TOBACCO Use: KILLING you, prematurely!

Sixty lac people die every year worldwide due to tobacco use alone, as per World Health Organisation. Tobacco kills ten lac people in India yearly. As per Global Adult Tobacco Survey (GATS) 48% of males and 20% of females in India consume tobacco products. More alarming is the fact that the average age of initiation of tobacco use is just 17 years in India. 60,000 people succumb to tobacco-related illness worldwide due to exposure to secondhand smoke. In India, more than 50% of people are exposed to secondhand smoking every day as per the household survey. Tobacco consumption is known to reduce the normal lifespan by 10 years due to a plethora of illnesses and disabilities linked to its use.

Smokers are twice likely to have heart attacks compared to non-smokers. One in three people admitted with heart failure has strong tobacco consumption history. Smoking increases around two to four fold risk of stroke. Smoking increases the risk of asthma and bronchitis, which can lead to gradually progressive breathlessness impairing ambulation and leading to premature death. Pregnant women exposed to smoke have a higher risk of premature, low birth weight babies and stillbirths. Young men often complain of erectile dysfunction and premature ejaculation. Tobacco use has also been linked to poor appetite, weight loss, loss of taste, cataracts, premature aging and blindness.

Smoking is the most common preventable risk factor for lung cancer. More than 80% of lung cancers are identified in current or past smokers. Unfortunately, more than 85% are diagnosed in the advanced metastatic stage where only one in ten patients manage to survive more than five years. Moreover, smoking-induced lung cancer responds dismally to standard chemotherapy and radiotherapy compared to cancer in non-smokers. Smoking also increases the risk by four-fold of throat, food pipe, stomach, bladder, pancreas and blood cancers. In India, the prevalence of a smokeless form of tobacco is 1.5 times higher compared to smoking. Consumption of tobacco, gutkha, pan masala, masheri, gul, snuff, areca nut, naswar etc has led to an epidemic of oral cancer in Indian Subcontinent. Majority of them present in advanced stages where curative therapy is impossible and average survival is measured in months.

The government on its part has introduced several prohibitive measures under the provisions of the Cigarette Act, Prevention of Food Adulteration Act, and more recently Cigarette and Other Tobacco Products Act (COTPA). Provisions under these acts include the prohibition of smoking in public places, prohibition of advertisements of tobacco products, prohibition on the sale of tobacco products to and by minors (person aged less than 18 years) and mandatory display of pictorial warnings on tobacco products. However, due to lack of legal teeth and half-hearted attempts, implementation and monitoring of such provisions remain a practical challenge and violators are rarely penalised. Moreover, active tobacco lobby with deep pockets counteract such prohibitive measures with vengeance in court and civil society by surrogate advertising, celebrity endorsement in mass media and sponsoring public events targeting vulnerable youths.

Though two-thirds of active smokers are desirous to quit, but less than 3% manage to do so by themselves without medical assistance, largely due to a strong addictive ingredient called nicotine in tobacco smoke. With integrated behavioral therapy and pharmacological measures under specialized physician care, tobacco quit rates can increase dramatically. India shares 20% of the oral cancer burden of the World, making it the capital of oral cancers. Similarly, 1% of the total population of India has underlying oral premalignant lesions which can be easily detected by an oral cancer screening program and prompt complete cessation of tobacco products. Though Low dose CT scan of the chest can help detect early pre-symptomatic lung cancers in high-risk smokers, but implementation on community level remains a major technical and economic challenge in India. Primordial and primary prevention by increasing awareness in the community at schools, colleges and workplace level respectively will boost the goal of achieving ‘no- tobacco’ milestones early in near future. Implementing a strict ban on advertisement, promotion and sale of tobacco products with an increase in taxation and embargo on tobacco mandates unwavering will and determination by local authorities, government and civil society to curb this rampant menace of tobacco with kills people like’ puff of smoke’.

Dr. Avinash Kumar Pandey,

MD, DM, DNB, PDCR, ECMO

Medical Oncology