Cancer killing younger people in India, tobacco main cause
Cancer is killing younger people in India and affecting far more poor and less-educated villagers than wealthier, better-educated urban people, researchers reported on Wednesday.
“Cancer appears earlier (in India) than say in China or the U.S., so it’s a disease of the young,” said the lead author of the paper, Professor Prahbat Jha at the Centre for Global Health Research at the University of Toronto in Canada.
Jha said this could be because of India’s younger population and the long-standing use of tobacco, which is the main cause of cancer in the country and responsible for 40 percent of cancers in men and 20 percent in women.
In men, the top three cancer killers were oral, stomach and lung cancer, while in women, they were cervical, stomach and breast cancer.
“The males have been smoking for a very long time, even longer than the Chinese and the patterns of diseases that come from prolonged smoking can occur in a population even at a younger ages,” Jha told Reuters in a telephone interview.
According to The Tobacco Atlas, 26.2 percent of males in India use tobacco, either smoking or chewing it, or both. For females, 3.6 percent use tobacco and most of them chew it.
Chewing tobacco has long been linked to oral cancer, and this study found that the number of oral cancers was twice that of lung cancer in India.
Tobacco use in India: An evil with many faces
- Tobacco has been used in India for centuries.
- Early forms of tobacco were limited to chewing tobacco leaves or smoking tobacco. Today, several products made of, or containing tobacco, are available in the market.
- More than 4,000 diferent chemicals have been found in tobacco and tobacco smoke. More than 60 of these chemicals are known to cause cancer (carcinogens).
- Nicotine is a drug found in tobacco. It is highly addictive – as addictive as heroin or cocaine. Over time, a person becomes physically and emotionally addicted to, or dependent on, nicotine.
- Almost 30 percent of the Indian population older than age 15 uses some form of tobacco. Men use more smoked tobacco than smokeless tobacco.
Women are more likely to use smokeless (chewed) tobacco. Beedis are smoked more than cigarettes.
Jha said the most important message from the study, which was published in The Lancet, is for India’s government to increase tobacco taxes and prices substantially - which studies have shown to be the single most effective measure to reduce smoking.
Tobacco use in India
Thirty per cent of the population 15 years or older - 47% men and 14% of women - either smoked or chewed tobacco, which translates to almost 195 million people - 154 million men and 41 million women in India. However, the prevalence may be underestimated by almost 11% and 1.5% for chewing tobacco among men and women, respectively, and by 5% and 0.5% for smoking among men and women, respectively, because of use of household informants. Tobacco consumption was significantly higher in poor, less educated, scheduled castes and scheduled tribe populations. The prevalence of tobacco consumption increased up to the age of 50 years and then levelled or declined. The prevalence of smoking and chewing also varied widely between different states and had a strong association with individual’s sociocultural characteristics.
“Higher tobacco taxes are as close to an effective anti-cancer vaccine as you can get,” Jha said, although he noted that the government’s budget on March 16 failed to raise tobacco taxes or prices.
Smokeless tobacco use
Smokeless tobacco is very common in India. Tobacco or tobacco-containing products are chewed or sucked as a quid, or applied to gums, or inhaled.
Khaini: his is one of the most common methods of chewing tobacco. Dried tobacco leaves are crushed and mixed with slaked lime and chewed as a quid.
he practice of keeping the quid in the mouth between the cheeks and gums causes most cancers of the gums – the most common mouth cancer in India.
Gutkha: his is rapidly becoming the most popular form of chewed tobacco in India. It is very popular among teenagers and children because it is available in small packets (convenient for a single use), uses lavoring agents and scents, and is inexpensive (as low as Re 1/- equivalent to 2 cents). Gutkha consists of areca nut (betel nut) pieces coated with powdered tobacco, lavoring agents, and other “secret” ingredients that increase the addiction potential.
Gutkha use is responsible for increased cases of oral cancers and other disorders of the mouth and teeth in young adults.
Paan with tobacco: he main ingredients of paan are the betel leaf, areca nut (supari), slaked lime (chuna), and catechu (katha). Sweets and other condiments can also be added. he varieties of paan are named for the diferent strengths of tobacco in it. Some people think that chewing paan without tobacco is harmless, but this is not true. The International Agency for Research on Cancer (IARC) has established that people who chew both the betel leaf and the areca nut have a higher risk of damaging their gums and having cancers of the mouth, pharynx, esophagus, and stomach.
Paan masala: Paan masala is a commercial preparation containing the areca nut, slaked lime, catechu, and condiments, with or without powdered tobacco. It comes in attractive sachets and tins, which are easy to carry and store. he tobacco powder and areca nut are responsible for oral cancers in those who use these products a lot.
Mawa: his is a combination of areca nut pieces, scented tobacco, and slaked lime that is mixed on the spot and chewed as a quid. he popularity of mawa and its ability to cause cancer matches that of gutkha. Its use is rising among teenagers and young adults in India.
The study also found that cancer rates varied significantly between different states in the country and between villagers and city-dwellers.
“Cancer death rates were two-fold higher in the least educated than the most educated, and (the differences) were similar between urban and rural areas. We used to think that cancer is a luxury of the rich, it is a suffering of the poor,” Jha said.
Possible explanations were that tobacco use was higher among the less educated and that richer Indians tended to seek treatment earlier.