Tobacco use linked to increased risk of at least 13 cancers

New Delhi: With rising incidence of cancer, experts today are zeroing in on preventable lifestyle factors that are fuelling the surge in the disease across the world. Use of tobacco – both in smoke and smokeless forms — has been identified as the leading preventable risk factor for several forms of cancers. In fact, it is estimated that smoking or chewing tobacco increases your risk for at least 13 types of cancers. This includes cancers of the mouth, throat, larynx, oesophagus, stomach, cervix, bladder, liver, pancreas, kidney, colon, rectum and not to forget lung cancer – the prime carcinoma fuelled by smoking cigarettes, bidis and hookas. Not just direct use, even second hand smoke exposure is responsible for upping your cancer risk.

When 57-year-old Sunidhi Gupta reported a persistent cough to a doctor, she was initially treated for a bronchial allergy. However, when the cough didn’t subside, further investigations revealed that the lady had stage 3 lung cancer. Not only was Sunidhi devastated by the diagnosis, she was also flabbergasted because having never touched a cigarette, this was the last thing she had expected. Even as she was referred to an Oncologist, it was discovered that both her 60-year-old husband and 30–year-old son were chain smokers who couldn’t keep their hands off the cigarette butt. The persistent second hand exposure might have been responsible for her disease.

Unfortunately, despite all the facts and figures being in the public domain, and anti tobacco health campaigns blaring aloud every day, people fail to realize and internalize the consequences of this addiction.

Fact check

If you are one of those who believe that smoking a cigarette is a cool thing to do, you must know that tobacco use is the most important risk factor for cancer and is responsible for approximately 22% of cancer deaths. In fact, tobacco is the single biggest preventable risk factor for several forms of cancer. When it comes to lung cancer, almost 70% of the disease burden can be attributed to tobacco smoking. Interestingly, the disease too manifests itself differently between smokers and non-smokers. Recent studies have indicated that smoking tobacco might also be linked to increased risk of breast cancer.

According to WHO, around one third of all deaths from cancer are due to 5 leading behavioral and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, alcohol and tobacco use. This implies that curbing the use of tobacco is a key element in our fight to reduce the surging rates of cancers. Interestingly, nearly 80% of the world’s 1 billion smokers live in low and middle income countries like India.

Gutka – the leading health concern in India

When Pierce Brosnan featured in a print ad of a major pan masala brand last year, there was much uproar in India. The actor later apologized for being part of the campaign of an unhealthy product, and clarified that the brand falsely presented him as a brand ambassador of its mouth fresheners and tooth whitening products. The fiasco rightly highlighted the health concern presented by chewable tobacco, the consumption of which needs to be urgently curtailed in India.

According to the Global Adult Tobacco Survey in India (GATS) 2010, smokeless and chewable tobacco was the most prevalent form of tobacco consumption in India, with over 200 million users. Evidence also suggests that India bears the largest burden of oral cancers in the world. Oral cancer constitutes one of the largest forms of cancers found in the Indian male population, (approximately 11.28%). Incidentally, over 80% of all oral cancers can be attributed to tobacco usage.

How does Tobacco cause Cancer?

Tobacco, a preparation of the nicotine-rich leaves of a plant, contains a series of dangerous chemicals that make breathing even a little amount of tobacco harmful. Out of more than 7,000 chemicals that are present in tobacco smoke, at least 250 are known to be harmful, with at least 69 of them being carcinogenic. The cancer-causing substances in tobacco smoke include arsenic, benzene, acetaldehyde, chromium, benzo(a)pyrene, nickel, and vinyl chloride.

Inhaling this deadly cocktail of chemicals and carcinogens has the potential to damage our DNA. These chemicals also trigger changes in the genes that play a protective role against cancer. Further, these substances when consumed together become all the more deadly. For example, chromium makes the dangerous benzo(a)pyrene stick more strongly to the DNA, increasing the risk of cell damage. At the same time, chemicals in the smoke also inhibit the body’s natural capacity to remove toxins and cleanse itself.

At the same time, chewable or smokeless tobacco is as dangerous as cigarette. The fact that you spit this form of tobacco must not make you believe that it is not harmful. According to American Cancer Society, people who chew get about the same amount of nicotine as regular smokers. Along with it, they also get at least 30 chemicals that are known to cause cancer. The most harmful cancer-causing substances in smokeless tobacco are tobacco-specific nitrosamines (TSNAs) which are linked to cancers of the mouth, tongue, cheek, gum, esophagus and the pancreas.

Taxes discourage tobacco use

As we grapple with the rising incidence of different types of cancers, governments have to play a leading role, not just in raising awareness but also in imposing higher taxes on tobacco products to discourage their use.

According to WHO, tobacco taxes are the most cost-effective way to reduce tobacco use, especially among young and poor people. In fact, a tax increase that increases tobacco prices by 10% decreases tobacco consumption by about 4% in high-income countries and about 5% in low- and middle-income countries.

Unfortunately, taxation on tobacco has not been significantly upped in recent years. Under India’s current taxation regime, the taxation on cigarettes varies from 39 per cent to 42 per cent, from state to state. The hopes of the impending GST regime inviting high taxation rates on tobacco were also dashed, with the GST Council stating that applicable tax on tobacco would be 28 per cent plus cess, that would make it roughly equivalent to the current tax rates.