Chewing on danger

Blood red splatters on walls. Tiny silver and coloured sachets strewn all over the pavements. Tobacco-laced projectiles directed from moving buses falling on hapless passers-by. At first glance, this appears to be an urban cleanliness issue. But it is actually symptomatic of a much larger, deeper and serious public health problem — a head and neck (H&N) cancer  epidemic.
India has the highest rate of H&N cancer in the world and about two lakh cases are diagnosed in the country every year. As many as 40 per cent of these are thought to be linked with the use of tobacco in some form. According to the World Health Organisation, smokeless tobacco products raise the risk of oral cancer by 80 per cent. About 30 per cent of Indian cancer cases are in the head and neck, compared with 4.5 per cent in the West.

More prone

Why do Indians seem to be more prone to H&N cancer? Why has the disease assumed such menacing proportions in the country? A primary reason for this is the alarmingly high usage of gutka. Gutka is a dangerous cocktail of tobacco, nicotine, and carcinogens and it is cheap, tasty, readily available and highly addictive. In a country where smoking cigarettes remains taboo, gutka has no social stigma and can be consumed conveniently at very little monetary cost.  Although seen in every level of society, the habit of chewing gutka is particularly prevalent among people from the lower socioeconomic strata. Often, people are unaware of its dangers and even children have grown addicted to this form of tobacco consumption.

Many challenges

The challenges of confronting H&N cancer in India are manifold, with a lack of awareness being the most critical one. Not only are people unaware of the fact that gutka and other tobacco products cause cancer but they also do not have knowledge about cancer in general. As a result, over 70 per cent of the cases report for diagnostic and treatment services in advanced stages of the disease, resulting in poor survival and high mortality rates. Myths and misconceptions rule our perception of cancer in India. Much of the population is not aware that cancer is largely treatable through early detection and treatment. Thus, education to create awareness and enable early diagnosis is the key pillar of cancer management.  
H&N cancer is also more common among people from the lower socioeconomic strata. This makes cancer treatment, already an expensive proposition, unaffordable and prohibitive. The economic shock often includes both the loss of income and the expenses associated with healthcare. Thus, cancer can be distressing for the patient and the family, profoundly affecting both their daily functioning and economic situation.
Treatment options are also a hurdle in the management of H&N cancer. Due to the huge patient load in government institutions, most hospitals have a waiting period of a few weeks for the patients. The consequent delay in initiating radiation therapy can have an adverse impact on the treatment outcome. Moreover, specialised cancer centres are not available in all towns, which causes tremendous hardship to people who come from smaller towns and villages. Nor is there an organised screening programme for any of the common cancers in the country.
It is not that India has not made any efforts to manage cancer. Recognising that cancer constitutes one of the biggest challenges, India is the one of the few developing countries that has formulated a National Cancer Control Programme. The programme envisages control of tobacco-related cancers; early diagnosis and treatment of cancer; and therapy services, pain relief and palliative care through augmentation of the health infrastructure.
Prevention and early detection is the best protection. Thus, with H&N cancer being preventable and, with early detection, curable, spreading awareness about tobacco and cancer is a must in order to control the disease. This approach offers the most effective and cost-efficient method of cancer control at the macro-level. At the individual level, it offers the greatest gift to people — the gift of life.


The author is a consultant oncologist, Manipal Hospital.