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India has the highest number of oral cancer cases in South Asia, primarily driven by the widespread use of smokeless tobacco products such as betel quid with tobacco, gutka, khaini, and the consumption of areca nut, according to a recent study published in The Lancet Oncology.
The study, led by the International Agency for Research on Cancer (IARC), revealed that in 2022, India accounted for a staggering 83,400 out of 120,200 global cases of oral cancer linked to smokeless tobacco and areca nut use. The findings underscore the public health burden posed by these products, especially in low- and middle-income countries like India, where access to these products is easy and widespread.
Smokeless Tobacco and Areca Nut: A Major Contributor to Oral Cancer
Smokeless tobacco and areca nut (the seed of the areca palm) are popular across many South Asian countries in various forms, including betel quid (often mixed with tobacco), gutka, and khaini. The IARC study highlighted that these substances significantly contribute to the rising number of oral cancer cases in India.
For women, the consumption of areca nut (30%) and betel quid with tobacco (28%) were the leading causes of oral cancer, followed by gutka (21%) and khaini (21%). In men, khaini (47%) and gutka (43%) were the major drivers, with betel quid with tobacco (33%) and areca nut (32%) also contributing significantly to the burden of oral cancer.
Dr. Harriet Rumgay, a scientist at IARC’s Cancer Surveillance Branch, noted, “Smokeless tobacco and areca nut products are linked to multiple diseases, including oral cancer. Our estimates highlight the burden these products pose on health care and the importance of prevention strategies to reduce consumption.”
The Global Impact: Low- and Middle-Income Countries Bear the Brunt
The global tally for oral cancer cases attributed to smokeless tobacco and areca nut use stood at 120,200 in 2022, out of a total of 389,800 oral cancer cases. This means that over 31% of all oral cancer cases could potentially be prevented by curbing the use of these products.
A staggering 95% of these cases occurred in low- and middle-income countries, with India topping the list, followed by Bangladesh (9,700 cases), Pakistan (8,900 cases), and China (3,200 cases). Other affected countries included Myanmar, Sri Lanka, Indonesia, and Thailand.
Need for Enhanced Regulation and Prevention
Despite the advances in controlling tobacco smoking, efforts to regulate smokeless tobacco have lagged, and the areca nut remains largely unregulated. This lack of control has contributed to the rising incidence of oral cancer in regions like South Asia, where cultural and economic factors drive high consumption rates.
Dr. Isabelle Soerjomataram, Deputy Head of IARC’s Cancer Surveillance Branch, stressed the need for action: “Prevention of smokeless tobacco use has stalled, and areca nut remains largely unregulated. There is an urgent need for prioritising smokeless tobacco control and developing frameworks for areca nut prevention to integrate into cancer control programmes.”
Call for Action
The study calls for immediate public health interventions to reduce the consumption of smokeless tobacco and areca nut products. This could involve stricter regulation, public awareness campaigns, and integrating prevention strategies into broader cancer control initiatives. With nearly one-third of all oral cancer cases attributable to these products, tackling their consumption could significantly reduce the global cancer burden, particularly in countries like India, where the issue is most pressing.
As the study’s findings reveal, oral cancer linked to these products remains a major challenge in public health, requiring a multi-pronged approach to regulation, education, and prevention.
