Oral cancer, which includes the cancer of lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and throat, can be life threatening if not diagnosed at the right time.
Tobacco and Cancer
Over one-third of all cancers are related to the use of tobacco. Tobacco-related cancers constitute a major proportion of the so-called ‘preventable cancers’, i.e., cancers related to dietary habits and lifestyle. Both epidemiological and experimental studies have clearly shown that chronic exposure to tobacco in any form induces changes in the cells that lead to the development of cancer.
Smokers have a higher risk of lung and throat cancers, while those who chew tobacco run an increased risk of cancers of the mouth, throat and food passage. The brunt of the effect of tobacco is borne by the lungs in smokers and by the oral cavity in tobacco chewers. The extent of the carcinogenesis of tobacco can be gauged by the fact that even the metabolites of tobacco, which are filtered by the kidneys and accumulate in the urinary bladder, result in an increased incidence of kidney and bladder cancers in smokers.
It is the rampant habit of tobacco-chewing which is responsible for the extremely high reports of head and neck cancers in India (over a third of all cancers).
The craze for tobacco chewing in India
In India, tobacco chewing is not just a habit; it is a religion! It is no surprise, therefore, that the country has one of the highest incidences of oral cancer in the world and has the dubious distinction of being referred to as ‘the oral cancer capital’. Tobacco is generally consumed as a constituent of the betel leaf, locally known as pan. Pan has traditionally been in use since generations by both men and women, young and old.
It is even customary to serve pan during marriage functions and festivals. In recent times, tobacco has become commercially available in convenient, ready-to-use, attractive packs in forms such as gutka (a powdered mixture of tobacco and areca nut), khaini, mishri, snuff (which is inhaled through the nose) and pan masala (a mixture of areca nut and lime paste, which may or may not contain additional tobacco).
The ugly side-effects
Areca nut by itself has been shown by many scientific studies to be the cause of oral sub-mucous fibrosis, a condition characterized by stiffening of the inner mucosal lining of the cheek and other parts of the oral cavity due to the deposition of fibrous tissue. This restricts the extent to which the mouth can open and in severe cases, can result in a total inability to open the mouth. Though not cancer per se, this is an extremely debilitating condition by itself and very difficult to treat.
Oral sub-mucous fibrosis is also precancerous and a significant proportion of people with this condition ultimately succumb to oral cancer. This condition is increasingly being seen among students and young adults who are attracted to the stylish packaging and marketing of pan masala products. The absence of tobacco engenders the erroneous belief that these products are safe to consume.. It is estimated that there are over 20 million adolescents in the age group of 15–20 years, who are addicted to some form of tobacco or pan masala in India.
Battling tobacco consumption in India
The Indian government has only recently woken up to the reality of the health hazards of these chewable tobacco products. While restrictions on smoking in public places and a ban on the advertisement of all tobacco products have been in existence since 2003, they have done little to curb the evil of tobacco-chewing. Subsequent to 2003, a modest reduction in the sale of cigarettes and other smoking products was negated by a significant increase in the sale and consumption of chewable tobacco.
A pictorial warning depicting oral cancer on all tobacco products (including chewable) was to replace the existing warnings from June 2010 onwards. However pressure from the strong tobacco lobby has put this on hold as of now. The present warnings enforced from 31 May 2009 show an X-ray picture of a cancer stricken lung which is considered too soft to have any real impact.
Pictorial warnings have significantly reduced the consumption of tobacco products in countries such as Brazil and Mauritius, and thus brought down the incidence of oral and lung cancers there. Many countries of the European Union, Canada, Singapore, and others have also adopted pictorial warnings with encouraging results.
Hopefully, the Indian government will be able to resist pressures from vested interests to enact this legislation and curb the menace of tobacco-chewing, which has reached epidemic proportions in our country. Whether this rule, once enforced, will also apply to the pan masala products that do not contain tobacco, is not clear. These products are equally dangerous and are consumed by a segment of the population that is largely clueless about their catastrophic effects.
Maybe only public interest litigation on the lines of what happened in the United States during the eighties in connection with smoking, can ultimately result in any significant impact on the evils of tobacco chewing in our country.