KARACHI: Whenever the topic of oral cancer is brought up in Pakistan, people instantly associate the disease with smoking. Many cigarette brands in Pakistan print a health warning, along with mandatory graphic images, meant to starkly lay out the health risks smoking can present.
Similar warnings or mass awareness, however, has hardly ever been witnessed when it comes to the rampant consumption of gutka, areca nut (chaalia), mawa, mainpuri, naswar, betel quid (paan) and other harmful concoctions.
According to the World Health Organisation, in all of South Asia, oral cancer is most prevalent among Pakistani men. While the rate of oral cancers has grown beyond 4% (4 out of every 100 cases of cancer is oral) in the country, it stands at an alarming 30% in Karachi. As a result, the Sindh High Court (SHC) recently ordered strict action against the sale of gutka and mainpuri across the province.
“The main reason behind the recent surge in oral cancers among Pakistanis is genetic alteration,” the Jinnah Sindh Medical University Vice-Chancellor Prof Tariq Rafi told The Express Tribune. “The situation is worsening with time, as annually, more than 1.4 million people fall prey to the deadly disease, mostly because of the consumption of addictive substances like gutka.”
Prof Rafi explained that the consumption of harmful ingredients used in gutka, mainpuri and other addictive substances not only leads to oral cancers, but can also increase the risk of prostrate, lung and kidney cancers.
“In the past, oral cancers were most prevalent among people above the age of 50 but nowadays, the disease is widespread among youngsters aged 14-15 years because of smoking and the consumption of chhalia, paan, mainpuri and gutka,” he explained.
Gutka is prepared by crushing betel nut, nicotine, and several harmful chemicals. According to sources, the items required to produce gutka are smuggled from India and its rampant consumption, together with the interest of manufacturers, has enabled its proliferation in the market.
JPMC’s ENT specialist Dr Razzaq Dogar said that a special type of addictive substance is added to gutka which is extremely injurious to health. “The oxides added to gutka, paan, chhalia mawa and mainpuri disturb the normal function of cells in the human body,” said Dr Dogar.
“Regular consumption of gutka and other concoctions changes the colour of the inner lining of the cheek from its natural pink to white. It is the first sign of oral sub-mucous fibrosis (OSF), which develops into a blister and eventually into big, painful mouth ulcers.”
He added that during the onset of OSF, patients also experience burning and irritation while eating. The disease causes the weakening of teeth and reduces appetite.
According to the head of the Civil Hospital’s Oncology Unit, Dr Noor Muhammad Soomro, the majority of 900 patients examined for oral and throat cancer from January 2019 to mid-Oct were youngsters suffering from initial stages of oral jaw and throat cancer.
“It was alarming to see so many youngsters suffering from the deadly disease, all because of chewing betel nuts and gutka,” Dr Soomro said. “In fact, paan, gutka, mainpuri, tobacco, sheehsa, naswar and alcohol consumption contribute to about 70 to 75% of oral cancers prevalent in Pakistan.”
According to statistics, Pakistan tops the list of countries with the highest number of gutka consumers, followed by India. Every fifth person in Karachi is a gutka, mainpuri and mawa addict and the trend is fast growing among teenagers.
While many gutka brands are manufactured in Pakistan, several ones from India are also readily available in Karachi and other parts of Sindh.
A research conducted by the Aga Khan University Hospital shows that until the recent directives of the SHC, the threat of oral cancer and other diseases was largely neglected by authorities.
Per statistics, over 300 million people across the globe use some form of smokeless tobacco, and 85% of those consumers hail from South Asian countries like Pakistan, India, and Bangladesh.
While paan has been commonly consumed by people in South Asia for hundreds of years, chemical-laced addictive substances like gutka and mainpuri are products of recent decades, available as dry, portable and ready made variants of the traditional paan, to cater for a fast-paced, modern life.
Published in The Express Tribune, October 17th, 2019.