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 Table of Contents  
Year : 2020  |  Volume : 12  |  Issue : 3  |  Page : 226-230

Awareness and knowledge of head and neck cancer risks: Do Saudi adults know enough?

1 Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
2 General Dental Clinics, King Abdulaziz University Dental Hospital, Jeddah, Saudi Arabia
3 Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
4 Department of Oral and Maxillofacial Prosthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia

Date of Submission30-Jun-2019
Date of Decision09-Nov-2019
Date of Acceptance03-Dec-2019
Date of Web Publication02-Jun-2020

Correspondence Address:
Dr. Nadia Al-Hazmi
Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80498, Ahmad Altaybee Street, Jeddah 21589.
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JIOH.JIOH_174_19

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Aim: The aim of this study was to assess knowledge, attitudes, and behaviors regarding head and neck cancer (HNC) in a random sample of Saudi adults. Materials and Methods: A cross-sectional survey of patients was carried out in tertiary hospitals in Saudi Arabia. A pretested questionnaire was administered to a convenience sample of 280 patients in several government hospitals in Jeddah. The questionnaire assessed knowledge and perception about oral cancer as well as habits known to be risk factors. Descriptive Statistical analysis was used for this study, and association between demographic and knowledge variables was analyzed by chi-squared test and multivariable logistic regression. Results: Although about half of respondents had heard of HNC, 37.7% felt that they had insufficient knowledge about HNC and 55.0% felt that they knew nothing about it. Men were more likely to have heard of HNC than women (P = 0.046), whereas being better educated (university level or above) was associated with a higher level of knowledge about HNC (P = 0.004), although these variables were not significant in multivariable analysis. Knowledge about the signs of HNC was low. 69.5% were aware that tobacco use is a risk factor, but only 39.8% thought alcohol was also a risk factor. Only 11.5% reported having had a medical examination for HNC. Conclusion: The Saudi Arabian people are poorly informed about HNC. Lack of public awareness is considered a potent barrier for the early detection of HNC. In a country where tobacco use is common, HNC poses a serious health concern and targeted public health strategies are warranted.

Keywords: Alcohol, Head and Neck Cancer, Risk Factors, Smoking, Tobacco

How to cite this article:
Bukhary S, Alreheli R, Albahiti MH, Al-Dabbagh RA, Al-Hazmi N, Alhazzazi T. Awareness and knowledge of head and neck cancer risks: Do Saudi adults know enough?. J Int Oral Health 2020;12:226-30

How to cite this URL:
Bukhary S, Alreheli R, Albahiti MH, Al-Dabbagh RA, Al-Hazmi N, Alhazzazi T. Awareness and knowledge of head and neck cancer risks: Do Saudi adults know enough?. J Int Oral Health [serial online] 2020 [cited 2021 May 10];12:226-30. Available from:

  Introduction Top

Head and neck cancer (HNC) refers to a group of malignancies arising in the head and neck region and includes cancers of the oral cavity, nasal cavity, pharynx, larynx, paranasal sinuses, salivary glands, and cervical lymph nodes. It is the sixth most common cancer worldwide,[1] with a global incidence exceeding half a million cases annually. There were 11,449 HNC cases diagnosed in the UK in 2014, comprising 3.0% of all new cancer cases. HNC also accounts for approximately 3.0% of all cancers in the US, with >63,000 cases in 2016 (about two-thirds of men) resulting in >13,000 deaths.[2]

The overwhelming majority of HNCs are squamous cell carcinomas (SCCHN),[1] which are more common in men and in people over the age of 50 years. However, there has recently been a dramatic increase in the incidence rates of some types of HNC in younger populations,[3] especially oropharyngeal cancer in adults younger than 45 years of age.[4],[5]

The high incidence of SCCHN is attributed to high alcohol and tobacco consumption.[6],[7] Despite recent advances in biological and clinical research, the 5-year survival rate of HNC has not improved over the last two decades, with only 50% of patients diagnosed with the disease surviving it.[8] Although HNC can be often cured when diagnosed and treated at early stage,[9] most cases are late stage at diagnosis. Awareness of HNC risk factors is a recognized preventive measure to diagnose HNC at early stage.[10] Therefore, the aim of this study was to assess knowledge, attitudes, and behaviors regarding HNC in the Saudi Arabian population, particularly with respect to risk factors previously studied in the literature.

