Research Article
Volume 19 Issue 7 - 2020
Oral Cancer Awareness among Smokeless Tobacco (Toombak) Dippers
Amel Eltayeb1* and B Elhussein2
1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Nile University, Khartoum, Sudan
2Department of Biochemistry, Faculty of Medicine, Nile University, Khartoum, Sudan
*Corresponding Author: Amel Eltayeb, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Nile University, Khartoum, Sudan.
Received: May 28, 2020; Published: June 17, 2020


Objective: Toombak is a form of smokeless tobacco, which is widely used in Sudan. Toombak is playing a significant role in oral cancer and it consider a major risk factor for squamous cell carcinoma. Therefore, the aim of this study was to evaluate the oral cancer awareness among Toombak dippers in Sudan.

Methods: A descriptive cross-sectional study questionnaire- based survey was performed on the general population in different geographic areas of Sudan. A total of 338 Participants were included in this study from January 2015 and January 2016.

Result: Three hundred thirty-eight participants were included in this study, 299 (88.5%) were male and 39 (11.5%) were female. Toombak dipping is most common in individual with age (45 - 54 years) and more than 65 years old. A statistically significant correlation was reported between age and Toombak dipping (r = 0.342 and p ≤ 0.00). Results revealed that most of the Toombak dippers were male. Of all participants, 82% heard about oral cancer but the general knowledge was low since 86.4% of them mentioned that they don’t have enough knowledge and 58.0% mentioned that they know nothing about the treatment.

Conclusion: This study provides a general overview of oral cancer awareness among Toombak dippers in Sudan as they are considered a high-risk group for oral cancer development. It is important to have healthcare professionals informed about oral cancer, as their knowledge and awareness of oral cancer and its risk factors, are vital in prevention and early detection of oral cancer.

