India currently holds the highest number of oral cancer cases linked to the use of smokeless tobacco and areca nut (betel nut) in South Asia, with a staggering 83,400 cases out of the 120,200 reported globally in 2022, according to a recent study published in The Lancet Oncology.

The study highlighted that smokeless tobacco products, such as those chewed, sniffed, or sucked on, account for over 30 per cent of all oral cancer cases worldwide. South-Central Asia saw the highest numbers, with 105,500 cases in total, primarily driven by India's 83,400 cases. Bangladesh contributed 9,700 cases, Pakistan reported 8,900, and Sri Lanka added 1,300. Other regions significantly affected include Southeast Asia, with 3,900 cases spread across Myanmar, Indonesia, and Thailand, and East Asia, which recorded 3,300 cases, largely from China.

In India, the consumption of specific products such as areca nut (30 per cent) and betel quid with tobacco (28 per cent) were the leading causes of oral cancer cases among women. Other contributors included gutka and khaini, each responsible for 21 per cent of cases. Among men, the most significant risk factors were khaini (47 per cent), gutka (43 per cent), betel quid with tobacco (33 per cent), and areca nut (32 per cent).

Experts have raised concerns over the advertising practices of the areca nut industry, which has often enlisted Bollywood celebrities to promote paan masala as a mouth freshener. Areca nut is linked to a debilitating condition called submucous fibrosis, which can lead to incurable mouth cancer. This disease disproportionately affects younger populations, putting a heavy emotional and financial burden on families. Public health advocates are calling for stricter enforcement of existing laws to control the sale and promotion of smokeless tobacco and areca nut products.

Globally, an estimated 300 million people use smokeless tobacco, while around 600 million use areca nut. The highest rates of usage are found in South-Central Asia, Southeast Asia, and Melanesia, reflecting the cultural and economic factors that drive the consumption of these products.

Smokeless tobacco products vary in form and use. They are not burned like traditional cigarettes but are instead chewed, sucked, inhaled, applied locally, or even ingested. Popular smokeless tobacco products include gutkha, a mixture of tobacco, crushed areca nut, flavourings, and spices. Khaini, another common product, is made from sun-dried or fermented tobacco leaves. Paan masala, a notorious blend of areca nut, tobacco, lime, catechu, and spices, is widely consumed in India and is often marketed as a harmless mouth freshener.

According to Dr Harriet Rumgay, a scientist at the Cancer Surveillance Branch at the International Agency for Research on Cancer (IARC) and the lead author of the study, these products are available in numerous forms across different regions, contributing to their widespread use.

The study also examined the gender-based burden of oral cancer. Globally, 77 per cent of oral cancer cases attributable to smokeless tobacco and areca nut use were among men, accounting for 92,600 cases. Women made up the remaining 23 per cent of cases, with 27,600 affected. While men are generally more frequent users of smokeless tobacco and areca nut, regions like Southern Africa and Southeast Asia see higher prevalence rates among women than men.

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