Two thirds of the cancer can be conquered by implementing existing policies in India

A press release on World Cancer Day (4th February, 2014)

Cancer accounts for more deaths worldwide than AIDS, malaria, and tuberculosis combined. According to the World Economic Forum (WEF) – “cancer is among one of the three greatest risks to the global economy”. In India, cancer is one of the ten leading causes of deaths in India, and is an increasing public health challenge. With a prevalence of 3 million and annual incidence of 1 million, the statistics are alarming. It kills around 5 lakh people annually. Further, as per WHO Report 2005, the estimated Cancer deaths in India may to increase to 7 lakh by 2015. In 2011, the UN resolution declared 4 key strategies to curb rising burden of cancers – tobacco control, controlling unsafe use of Alcohol, obesity control and better nutrition. It is a mammoth task to improve the nutritional status of a nation of one billion people. However, importantly control on tobacco / areca nut / alcohol / junk food is well within the reach of our policy makers. While the cancer causing effects of Tobacco are well known, most are still unaware of harmful effects of Alcohol, areca nut and obesity. In this article, I try to address these three lesser known issues.

Tobacco – Data from National Family health survey shows that almost a third of all Indian males consume tobacco is some form. It is estimated that nearly one third of them will die prematurely due to serious illnesses such as cancers, heart diseases etc. According to the recent WHO Global Report almost two in five deaths, among adults aged 30 years and above are caused due to smokeless tobacco. It is important to note that a massive number of people are using tobacco in the smokeless form causing an epidemic proportion of oral cancer especially among youth. Though Gutka is banned in several states, more stringent measures are required. There is no law to prohibit smoking products (cigarette and bidi). The only way to discourage their usage is to strictly implement Cigarette and Tobacco Product (COTPA) act that aims to prohibit smoking in public places, prohibit sale to minors, stop direct and indirect advertizing.  

Alcohol – Alcohol is a confirmed cancer causing substance as per the International Agency for Research on Cancer (IARC). Alcohol is causally related to cancers of the mouth, oropharynx, liver, oesophagus and breast. Alcohol consumption increases the risk of Larynx cancer by 17 fold and mouth cancer by 10 fold. The risk becomes much higher when tobacco is consumed along with Alcohol. Apart from cancer, it causes several other health problems. There are about 2 billion people worldwide who consume alcohol and 76.3 million suffer from nearly 60 types of alcohol related diseases and injury. Alcohol causes 1.8 million deaths (3.2% of total). Akin to tobacco in 80s, alcohol has great social acceptability due to several decades of shrewd marketing. Both continue as profit making industry despite plethora of evidence against them. 

Areca nut- India suffers one of the highest incidences of Oral cancer in the world. The cause behind this is the chewing of smokeless tobacco and areca nut in varying combinations such as Zarda, Khaini, betel quid, Gutka, Pan Masala etc. While smokeless tobacco is a well accepted carcinogen and regulated under COTPA, Areca Nut is considered to be safe by most. However, like tobacco, Areca nut or betel nut is an addictive substance and a well known carcinogen.  The cancer causing properties of areca nut have been well reported in studies.  The IARC classifies Areca nut as a Group 1 human carcinogens with sufficient evidence.  Pan Masala or supari mix (a combination of areca nut, spices, sugar, flavoring agents, perfumes) glamorizes this inherently harmful food. As per the food standards authority of the Government of India, such Areca Nut products are permitted to be sold with a health warning printed on the packets. Pan Masala is sold as a mouth freshener with a miniscule warning on the packet. It is advertised aggressively on all popular media with celebrity endorsements. 

Obesity – Obesity is a condition where an individual has an abnormally high proportion of body fat. It is associated with increased risks of the cancers of esophagus, pancreas, colon, rectum, breast, endometrium etc. One study estimated that in 2007 in the United States, about 34,000 new cases of cancer in men (4 percent) and 50,500 in women (7 percent) were due to obesity. This analysis also reported:  “ if every adult reduced their BMI by 1 percent (approximately 1 kg for an average adult ), it would prevent about 100,000 new cases of cancer. Fast Food industry has mushroomed all over India and their powerful advertising has influenced the eating habit of most urban kids. Publicity has propelled acceptance and consumption of burgers, pizzas, chocolates, soft drinks, noodles, etc. This, along with lack of exercise has lead to sharp increase in obesity in urban population.

Published by Prof Pankaj Chaturvedi

Deputy Director, Center for Cancer Epidemiology, Tata Memorial Center, Mumbai. Professor, Department of Head Neck Surgery, Tata Memorial Hospital, Mumbai

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