Keywords: Oral Cancer; Toombak; Smokeless Tobacco; Awareness


  1. Idris AM., et al. “Toombak use and cigarette smoking in the Sudan: estimates of prevalence in the Nile state”. Preventive Medicine 27 (1998): 597-603.
  2. Idris AM. “The etiological association between use of toombak and oral squamous cell carcinoma”. Khartoum, University of Khartoum (1992).
  3. Warnakulasuriya S. “Global epidemiology of oral and oropharyngeal cancer”. Oral Oncology 4-5 (2009): 309-316.
  4. Petti S. “Lifestyle risk factors for oral cancer”. Oral Oncology 4-5 (2009): 340-350.
  5. Hoffmann D., et al. “Toxic and carcinogenic agents in dry and moist snuff”. Journal of the National Cancer Institute 6 (1987): 1281-1286.
  6. Djordjevic MVB and KD Hoffmann D. “The need for regulation of carcinogenic N-nitrosamines in oral snuff”. Food and Chemical Toxicology 7 (1993): 497-501.
  7. Hecht SS and Hoffmann D. “The relevance of tobacco-specific nitrosamines to human Cancer”. A Cancer Survivor 2 (1989): 273-294.
  8. Idris A NJ., et al. “Unusually high levels of carcinogenic tobacco-specific nitrosamines in Sudan snuff (toombak)”. Carcinogenesis 6 (1991): 1115-1118.
  9. Elbashir EI., et al. “Snuff dipping and oral cancer in Sudan: a retrospective study”. British Journal of Oral and Maxillofacial Surgery 3 (1989): 243-248.
  10. Osman TA., et al. “Pattern of malignant tumours registered at a referral oral and maxillofacial hospital in Sudan during 2006-2007”. Journal of Cancer Research and Therapeutics 4 (2010): 473-477.
  11. Idris AM., et al. “Toombak dipping and cancer of the oral cavity in the Sudan: a case control study”. International Journal of Cancer 4 (1995a): 477-480.
  12. Peker I. “AM: Public awareness level of oral cancer in a group of dental patients”. The Journal of Contemporary Dental Practice 11 (2010): 4-56.
  13. Rogers SN., et al. “Awareness of oral cancer in the Mersey region”. British Journal of Oral and Maxillofacial Surgery 49 (2011a): 176-181.
  14. Amel S Eltayeb., et al. “Oral Cancer Awareness in Sudan: Assessment of Knowledge, Attitude and Treatment Seeking Behavior”. Asian Pacific Journal of Cancer Prevention 6 (2017): 1645-1649.
  15. Warnakalasuriya KAAS., et al. “An alarming lack of public awareness towards oral cancer”. British Dental Journal 187 (1999): 319-322.
  16. Wahlberg ITR. “Smokeless tobacco”. In Tobacco: production, chemistry, and technology Edited by: Davis DEL, Nielsen MR. Oxford: Blackwell Science Ltd (1999): 452-460.
  17. Pershagen G. “Smokeless tobacco”. British Medical Bulletin (1996).
  18. Rolf Weitkunat ESaPNL “Meta-analysis of the relation between European and American smokeless tobacco and oral cancer”. BMC Public Health 7 (2007): 334.
  19. Idris AM., et al. “A major risk factor for cancer of the oral cavity in Sudan”. Preventive Medicine 23 (1994): 832-839.
  20. Brunnemann KD., et al. “Formation and analysis of tobacco-specific N-nitrosamines”. Critical Reviews in Toxicology 26 (1996): 121-137.
  21. Idris AM., et al. “Toombak-associated oral mucosal lesions in Sudanese show a low prevalence of epithelial Dysplasia”. Journal of Oral Pathology and Medicine 5 (1996): 239-244.
  22. Ahmed HG MR. “Impact of Toombak dipping in the etiology of oral cancer: Gender-exclusive hazard in the Sudan”. Journal of Cancer Research and Therapeutics 3 (2007): 127-130.
  23. Costea DE., et al. “Adverse effects of Sudanese toombak vs. Swedish snuff on human oral cells”. Journal of Oral Pathology and Medicine 2 (2010):128-140.
  24. AM Idris., et al. “The Swedish Snus and the Sudanese Toombak: are they different?” Oral Oncology 34 (1998): 558-566.
  25. Idris AM., et al. “Descriptive Epidemiology of oral Neoplasms in Sudan 1970 - 1985 and the role of Toombak”. International Journal of Cancer 61 (1995): 155-158.
  26. Winn DM., et al. “Snuff dipping and oral cancer among women in the southern United States”. The New England Journal of Medicine 304 (1981): 745-749.
  27. Winn DM. “Tobacco Use and Oral Disease”. Journal of Dental Education4 (2001).
  28. Adebola RA., et al. “Awareness of oral cancer in a northwestern nigerian state: Assessing the knowledge, opinion, and practice of traditional healers and herbalists”. Journal of Oral Oncology (2013).
  29. Elango JK., et al. “Factors affecting oral cancer awareness in a high-risk population in India”. Asian Pacific Journal of Cancer Prevention 4 (2009): 627-630.
  30. Ghani WMN., et al. “Oral cancer awareness and its determinants among a selected Malaysian population”. Asian Pacific Journal of Cancer Prevention3 (2013).
  31. Rodu BPC. “Tobacco-related mortality [Letter]”. Nature 370 (1994): 184.
  32. Leite ICC SK. “Survival analysis in a sample oral cancer patients at references hospital in Rio de Janeiro- Brazil”. Oral Oncology 5 (1998): 347-352.
  33. Comunian CR., et al. “Basic knowledge on oral cancer among a specifi Brazilian population”. A Revista Odontologia 4 (2011) 351-356.
  34. Luıs Silva Monteiro., et al. “Oral Cancer Awareness and Knowledge in the City of Valongo, Portugal”. International Journal of Dentistry (2012).
Citation: Amel Eltayeb and B Elhussein. “Oral Cancer Awareness among Smokeless Tobacco (Toombak) Dippers”. EC Dental Science 19.7 (2020): 46-55.

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