submucous fibrosis and oral leukoplakia (9.1-17.3). Lower schooling, alcohol drinking and tobacco smoking were identified as being associated with BQ chewing. In conclusion, the ABC study reveals the significant cultural and demographic differences contributing to practice patterns of BQ usage and the great health risks that such practices pose in the Asian region. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

Background Tobacco consumption peak in developed countries has passed, however, it is on the increase in many developing countries. Apart from cigarettes, consumption of local hand-rolled cigarettes such as bidi and rokok daun are prevalent in specific communities. Although factors associated with smoking initiation and cessation has been investigated elsewhere, the only available data for Malaysia is on prevalence. This study aims to investigate factors associated with smoking initiation and cessation which is imperative in designing intervention programs. Methods Data were collected from 11,697 adults by trained recording clerks on sociodemographic characteristics, practice of other risk habit and details of smoking such as type, duration and frequency. Smoking commencement and cessation were analyzed using the Kaplan-Meier estimates and log-rank tests. Univariate and multivariate Cox proportional hazard regression models were used to calculate the hazard rate ratios. Results Males had a much higher prevalence of the habit (61.7%) as compared to females (5.8%). Cessation was found to be most common among the Chinese and those regularly consuming alcoholic beverages. Kaplan-Meier plot shows that although males are more likely to start smoking, females are found to be less likely to stop. History of betel quid chewing and alcohol consumption significantly increase the likelihood of commencement (p < 0.0001), while cessation was least likely among Indians, current quid chewers and kretek users (p < 0.01). Conclusions Gender, ethnicity, history of quid chewing and alcohol consumption have been found to be important factors in smoking commencement; while ethnicity, betel quid chewing and type of tobacco smoked influences cessation.

Objectives The role of diet in cancer risk has mainly been investigated based on intake of individual food items. However, food consumption is made up of a combination of various food items. This study aims to determine the association of dietary patterns with oral cancer risk. Methods A total of 306 matched cases and controls were recruited in this study. Data on dietary intake were obtained using food frequency questionnaire (FFQ). Factor analysis (FA) was performed to identify dietary patterns based on the intake of nine major food groups, resulting in four factors/components being retained. The odds ratio (OR) was computed for each component using conditional logistic regression. Results The first pattern labelled as modern was loaded with processed foods and snacks, whereas the second pattern termed as prudent was characterized by intake of fruits and vegetables. The third pattern labelled as traditional consisted of beverages and starches, while the fourth pattern termed as combination was loaded with intakes of dairy, fermented/salted and meat/by-products. A significant reduced risk was found for prudent (OR 0.53, 95 CI = 0.280.98), whereas an increased risk was found for both combination (OR 2.43, 95 CI = 1.334.45) and traditional (OR 2.32, 95 CI = 1.234.25) patterns. However, after adjusting for risk habits of tobacco smoking, alcohol consumption and betel quid chewing, only combination (aOR 2.99, 95 CI = 1.555.75) and traditional (aOR 2.08, 95 CI = 1.093.97) patterns remained significant. Conclusion Consumption in the highest tertile of traditional and combination patterns may induce twice and thrice the risk of oral cancer, respectively.

Background Betel quid chewing is a common habit widely practiced in Southern Asian populations. However, variations are seen in the content of a betel quid across the different countries. Factors associated with commencement and cessation of this habit has been numerously studied. Unfortunately, data on Malaysian population is non-existent. This study aims to determine the factors associated with the inception and also cessation of betel quid chewing behaviour among Malaysian adults. Method This study is part of a nationwide survey on oral mucosal lesions carried out among 11,697 adults in all fourteen states in Malaysia. The questionnaire included sociodemographic information and details on betel quid chewing habit such as duration, type and frequency. The Kaplan-Meier estimates were calculated and plotted to compare the rates for the commencement and cessation of betel quid chewing behaviour. Cox proportional hazard regression models were used to calculate the hazard rate ratios for factors related to commencement or cessation of this habit. Results Of the total subjects, 8.2% were found to be betel quid chewers. This habit was more prevalent among females and, in terms of ethnicity, among the Indians and the Indigenous people of Sabah and Sarawak. Cessation of this habit was more commonly seen among males and the Chinese. Females were found to be significantly more likely to start (p < 0.0001) and less likely to stop the quid chewing habit. Females, those over 40 years old, Indians and a history of smoking was found to significantly increase the likelihood of developing a quid chewing habit (p < 0.0001). However, those who had stopped smoking were found to be significantly more likely to promote stopping the habit (p = 0.0064). Cessation was also more likely to be seen among those who chewed less than 5 quids per day (p < 0.05) and less likely to be seen among those who included areca nut and tobacco in their quid (p < 0.0001). Conclusion Factors that influence the development and cessation of this behaviour are gender, age, ethnicity, and also history of smoking habit while frequency and type of quid chewed are important factors for cessation of this habit.

The rising burden of cancer in the developing world calls for a re-evaluation of the treatment strategies employed to improve patient management, early detection and understanding of the disease. There is thus an increasing demand for interdisciplinary research that integrates two or more disciplines of what may seemed to be highly unrelated and yet very much needed as strategies for success in research. This paper presents the processes and barriers faced in building partnerships in oral cancer research in a developing country.A case study was undertaken in a developing country (Malaysia) to assess the strengths and weaknesses of the situation leading to the formation of a multidisciplinary research partnership in oral cancer. Following the formalization of the partnership, further evaluation was undertaken to identify measures that can assist in sustaining the partnership.The group identifies its strength as the existence of academia, research-intensive NGOs and good networking of clinicians via the existence of the government's network of healthcare provider system who are the policy makers. The major weaknesses identified are the competing interest between academia and NGOs to justify their existence due to the lack of funding sources and well trained human resources.With the growing partnership, the collaborative group recognizes the need to develop standard operating procedures (SOPs) and guidelines for the sharing and usage of resources in order to safeguard the interest of the original partners while also attending to the needs of the new partners.

Introduction: Dietary intake has been hypothesized to be associated with various diseases including oral cancer. According to studies worldwide, imbalanced diet and nutrient deficiency have been attributed to promote oral malignancies. However, the function of specific nutrients in preventing oral cancer remains largely undefined. This study aims to investigate the association between intake of retinol and vitamin C with the risk of oral cancer. Materials and methods: Dietary intake data was collected from 8 participating hospitals throughout Malaysia using a validated foodfrequency questionnaire (FFQ). Intake of retinol and vitamin C were computed using the Nutriemart software. This case-control study included 150 cases and 150 controls matched for age, gender and ethnicity.The association between micronutrients, risk habits and oral cancer was analysed using Pearson Chi-Square test and multiple logistic regression. Results: Significantly more controls were found to consume retinol (27.3%) and vitamin C (83.3%) above the Recommended Daily Allowance (RDA) as compared to cases (10.7% and 72.0%, respectively). Among risk habits, only cigarette smoking was found to have an inverse association with vitamin C (p = 0.021) where as no risk habits were found to be associated with retinol intake. After adjusting for confounding factors, only retinol intake was found to be inversely related to the risk of oral cancer (aOR 0.272, 95%CI 0.135– 0.548). Discussion: This study suggests that vitamin C appears to reduce risk of oral cancer and this relationship is weakened after adjusting for risk habits. Meanwhile, retinol intake proves to provide protection against oral cancer up to 72.8% independent of risk habits practiced.