In the heart of Karachi, where bustling streets meet quiet alleys, lies a story that exemplifies the urgency of Pakistan’s battle against oral cancer. Ali, a 19-year-old son of a humble chowkidar, had his life irrevocably altered due to a habit that began when he was just three years old. His journey from innocent mimicry to life-threatening illness underscores the critical need to address the widespread use of smokeless tobacco products in Pakistan. Ali’s story is a stark reminder of the perils concealed in seemingly harmless packets of gutka. Observing his father chewing the addictive mixture of betel nut and tobacco, Ali began to emulate him, unknowingly succumbing to a habit that would eventually ensnare him in addiction. By his teenage years, Ali was unable to start his day without a pouch of gutka, oblivious to the looming threat of oral cancer.Smokeless tobacco, like gutka, is a well-documented risk factor for oral cancer. At 19, Ali’s world came crashing down with a diagnosis of oral cancer, a disease silently ravaging his oral cavity and threatening his future. His family grappled with regret, lamenting their failure to recognize the warning signs earlier. Ali’s story serves as a wake-up call for the nation, shedding light on the escalating menace of smokeless tobacco use. Dr Romaina Iqbal, a professor and researcher at the Aga Khan University, states,”Adolescents are vulnerable to the use of smokeless tobacco products. The government should implement awareness programs, including school education programs, to educate them about the harms associated with their use so that they may refrain from using them.” Data from the National Cancer Registry of Pakistan highlights oral cancer as the leading cancer among males, indicating a severe public health crisis1. Research from the University of York reveals small smokeless tobacco products lacking health warnings and employing misleading marketing2.These findings illuminate the deceptive strategies used by manufacturers. Further research has revealed significant gaps in policies governing smokeless tobacco compared to smoking3.
Dr Kamran Siddiqi, professor in Public Health from the University of York, has noted: “Chewing tobacco and areca nut is the root cause of oral cancer in Pakistan, and yet these lethal products remain widely accessible. To stop further loss of lives and human suffering, the government must act now to regulate these products.” To address Pakistan’s oral cancer crisis, policymakers must enact strict regulations: comprehensive health warnings, bans on sales to minors, standardized packaging, and increasing taxes for funding public health campaigns. Expanding healthcare services for early detection and treatment across urban and rural areas is crucial. These efforts can mitigate the oral cancer epidemic and ultimately save lives. The writers are from the Department of Medicine at the Aga Khan University, Karachi. The research reported in this publication is supported by the Fogarty International Center of the National Institutes of Health under Award Number 5D43TW011625. The content is solely the authors’ responsibility and does not necessarily represent the official views of the National Institutes of Health.
References:
1. Ikram A, Pervez S, Khadim MT, Sohaib M, Uddin H, Badar F, Masood AI, Khattak ZI, Naz S, Rahat T, Murad N. National cancer registry of Pakistan: first comprehensive report of cancer statistics 2015–2019. J Coll Physicians Surg Pak. 2023 Jun 1;33(6):625-32.
2. Abdullah SM, Huque R, Siddiqi K, Kanaan M, Huque S, Ullah S, Garg S, Singh MM, Deshmukh C, Borle AL, Iqbal R. Non-compliant packaging and illicit smokeless tobacco in Bangladesh, India and Pakistan: findings of a pack analysis. Tobacco Control. 2024 May 1;33(3):333-40.
3. Khan A, Dobbie F, Siddiqi K, Ansaari S, Abdullah SM, Iqbal R, Khan Z, Sohail S, Kanaan M, Huque R, Islam Z. Illicit cigarette trade in the cities of Pakistan: comparing findings between the consumer and waste recycle store surveys. Tobacco control. 2022 Sep 1;31(5):635-41.
Zeerak Jarrar and Zainab Samad
