 "Why India has most oral cancer cases in South Asia")
India has previously been dubbed the ‘cancer capital of the world.’ A recent study points out just how significant this health crisis has become.
The research published in the leading medical journal The Lancet Oncology revealed that India accounted for a staggering 83,400 of the global 120,200 oral cancer cases reported in 2022.
The study highlighted the alarming impact of smokeless tobacco and areca nut (betel nut) consumption in South-Central Asia. The region was found to have the highest consumption of cancer-causing products, with India topping the list.
So, what’s driving the high disease burden in India? How does it compare to other countries? Here’s a closer look
A concerning rise
The study conducted by the International Agency for Research on Cancer (IARC) revealed that oral cancer cases in India were primarily driven by the consumption of smokeless tobacco products such as gutkha, khaini, and betel quid, along with areca nut (betel nut).
“Smokeless tobacco and areca nut products are available to consumers in many different forms across the world, but consuming smokeless tobacco and areca nut is linked to multiple diseases, including oral cancer,” noted Dr. Harriet Rumgay, a scientist at the Cancer Surveillance Branch at IARC and the first author of the study.
The data shows that smokeless tobacco and areca nut use accounted for over 30 per cent of all oral cancer cases globally, with an overwhelming 95 per cent of these cases occurring in low- and middle-income countries, amounting to approximately 115,900 cases.
India alone reported 83,400 out of 105,500 oral cancer cases in South-Central Asia, significantly overshadowing its neighbours—Bangladesh (9,700 cases), Pakistan (8,900), and Sri Lanka (1,300). In comparison, the South-East Asia region recorded a total of 3,900 cases, including 1,600 in Myanmar, 990 in Indonesia, and 785 in Thailand. East Asia also faced challenges, with a total of 3,300 cases, primarily in China (3,200 cases).
“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,” Dr. Rumgay emphasised.
Why India has such high cases?
Dr. Isabelle Soerjomataram, Deputy Head of the Cancer Surveillance Branch at IARC said that while “control of tobacco smoking has improved, prevention of smokeless tobacco use has stalled, and areca nut remains largely unregulated.”
According to market research firm Imarc, pan masala is among India’s biggest industries, with a market estimated at over Rs 40,000 crore in 2021, and predicted that it will grow to approximately Rs 53,081.5 crore by 2027.
Dr Pankaj Chaturvedi, Head and Neck Cancer surgeon and Director, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, in Navi Mumbai told Indian Express, “Free accessibility with intense surrogate marketing of smokeless tobacco and areca nut have meant that India has one of the highest burdens of oral cancer in the world.”
“While the revenue to the government is minimal, the health impact and associated healthcare losses are huge. The ban on gutkha was a courageous step that has been circumvented by the tobacco industry,” he added.
One of the co-authors of the study, Dr Chaturvedi raised a red flag about the areca nut industry that has engaged Bollywood celebrities to advertise paan masala as a mouth freshener. In fact, they have been cleverly marketed as commercials of saffron or cardamom instead.
Routinely sold at kiosks, these products are sold in small packets for consumers to just mix and eat.
“Gutka or pan masala mixed with tobacco made an otherwise inedible substance attractive to a whole new cohort of consumers,” Ranjit Singh, a lawyer representing the central government in the Supreme Court in a body of litigation related to pan masala and chewing tobacco explained to ThePrint.
“Low costs expanded the reach to the poor consumers,” Singh said. “The nicotine in the chewing tobacco ensured they developed an addiction and kept on buying.”
Moreover, many prominent brands have been sponsoring major sporting events like the Indian Premier League (IPL) and engaging with elite audiences through film, music, and literature festivals. Despite extensive marketing campaigns, the health risks associated with smokeless tobacco and areca nut consumption often fail to reach consumers effectively.
The gender burden
Globally, an alarming 77 per cent of oral cancer cases were linked to smokeless tobacco and areca nut use occur among men, amounting to 92,600 cases, while women account for 23 per cent, or 27,600 cases.
In India, areca nut (30 per cent) and betel quid with tobacco (28 per cent) are the leading causes of oral cancer among women, followed closely by gutkha (21 per cent) and khaini (21 per cent).
Among men, khaini (47 per cent) and gutkha (43 per cent) lead to the highest proportions of oral cancer cases, with betel quid with tobacco (33 per cent) and areca nut (32 per cent) also significant contributors.
The study emphasises the urgent need for prioritising smokeless tobacco control and developing a prevention framework for areca nut use, which must be integrated into existing cancer control programs to address the growing burden of oral cancer effectively.
With input from agencies
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