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Tobacco and Cancer

Tobacco and Cancer

Tobacco use in India:  An evil with many faces

Tobacco has been used in India for centuries. Early forms of tobacco were limited to chewing tobacco leaves or smoking tobacco. Today, several products made of, or containing tobacco, are available in the market. More than 4,000 different chemicals have been found in tobacco and tobacco smoke. More than 60 of these chemicals are known to cause cancer (carcinogens). 
Nicotine is a drug found in tobacco. It is highly addictive – as addictive as heroin or cocaine. Over time, a person becomes physically and emotionally addicted to, or dependent on, nicotine. 
Almost 30 percent of the Indian population older than age 15 uses some form of tobacco. Men use more smoked tobacco than smokeless tobacco. Women are more likely to use smokeless (chewed) tobacco. Beedis are smoked more than cigarettes.

Deaths in India Due to Tobacco Use

Tobacco use one of the major reasons for death in India. Here are some facts about Tobacco use in India and its effect:

Lancet reports 1.2 lakh deaths due to tobacco related cancer deaths in 2010.
More than one-third of adults (35%) use tobacco in India, or 274.9 million
163.7 million use only smokeless tobacco; 68.9 million are only smokers and 42.3 million users of both smoking and smokeless tobacco.
14.1% children in the age group of 13-15 years are consuming tobacco in some form
Bidis, along with smokeless tobacco, account for 81% of the Indian tobacco market.
India is also the second largest consumer and second largest producer of tobacco in the world, second only to China.
The prevalence of overall tobacco use among males is 48% and among females is 20%.
Nearly two in five adults (38%) in rural areas and one in four adults (25%) in urban areas use tobacco in some form
The extent of use of smokeless tobacco products among males (33%) is higher than among females (18%)
Globally 6 million people die each year due tobacco consumption-related diseases
The death toll is estimated to rise to eight million by 2030.
It is estimated that more than 80% of these deaths occur in the developing countries.
Tobacco has also been identified as the risk factor for 6 of the 8 leading causes of death.
Nearly 30% of cancers in males in India, and more than 80% of all oral cancer are related to tobacco use.
Smoked tobacco in India
Cigarettes and cigars: A cigar is a roll of tobacco wrapped in leaf tobacco, and a cigarette is a roll of tobacco wrapped in paper. Cigarettes may come with ilters, as thins, low-tar, menthol, and lavored – to entice more users, including women and youth and also to suggest the cigarettes have a lower health risk, which they do not. Many people view cigar smoking as less dangerous than cigarette smoking. Yet one large cigar can contain as much tobacco as an entire pack of cigarettes.  Cigarette smoking is more common in the urban areas of India, and cigar use is seen in the big cities. Cigarette smoking in on the rise and is now also seen among teenage girls and young women.
Beedis:- Beedis are smaller in size than the regular company-made cigarettes so more beedis are smoked to achieve the desired feeling caused by nicotine. Beedi smokers are at least at an equal risk of developing cancers as cigarette smokers due to use of smoked tobacco. 
Chillum: This involves smoking tobacco in a clay pipe. Chillum smoking increases chances of oral cancer and lung cancer. A chillum is shared by a group of individuals, so in addition to increasing their risk of cancer, people who share a chillum increase their chances of spreading colds, flu, and other lung illnesses. A chillum is also used for smoking narcotics like opium. 
Hookah: Hookah smoking involves a device that heats the tobacco and passes it through water before it is inhaled. It is not a safer way to use tobacco. The use of hookah was once on the decline, but it has increased in recent years. Hookah is thought to be a sign of royalty and prestige and is available in highpriced cofee shops in lavors like apple, strawberry, and chocolate. It is marketed as a "safe" recreational activity, but it is not safe and is inding increasing use among college students of both sexes. Use of tobacco 
in this form can result in tobacco addiction.
Cancers caused by smoking
Cigarette smoking accounts for at least 30% of all cancer deaths. It is linked with an increased risk of these cancers:
Larynx (voice box)
Oral cavity (mouth, tongue, and lips)
Nose and sinuses
Pharynx (throat)
Esophagus (tube connecting the throat to the stomach)
Ovary (a type called mucinous ovarian cancer)
Colorectum (the colon and/or the rectum)
Acute myeloid leukemia
Other health problems caused by smoking
Consumption of tobacco causes the following health hazards:
Cardiovascular diseases and lung disorders
Stroke, cataract, peripheral vascular diseases etc
Studies show that tobacco use leads to impotency
Tobacco use by pregnant women leads to low birth weight of babies, premature deliveries, still births and birth defects.
Respiratory problems

Secondhand Smoke

What is secondhand smoke?

