India’s triple health challenge

Pankaj Chaturvedi | Updated on July 19, 2021

Carcinogenic substances: Tobacco and supari — a common ingredient in gutka, pan masala, khaini, and mawaas — are a deadly combination.   -  istock.com

Cancer, tobacco and the pandemic, we need to take preventive measures now

India is facing a triple challenge: fighting the COVID-19 pandemic, while also keeping sight of the tobacco menace and cancer. Tobacco use kills an estimated 1.35 million people each year in India. Even as we prepare ourselves for a potential third wave of the pandemic, we can’t ignore the terrible burden of cancer in India or let down our guard as millions of youth endanger their future health by using tobacco. And the link between tobacco use, and severity of COVID-19 has to be understood in order to galvanize public health measures for tobacco control and bring them into a broader COVID-19 prevention strategy.

Tobacco-related cancers are the top contributors to the cancer burden in our country. Tobacco caused over 27 percent of cancer cases in the country in 2020, a number that will increase by 12 percent or 15.7 lakh by the year 2025. (National Cancer Registry Programme)

Indians use various smokeless forms of tobacco, leading to one of the highest rates of oral cancer in the world with an annual incidence as high as 10 per 100,000. All tobacco products contain cancer-causing chemicals (carcinogens) and toxins as well as nicotine, an addictive substance. All of these substances enter the bloodstream and damage the DNA of our body cells. Damaged DNA can mutate into cancerous tumors. Smokeless tobacco products contain more than 28 carcinogens.

A young mother and wife in Madhya Pradesh, Sunita Tomar developed oral cancer after using smokeless tobacco. It took a terrible toll on her health, and she died at age 28, within a year of diagnosis – leaving behind two young children. Tobacco does not discriminate. Sunita, like many other tobacco users, embodied the havoc and trauma that tobacco can cause.

Tobacco use among adolescents in India is a worrying trend, measured at nearly 11 percent in 2016 (Global Adult Tobacco Survey, GATS 2016-17). Data also shows that those between 15 and 24 years started smoking at an early age. As a cancer surgeon, I see several such cancer cases every year that cost people both their lives and livelihoods. I’m witness to the extensive damage that tobacco causes and consequently, the growing tobacco-related cancer burden. The patients we treat are a constant reminder of the deadly impact of tobacco.

It is therefore imperative that we sustain our focus on ways to fight the tobacco menace. The COVID-19 pandemic is not the time to ignore tobacco or cancer – it offers us an opportunity to redouble our efforts. Experts have also confirmed that smokers are more likely to develop severe symptoms or die from COVID-19, as it primarily attacks the lungs.

Nationwide lockdowns imposed last year to curb the spread of COVID-19 affected cancer care delivery in many parts of India. Many patients found it challenging to access care. As a result, their cancers were diagnosed later and treatment initiation was delayed. Patients already on treatment found their care interrupted or postponed, allowing the disease to progress. Cancer treatment has many complexities; when health care resources have to be diverted to handle a pandemic, cancer patients can suffer.

Even during such a challenging year, we have an opportunity to make great strides towards a tobacco-free India, especially by addressing the use of this deadly product among our youth. The pandemic has presented us with a new opportunity to alert our youth about the health hazards of tobacco consumption.

For the tobacco industry, India’s youth has become a lucrative market. An estimated 5% to 25% of Indian adolescents currently use or have used tobacco. What’s more disconcerting is that the early initiation of tobacco use among our adolescents is also a key driver of the tobacco burden. This can lead to lifelong tobacco addiction and increase the risk of lung cancer, among other diseases.

Tobacco and supari – a common ingredient in gutka, pan masala, khaini, and mawaas – are a deadly combination. Both are addictive, cancer-causing substances that are often falsely marketed to our young people as mouth fresheners. The sale of loose cigarettes also makes access to this deadly habit easy and affordable for young people.It is tragic that as a society we have let our children become targets and we are only now beginning to address the issue. Making age-specific interventions to control the tobacco epidemic among adolescents is essential. We can step up mass sensitization through workshops and public education campaigns in schools and colleges that can demonstrate and convey the lethal impact of tobacco consumption. This can help prevent our youth from taking up the habit altogether.

One way to keep young people safe from tobacco would be for prominent citizens and celebrities to stop endorsing tobacco brands. These kinds of disguised promotions are one way the tobacco industry gets around India’s laws regulating tobacco advertising, promotion and sponsorship. Most recently, online streaming platforms have been depicting tobacco consumption without any warning of its health hazards – which runs counter to the law.

There is not a single organ in our body which is not adversely affected by tobacco consumption, directly and indirectly. As a health care professional, I feel a responsibility to warn our young people. We must not overlook the fight against the tobacco epidemic and the disease burden associated with it amidst our war against COVID-19. Tobacco-related diseases are entirely preventable. As the pandemic has highlighted the need to take preventive health measures, we have a unique opportunity to stem the tobacco menace.

We have among the world’s largest adolescent and youth population. They are the nation’s future. It is within our power to help shield them from the dangers of tobacco.


(The writer is Professor, head & neck surgeon and deputy director, Center for Cancer Epidemiology, Tata Memorial Centre. Views are personal.)

Published on July 11, 2021

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