QuitPuff: A simple method using lipid peroxidative changes in saliva to assess the risk of oral precancerous lesions and oral squamous cell carcinoma in chronic smokers

Abstract

Abstract Introduction: Smoking, the leading cause of oral cancer in India, kills over 5 people every hour. As high mortality is due to late diagnosis, early detection is vital. Free radical-induced lipid peroxidation (LP) is known to promote multistep oral carcinogenesis. Free radicals generated by smoking damage polyunsaturated fatty acids releasing end product malondialdehyde (MDA). A simple, home-based test was devised to determine salivary MDA to assess early risk of oral precancer and cancer. It was hypothesized that heavier smokers would exhibit greater degree of salivary LP. Materials and Methods: A highly sensitive QuitPuff reagent was formulated which when heated with saliva, produces a color change, directly proportional to the amount of MDA. The MDA level was measured by matching the color change with a colorimetric LP index (LPI) chart. QuitPuff was tested on 500 subjects, validated using the gold standard, ultraviolet (UV) spectroscopy. Results: The mean LPI was consistently and significantly elevated (P < 0.001) in smokers with oral precancer and cancer (4.34) and smokers who smoked more than 20 (4.12), between 10 and 20 (3.43), and <10 cigarettes per day (2.43) as compared to nonsmokers (0.26). The mean LPIs of the test and validation methods correlated. Spearman's correlation indicated significant positive association between color changes and UV spectroscopy readings (r = 0.93). QuitPuff detected salivary MDA levels with 96% accuracy. Conclusion: Smokers exhibited greater degree of salivary LP as compared to nonsmokers; the heavier the smoker, greater was the degree of LP. QuitPuff has great potential as a point-of-care test for oral precancer and cancer.