Secondhand smoke (SHS) is also known as environmental tobacco smoke (ETS). SHS is a mixture of 2 forms of smoke that come from burning tobacco:

Sidestream smoke – smoke from the lighted end of a cigarette, pipe, or cigar

Mainstream smoke – the smoke exhaled by a smoker

Even though we think of these as the same, they aren’t. Sidestream smoke has higher concentrations of cancer-causing agents (carcinogens) than mainstream smoke. And, it has smaller particles than mainstream smoke, which make their way into the lungs and the body’s cells more easily.

When non-smokers are exposed to SHS it is called involuntary smoking or passive smoking. Non-smokers who breathe in SHS take in nicotine and toxic chemicals by the same route smokers do. The more SHS you breathe, the higher the level of these harmful chemicals in your body.

Why is secondhand smoke a problem?

Secondhand smoke causes cancer

Tobacco smoke contains more than 7,000 chemical compounds. More than 250 of these chemicals are known to be harmful, and at least 69 are known to cause cancer.

SHS has been linked to lung cancer. There is also some evidence suggesting it may be linked with childhood leukemia and cancers of the larynx (voice box), pharynx (throat), brain, bladder, rectum, stomach, and breast.

IARC reported in 2009 that parents who smoked before and during pregnancy were more likely to have a child with hepatoblastoma. This rare cancer is thought to start while the child is still in the uterus. Compared with non-smoking parents, the risk was about twice as high if only one parent smoked, but nearly 5 times higher when both parents smoked.

Secondhand smoke and breast cancer

Whether SHS increases the risk of breast cancer is an issue that’s still being studied. Both mainstream and SHS have about 20 chemicals that, in high concentrations, cause breast cancer in rodents. And we know that in humans, chemicals from tobacco smoke reach breast tissue and are found in breast milk.

One reason the link between SHS and breast cancer risk in human studies is uncertain is because breast cancer risk has not been shown to be increased in active smokers. One possible explanation for this is that tobacco smoke might have different effects on breast cancer risk in smokers and in those who are exposed to SHS.

Where is secondhand smoke a problem?

You should be especially concerned about exposure to secondhand smoke in these 4 places:

At work

The workplace is a major source of SHS exposure for many adults.

SHS in the workplace has been linked to an increased risk for heart disease and lung cancer among adult non-smokers. The Surgeon General has said that smoke-free workplace policies are the only way to do away with SHS exposure at work. Separating smokers from non-smokers, cleaning the air, and ventilating the building cannot prevent exposure if people still smoke inside the building. An extra bonus other than protecting non-smokers is that workplace smoking restrictions may also encourage smokers to smoke less, or even quit.

In public places

Everyone can be exposed to SHS in public places, such as restaurants, shopping centers, public transportation, schools, and daycare centers. The Surgeon General has suggested people choose restaurants and other businesses that are smoke-free, and let owners of businesses that are not smoke-free know that SHS is harmful to your family’s health.

Some businesses seem to be afraid to ban smoking, but there’s no proof that going smoke-free is bad for business. Public places where children go are a special area of concern. Make sure that your children’s day care center or school is smoke-free.

At home

Making your home smoke-free may be one of the most important things you can do for the health of your family. Any family member can develop health problems related to SHS.

Children’s growing bodies are especially sensitive to the poisons in SHS. Asthma, lung infections, and ear infections are more common in children who are around smokers. Some of these problems can be serious and even life-threatening. Others may seem like small problems, but they add up quickly — the expenses, time for doctor visits, medicines, lost school time, and often lost work time for the parent who must stay home with a sick child.

Think about it: we spend more time at home than anywhere else. A smoke-free home protects your family, your guests, and even your pets.

In the car

Most of the people spend a great deal of time in cars, and if someone smokes there, the poisons can build up quickly. Again, this can be especially harmful to children.

What can be done about secondhand smoke?

Local, state, and federal authorities can enact public policies to protect people from SHS and protect children from tobacco-caused diseases and addiction. Because there are no safe levels of SHS, it’s important that any such policies be as strong as possible, and that they do not prevent action at other levels of government.

Smokeless Tobacco use

Smokeless tobacco is very common in India. Tobacco or tobacco-containing products are chewed or sucked as a quid, or applied to gums, or inhaled.  

