31st May : World No Tobacco Day - Fighting India’s growing burden of head and neck cancers

Bangalore: Every year, since 1987, the World Health Organization (WHO) and global partners have been celebrating World No Tobacco Day (WNTD) on 31 st May. Given the worldwide tobacco epidemic and growing cases of preventable diseases and death it causes, the annual campaign is a significant step in the right direction. And as the world’s third largest tobacco user, India can no longer afford to be non-committal.

Hard Reality

A whopping 35 percent of the adult population in India consumes tobacco – by way of cigarettes, cigars, hookah, gutkha, bidi, khaini – as per the Global Adult Tobacco Survey. This is not counting the substantial number of passive smokers. Studies show that nearly one million new cancer cases are diagnosed in India every year. Of these, about 50 percent are linked to tobacco use. As per modest estimates by the WHO, tobacco kills more than 10 lakh Indians each year.

Head and Neck Cancers Factor

While myriad factors play critical roles in the global fight against cancer, in India our challenges are often unique. For instance, most people are surprised to know that head and neck cancers (HNC) – not breast cancer, lung cancer, prostate cancer, or cervical cancer – account for almost 40 percent of India’s cancer burden. Incidentally, 57 percent of the world’s HNC cases, studies concur, are found in India.

As practitioners in this field, we know that the real incidence is likely to be much higher as many cases of HNC go undiagnosed or unreported. Simply because there’s little awareness about the disease. HNC are, basically, tumours in and around the throat, larynx, nose, sinuses, or mouth. They include cancers of the oral cavity, which are especially common in India due to the widespread use of tobacco. Unfortunately, most patients come in for treatment at advanced stages, when the chances of survival have dropped drastically. Early detection, as is the case with most cancers, is the key to cure.

Problem Solving

The general perception is that India lacks the resources to deal with the cancer challenge. However, that’s not really the case. Today, with diagnostic tests such as biopsy, endoscopy, X-ray, ultrasound, CT scan, MRI, PET-CT and molecular testing, it’s easier, faster, more accurate and affordable to diagnose conditions like HNC. Also, we have cancer treatment methods – surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy – that are on par with the best in the world. Yet, the scenario is bleak. It’s disconcerting to see the average patient get younger. Men and women, in their 30s and 40s, are ignoring the early symptoms – red or white patches in the mouth, lump in the neck, swelling in the jaw, hoarseness in the voice, difficulty while swallowing, sores on the lips or mouth that do not heal.

The truth of the matter is that we are far from beating cancer. Because we fail to address the risk factors. Unless we bring down the usage of tobacco (smoking and chewing), things won’t truly change. The simplest, yet most trying, solution is to curb the widespread social acceptance of tobacco in the country.

The Big Picture

A recent study by The Lancet Oncology journal predicts that the number of patients needing chemotherapy world over is likely to increase by 53 percent from 9.8 million in 2018 to 15 million in 2040. Needless to say, India will also witness a surge in cancer cases. There’s no denying that preventing the onset and detecting the disease at an early stage are both critical. And for a developing nation like ours that is known for its state-of-the-art healthcare services, the need of the hour is to adopt an organ-site approach to cancer. Globally, dedicated organ-site focused multidisciplinary teams are providing holistic care in terms of diagnosis, treatment, and post-treatment services for all kinds of cancers. On this WNTD, let’s make concerted efforts to raise awareness on the deadly effects of tobacco use and second-hand smoke exposure, and to discourage the use of tobacco in any form. It’s time to rise to the challenge.