  Materials and Methods Top

Study sample

This was a retrospective study carried out on a convenience sample of 280 patients in three main government hospitals in Jeddah: King Abdulaziz University Dental Hospital, King Fahad General Hospital (Dental Department), and King Fahad Armed Forces Hospital (Dental Department). The inclusion criteria of the study were as follows: males and female patients aged ≥18 years, those able to read and write, and those able to give consent. The exclusion criteria of the study were as follows: males and female patients aged <18 years, those with history of HNC, those unable to read or write, and non-Arab speaking patients.


A questionnaire assessing knowledge and perception of oral cancers and habits known to be risk factors for HNC was administered to participants and was designed in four stages. The questionnaire was (1) formulated and adapted from the existing literature;[11],[12],[13] (2) forward translation was carried out from English to Arabic, and a group of bilingual experts were recruited to carry out back-translation into Arabic; tested as being both (3) valid and (4) reliable through pretesting of the Arabic translation on a sample group similar to the intended study sample to assess the need for any cultural modifications to the questions and to ensure that the questions were clear and unambiguous. The questionnaire was then finalized into a final version. Questionnaires were anonymous and voluntary and adhered to the Ethical Research Conduct of King Abdulaziz University, which follows the Declaration of Helsinki.

Statistical analysis

Data were analyzed using descriptive statistics. Univariable associations between demographic variables and awareness and knowledge of HNC were examined using the chi-square test, and multivariable associations were examined by logistic regression test (with hazard ratio [HR] and 95% confidence interval [CI]). A value of P < 0.05 was considered statistically significant. Statistical Package for the Social Sciences software, version 25.0 (IBM, Chicago, Illinois) was used for statistical analysis.

  Results Top

The participant characteristics are shown in [Table 1]. Two-hundred and eighty questionnaires were distributed to three government hospitals in Jeddah (King Abdulaziz University Hospital, King Fahad Armed Forces Hospital, and King Fahad Hospital). 56.5% of respondents were male and 43.5% were female, and the majority of them were aged between 18 and 35 years (39.6%). 38.5% had completed high school and 49.8% had completed university.
Table 1: Sample demographics

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The responses to the questionnaire are presented in [Table 2]. Only 50.9% of the study sample had heard of HNC, with 92.7% knowing little or nothing about the condition of HNC. Knowledge about the signs of HNC was generally low (4.6–36.7%), although 51.0% recognized that neck swelling was an early sign. 69.5% were aware that tobacco use is a risk factor for HNC, but only 39.8% thought alcohol consumption a risk factor. Eighty-five percent did not think exposure to sunlight was a risk factor for HNC. When asked about their main source of information, most of them replied the Internet (44.7%) or television (43.3%) rather than schools or the family doctor/dentist. Only 11.5% reported that they had been examined for HNC, usually by a dentist (69.6% of cases).
Table 2: Responses to questions about head and neck cancer

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Finally, we examined which, if any, sample characteristics were associated with awareness and knowledge of HNC [Table 3]. In univariable analysis, men were more likely to have heard of HNC than women (P = 0.046), whereas being better educated (university level or above) was associated with a higher level of knowledge about HNC (P = 0.004). Neither of these variables remained significant in multivariable analysis [Table 3].
Table 3: Associations between demographic variables and awareness and knowledge of head and neck cancer

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  Discussion Top

Here we report that average Saudi Arabian adults have relatively poor knowledge and awareness of HNC, with the majority of information being sourced from the Internet. This is consistent with previous studies; in a similar study conducted in Poland, 37.7% of participants were unaware of the early signs of HNC[11] and, similar to our findings, most individuals reported that the Internet was their main source of information (57.3%). Similarly, Merten et al.[12] reported that knowledge of the risk factors for cancer in undergraduate and graduate students was directly associated with its coverage in the community, that is, cancers that were widely publicized through campaigns were better understood than those that were not. Luryi et al.[13] reported that 66% of participants in their study were either “not very” or “not at all” knowledgeable about HNC. We found that although the majority of respondents were able to identify tobacco consumption as a risk factor for HNC, less than half recognized alcohol consumption or sunlight as risk factors.