Khaini: This is one of the most common methods of chewing tobacco. Dried tobacco leaves are crushed and mixed with slaked lime and chewed as a quid. The practice of keeping the quid in the mouth between the cheeks and gums causes most cancers of the gums – the most common mouth cancer in India.
Gutkha: This is rapidly becoming the most popular form of chewed tobacco in India. It is very popular among teenagers and children because it is available in small packets (convenient for a single use), uses lavoring agents and scents, and is inexpensive (as low as Re 1/- equivalent to 2 cents). Gutkha consists of areca nut (betel nut) pieces coated with powdered tobacco, lavoring agents, and other “secret” ingredients that increase the addiction potential. Gutkha use is responsible for increased cases of oral cancers and other disorders of the mouth and teeth in young adults.
Paan with tobacco: he main ingredients of paan are the betel leaf, areca nut (supari), slaked lime (chuna), and catechu (katha). Sweets and other condiments can also be added. he varieties of paan are named for the diferent strengths of tobacco in it. Some people think that chewing paan without tobacco is harmless, but this is not true. The International Agency for Research on Cancer (IARC) has established that people who chew both the betel leaf and the areca nut have a higher risk of damaging their gums and having cancers of the mouth, pharynx, esophagus, and stomach.
Paan masala: Paan masala is a commercial preparation containing the areca nut, slaked lime, catechu, and condiments, with or without powdered tobacco. It comes in attractive sachets and tins, which are easy to carry and store. he tobacco powder and areca nut are responsible for oral cancers in those who use these products a lot.
Dry snuff: his is a mixture of dried tobacco powder and some scented chemicals. It is inhaled and is common in the elderly population of India. Snuff is responsible for cancers of the nose and jaw.
How is smokeless or spit tobacco different from smoking?

The route is different, but the nicotine addiction is the same. Nicotine in smokeless tobacco products absorbs from the mouth or nose along with other compounds in the tobacco. Cigarettes, pipes, and cigars burn the tobacco, and the nicotine from the smoke gets into the body through the mouth, nose, and lungs along with other particles generated by combustion. Burning tobacco sends out secondhand smoke, which other people and the smoker breathe in as it lingers in the air and settles on surfaces.

All forms of tobacco and nicotine can harm or kill children and pets if accidentally or otherwise ingested.

What kinds of illness are caused by oral or smokeless tobacco

Harmful health effects of smokeless tobacco include:

Mouth, tongue, and throat cancer

Cancer in the esophagus (the swallowing tube that goes from your mouth to your stomach)

Stomach cancer

Pancreatic cancer

Possible increase in risk of heart disease, heart attacks, and stroke

Addiction to nicotine

Leukoplakia (white sores in the mouth that can become cancer)

Receding gums (gums slowly shrink from around the teeth)

Bone loss around the roots of the teeth

Abrasion (scratching and wearing down) of teeth

Tooth loss

Stained and discolored teeth

Bad breath

Mouth lesions

Leukoplakia is a white patch in the mouth that can become cancer. These are sometimes called sores but they are usually painless. Many studies have shown high rates of leukoplakia at the place in the mouth where users place their chew or dip. One study found that nearly 3 of 4 of daily users of moist snuff and chewing tobacco had non-cancerous or pre-cancerous lesions (sores) in the mouth. The longer a person uses oral tobacco, the more likely they are to have leukoplakia.

Tobacco can irritate or destroy gum tissue. Many regular smokeless tobacco users have receding gums, gum disease, tooth decay (from the high sugar content in the tobacco), and bone loss around the teeth. The surface of the tooth root may be exposed where gums have shrunken. All this can cause teeth to loosen and fall out.

Heart disease

Smokeless tobacco may also play a role in heart disease and high blood pressure. A study showed that men who switched from cigarettes to snuff or chewing tobacco had higher death rates from heart disease stroke, cancer of the mouth and lung, and all causes of death combined than former smokers who stopped using all tobacco products. It’s unclear whether the heart disease was caused by the smokeless tobacco products in this study.


The snuff and chewing tobacco products most widely used in India have very high levels of cancer-causing agents (carcinogens) called tobacco-specific nitrosamines. There are other kinds of cancer-causing agents in smokeless tobacco, too, such as benzo[a]pyrene and other polycyclic aromatic carcinogens. These carcinogens may be why several types of cancer are linked to use of smokeless tobacco.

How do the risks of using smokeless tobacco compare with cigarette smoking?

Smokeless tobacco products are less lethal than cigarettes: on average, they kill fewer people than cigarettes. But smokeless tobacco hurts and kills people all the same. Even though they are marketed as a less harmful alternative to smoking, smokeless products can be deadly. And they have not been proven to help smokers quit.

Smokers who delay quitting by using smokeless products between cigarettes greatly increase their risk of lung cancer. They also set themselves up for new health problems caused by smokeless tobacco.

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