Rise in oral cancer

Karachi Cancer Registry recorded nearly 66,000 mouth cancer cases in Sindh between 2017 and 2021 alone

Oral cancer cases in Sindh have risen by roughly 25% over the past five years, and doctors treating the disease describe a pattern of younger patients that did not exist a decade ago. Clinicians have consistent explained the core reason. Gutka, mawa, paan, chhalia, mainpuri and naswar remain in daily use across large parts of the province.

WHO has recorded Pakistan's oral cancer rate among men as the highest in South Asia. In Karachi specifically, doctors have put the local rate as high as 30% of all cancers diagnosed in the city, against a national figure closer to 4%. The Karachi Cancer Registry recorded nearly 66,000 mouth cancer cases in the province between 2017 and 2021 alone. What makes this rise difficult to accept is that Sindh already legislated against the substance most consistently linked to it. The Sindh Assembly passed the Gutka and Mainpuri Act in 2019, banning the manufacture, storage, sale and use of both products, with prison terms of one to three years for violators. The Sindh High Court has since ordered repeated crackdowns and demanded reports on police officers allegedly protecting the trade. None of this has translated into a functioning ban. Part of the problem is also that Sindh lacks the treatment infrastructure that would make early detection meaningful. There is no dedicated cancer hospital, and that radiation therapy cannot meet current demand.

Public information campaigns have a role to play, and health workers deserve credit for continuing to run them despite years of limited results. But the record makes clear that awareness alone has not moved the underlying numbers, because the products driving the disease remain freely available and the law meant to remove them has not been enforced. Sindh has spent five years demonstrating what happens when a law exists on paper without being enforced on the ground.