Tobacco and Cancer
Tobacco is a major cause of preventable mortality and morbidity around the world. It is responsible for more deaths than those resulting from road traffic accidents, suicides, homicides, maternity mortality and other causes combined. In India nearly half of all cancers in men are associated with tobacco use including mouth (oral cavity), lip and tongue, throat (oropharynx, larynx & hypopharynx), oesophagus, lung and urinary bladder cancer. In women, less than one fifth of cancers at these sites, including oesophagus and oral cavity are tobacco related. In general tobacco related cancers constitute a lower proportion of all cancers among women due to lower prevalence of tobacco consumption compared to men.
Prevalence of Tobacco Consumption in India
Around the world China is the largest consumer of tobacco where as much as 60 % of the population indulges in smoking followed by USA, UK and Australia. According to epidemiological studies by the Indian Council of Medical Research there are 184 million tobacco consumers in India. Fifty-five thousand children take up this habit every year. Nearly eight lakh deaths in India are tobacco related.
Prevalence of tobacco use among men above 15 years of age varies from 46 – 63% in urban areas and 32 – 74% in rural areas while in women it varies from 2 – 16% in urban areas and 20 – 50% in rural areas. Use of smokeless tobacco is however similar in both men and women. Several studies conducted in India on cancer at various sites have shown that both smoking and smokeless tobacco use (including tobacco with lime and paan with tobacco) lead to elevated risks for oral, oropharyngeal, oesophageal and cervical and penile cancers. Smoking also causes increase in risk for lung, hypopharynx, larynx and stomach cancers as well.
The determinants of tobacco use among the youth are many. Socio-demographic factors such as gender, state and region, and rural versus urban residence are the most important factors. Others include factors affecting social norms, family influence and tobacco use by friends, exposure to advertisements in media and community; access and availability of tobacco products in area of residence; concurrent alcohol and tobacco smoking, levels of awareness about harmful effects of tobacco and attitude towards government tobacco control policies on access and availability of tobacco products to minors; school policies; tobacco control strategies and tobacco industry tactics to attract the youth.
Tobacco is used by the youth all over India with a wide range of variation among states. Two in every ten boys and one in every ten girls use a tobacco product. There is no statistical difference in rural and urban populations. Many young people have the misconception that tobacco is good for teeth or health. Initiation to tobacco products before the age of 10 years is increasing. States having higher levels of curricular teaching have a low prevalence of tobacco use by students.
Besides cancer, tobacco consumption is also responsible for high blood pressure, heart diseases, peripheral vascular disease, bronchitis and emphysema ultimately leading to COPD, stroke, impotence and male infertility. Consumption of tobacco during pregnancy may lead to placental complications, perinatal death, low birth weight, miscarriage and fetal malformations.
Tobacco Habits in India
In India tobacco is consumed in a variety of forms across various regions with a wide variety of products available. It is important to note that all these tobacco forms are equally harmful.
- Smoked Tobacco- cigarette, cigar, bidi, dhumti, chutta, hookah, chillum etc.
- Chewed Tobacco- pan, gutkha, khaini, mawa, pan masala etc.
- Applied forms- snuff, tobacco based toothpaste, creamy snuff.