Smokeless tobacco products contribute to over 50% of oral cancer cases in India: Study

Popular smokeless tobacco products in India include gutka, khaini, zarda, betel quid with tobacco (paan), and region-specific products like mishri and gul. 
| Photo Credit: M. Srinath

Underlining the pressing need to regulate flavoured and smokeless tobacco (SLT) products in India, a research paper published in the Journal of Cancer Policy has pointed out that SLT use contributes to over 50% of oral cancer cases in the country. 

“Smokeless tobacco is deceptively dangerous,” stated the study, asserting that SLT contains over 30 cancer-causing chemicals and is a leading cause of oral cancer in India. 

Need to strengthen tobacco regulations

Co-authored by Amit Kumar Soni from Indore-based Devi Ahilya University and Mohit Kumar from All India Institute of Medical Sciences (AIIMS), Bhopal, the study has emphasised the need for the government to strengthen tobacco regulations and to reduce the appeal of these products, especially among young users.

“Despite implementing several tobacco control measures, India lags in addressing the specific challenges posed by flavoured smokeless tobacco. This oversight makes it easy for young and first-time users to become addicted, exacerbating the public health crisis,” Dr Soni, who was formerly with NIMHANS in Bengaluru, told The Hindu.

The paper has pointed out that use of flavoured SLT contributes to addiction, serious health risks, and is a rising public health burden in the country. “It increases the risk for stillbirths and low birth weight babies, and adds to the economic burden of healthcare,” the doctor said.

What is SLT?

Smokeless tobacco refers to products that do not require lighting. Instead, these products are chewed, sucked, or placed in the mouth. Popular smokeless tobacco products in India include gutka, khaini, zarda, betel quid with tobacco (paan), and region-specific products like mishri and gul. 

“Unlike cigarettes, these products are deeply ingrained in Indian cultural practices, with some even served at weddings and social gatherings. However, these seemingly harmless traditions have severe health consequences,” said Dr Soni, who is the corresponding author.

Flavoured tobacco products include ingredients like menthol, clove, cardamom, and saffron to enhance taste and mask the harshness of nicotine. These additives make smokeless tobacco more appealing, particularly to young and first-time users.

“Flavours are a gateway to addiction. They mislead users into thinking that these products are less harmful,” said Dr Soni.

Also Read:Fire without smoke: on chewable tobacco consumption

India’s efforts so far

“Although India has initiated several measures, including implementing the Cigarettes and Other Tobacco Products Act, 2003, a ban on gutka and high taxes on tobacco, to regulate tobacco use, these measures focus more on cigarettes and packaged products, leaving loose smokeless tobacco largely unregulated. Loose SLT accounts for 70% of sales in India, making it a significant challenge to enforce existing regulations,” the study pointed out.

“India has done well to ban packaged products such as gutka, but loose smokeless tobacco continues to bypass these restrictions. Flavoured SLT remains a major gap in India’s tobacco control framework,” stated the study.

Recommendations

Emphasising the need for India to address flavoured smokeless tobacco with stronger regulation, the authors recommended a ban on the use of flavours such as menthol to reduce the appeal of smokeless tobacco and the introduction of stricter rules for loose SLT, which currently escapes many regulatory measures.

“India must learn from the lessons of flavoured cigarette ban in countries like the U.S. Strengthening the regulation of flavoured smokeless tobacco is not just a policy decision, it is a public health imperative,” the authors concluded.