Awareness about HNC was greater in men than in women and being better educated was associated with greater knowledge about the disease. Although these findings should be regarded as preliminary given the relatively small sample size, to the best of our knowledge this is the first time that demographic-specific differences in HNC knowledge have been detected. Further establishing exactly which demographic groups have poor knowledge about HNC would allow more rational development of tailored public health campaigns that best match the at-risk population. Given that there may be geographic differences in knowledge and awareness, it will be important to conduct studies at the local or ethnic level.

HNC can be diagnosed by multiple specialties, but the responsibility often falls to dentists.[14],[15],[16] Early detection of HNC is pivotal to diagnosis and treatment. Patient education is a great adjunct to prevention but is still suboptimal.[17] In Saudi Arabia, the use of smokeless tobacco (shamma) is an important risk factor for HNC that has been studied particularly in the southern parts of the Kingdom.[18],[19],[20] However, other risk factors have not been adequately addressed in the population. Although many are aware of the detrimental effects of tobacco, very few are aware of the effect of alcohol consumption and sun exposure on HNC incidence.

The effects of HNC treatment on the quality of life of patients are significant.[21] Dentists are ethically obliged to educate their patients, particularly those at high risk.[14] Increased awareness among oral health-care providers is a proven efficient intervention that provides better referral.[22] Our results show evidence of a severe deficiency in this common practice by dentists in our community and warrant closer attention. In Saudi Arabia, more than 116,000 children and more than 2,889,000 adults use tobacco daily.[23] Furthermore, there is an increase in incidence of the human papillomavirus (HPV) infection in women,[4],[24] which is also likely to contribute to the HNC burden in the country.

This study is limited by both the size and randomization of the sample used, which were suboptimal. Nevertheless, this study provides an incentive for further work on this aspect of HNC in the Kingdom of Saudi Arabia.

In conclusion, lack of public awareness is a potent barrier of the early detection of HNC. Demographic differences in knowledge and awareness about HNC might lead to tailored public health interventions. In the Kingdom of Saudi Arabia, where tobacco use is common, HNC represents a very serious health concern. The first line of intervention needs to be the dissemination of knowledge and awareness by dentists and general practitioners but with coordinated public health campaigns to increase awareness.

Ethical policy and institutional review board statement

All the procedures have been performed as per the ethical guidelines laid down by Declaration of Helsinki (2013).

Data availability statement

Available on request from Dr. Rayan Alrehaili ([email protected]).

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Gooi Z, Chan JY, Fakhry C. The epidemiology of the human papillomavirus related to oropharyngeal head and neck cancer. Laryngoscope 2016;126:894-900.  Back to cited text no. 4
Ajila V, Shetty H, Babu S, Shetty V, Hegde S. Human papilloma virus associated squamous cell carcinoma of the head and neck. J Sex Transm Dis 2015;2015:791024.  Back to cited text no. 5
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Merten JW, Parker A, Williams A, King JL, Largo-Wight E, Osmani M. Cancer risk factor knowledge among young adults. J Cancer Educ 2017;32:865-70.  Back to cited text no. 12
Luryi AL, Yarbrough WG, Niccolai LM, Roser S, Reed SG, Nathan CA, et al. Public awareness of head and neck cancers: A cross-sectional survey. JAMA Otolaryngol Head Neck Surg 2014;140:639-46.  Back to cited text no. 13
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Al-Ahdal MN, Al-Arnous WK, Bohol MF, Abuzaid SM, Shoukri MM, Elrady KS, et al. Human papillomaviruses in cervical specimens of women residing in Riyadh, Saudi Arabia: A hospital-based study. J Infect Dev Ctries 2014;8:320-5.  Back to cited text no. 24


  [Table 1], [Table 2], [Table 3]


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