India recorded the highest number of oral cancer cases in South Asia due to consumption of smokeless tobacco and areca nuts.
According to a study by 'The Lancet Oncology', our country contributed the largest chunk of 83,400 oral cancer cases to the world's total count of 1.2 lakh in 2022, caused primarily by the consumption of these two items.
In fact, smokeless tobacco alone was found responsible for 30% of the cases across the globe.
The study estimated that 300 million people use smokeless tobacco and 600 million people consume areca nuts globally, with most hailing from South-Central Asia, Southeast Asia and Melanesia. Furthermore, 95% of these cases have been found to occur in low- and middle-income countries.
But in comparison to the total oral cancer cases of our neighbours like Bangladesh at 9,700, Pakistan's 8,900 and Sri Lanka with 1,300 cases, India's count of 83,400 sounds no less than a gigantic alarm.
Gender-Based Tobacco Consumption
In India, the study revealed that among women, 30% consumed areca nuts, 28% used betel quid with tobacco, followed by gutka and khaini at 21% each.
As for men, the products that caused the largest proportions of oral cancer cases were khaini at 47%, gutka at 43%, betel quid with tobacco at 33% and areca nut at 32%.
Globally, 77% of oral cancer cases caused by smokeless tobacco and areca nut use occur in men, while 23% constituted women, the report stated.
However, the report also clarified that although men were found to be the main consumers of smokeless tobacco or areca nut in most parts of the world, in Southern Africa and Southeast Asia, the prevalence of smokeless tobacco or areca nut use among women was higher than that among men.
Smokeless Tobacco Products
According to the report, smokeless tobacco products are consumed without burning and can be chewed, sucked, inhaled, applied locally, or ingested.
Areca nut, also called betel nut, is the seed of the areca palm and is consumed in various forms, with or without smokeless tobacco, including in betel quid or on its own.
Khaini is made from sun-dried or fermented coarsely cut tobacco leaves, where a small amount is placed in the mouth between the gums and cheeks and sucked slowly for 10–15 minutes.
Gutka is made of crushed areca nut, tobacco, catechu, paraffin wax, slaked line and sweet/savoury flavourings.
Khaini and gutka are very common in India.
Expert Views
Most experts believe that the growing prevalence of smokeless tobacco products is largely due to surrogate marketing and easier access.
Moreover, celebrities promoting tobacco products have a large influence on the younger generation.
"Although control of tobacco smoking has improved, prevention of smokeless tobacco use has stalled, and areca nuts remain largely unregulated. To reduce inequities, smokeless tobacco control must be prioritised, and a framework for areca nut prevention should be integrated into cancer control programmes,” said Dr Isabelle Soerjomataram, deputy head of the Cancer Surveillance Branch at the International Agency for Research on Cancer.
"Our estimates highlight the burden these products pose on healthcare and the importance of prevention strategies to reduce consumption of smokeless tobacco and areca nuts," said Dr. Harriet Rumgay, a scientist in the Cancer Surveillance Branch at IARC and the first author of the article.
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