Last month, a young man walked into my clinic. A frail looking man, appearing much older than his actual age. He was a 27 year old guy with the looks of a distressed 40 year old person. His eyes kept telling me that he has had sleepless nights. His skin was pale, hair were frail, and his gait was not matching his age. The worry on his face indicated that he feared something disastrous was about to happen in his life in recent times.

Upon conversing, I learnt about the cause of his worry. He had been a Gutkha chewer and smoker since 13 years of age. He got married at an early age and was fathering 3 daughters. Today his worries stood at the question of his life and death, Yes! Life and death! Whatever little research he could do on his own he had learnt that his body was showing signs of cancer.

This young man was suffering from all the early symptoms of first grade oral cancer. He narrated to me his problems. He could not eat hot or spicy food, his taste sensation was almost lost rendering him unable to relish the taste of anything he eats, he couldn’t open his mouth to more than a centimeter. He had pain in the neck region below his jaw. Upon intra-oral examination I could see multiple ulcers on his tongue and cheek mucosa (intra-oral skin of cheek). There was whitish discoloration of his tongue surface and also the cheek mucosa. Severe gum recession was resulting in compromised teeth support. Extra-oral examination revealed swollen lymph nodes, limited mouth opening and mild swelling on both the sides of the jaw. All these symptoms and signs are suggestive of early stage oral cancer.

Now I could imagine the cause of distress that I could see on his face since he met me, and the cause of the frail body despite being young. The fear of cancer had eaten him up internally, and the symptoms that we noted above had caused his body to become weak due to altered diet and hormonal changes.

This person today was seeing death in front of his eyes, and all he could think of was his wife, and three daughters. Who would look after them after him, who would love them and care for them? These are natural questions any dying person would have about his parents, siblings, spouse and children.

We carried out some further laboratory investigations, and it was the Almighty’s will that the final diagnosis was not cancer. He was suffering from what we call a pre-cancerous condition. His habit of smoking and Gutkha-chewing had led to this condition. Now, if he continued the habit, then it could led to fatal oral cancer within next few months.

It was a great relief for the patient, and also the doctor. But imagine the distress that one has to go through because of these debilitating oral habits of smoking, chewing Gutkha and tobacco.

Every year thousands of young men lose their lives to cancers caused by cigarette smoking, Gutkha and tobacco. These habits cause fatal oral cancers in addition to lung cancer which is additionally caused by cigarette smoking.

The growing use of tobacco and its derivatives by men of all ages, shockingly less than 15 years old suggests that they treat their mouth like a trash can. When they open their mouth to a dentist for treatment, the dentist can’t go any further before making them rinse their mouth with a strong antiseptic mouthwash. Same stands true for friends and family they meet on a daily basis. Yes! Gutkha, pan, tobacco, betel nut, is nothing but trash! They have zero nutritional value and they seriously destroy your teeth, gums, taste buds and lungs.

Innumerable men, adolescents and women are addicted to the debilitating drug called ‘Nicotine’. Nicotine is found primarily in tobacco. Hence, tobacco, in smokeless and smoke forms, is the staple choice of nicotine addicts.

Smoking is usually taken up by youngsters in response to social peer pressure, provided by either friends, siblings or even parents, who smoke in front of kids, leading to development of curiosity in the kids’ minds as to what happens upon smoking or how Gutkha tastes, and how ‘pleasing’ it is. All this acts as a positive reinforcement in initial stages that results in adolescents taking up smoking. Continual use of smoked tobacco then leads to addiction to nicotine which is the active ingredient in tobacco. Thus it becomes a lifetime habit.

Another form of smoked tobacco that is catching up the trend among youngsters is “Hookah” or “Sheesha”. Research shows that smoking of tobacco through Hookah is multiple times risky than smoking. There may be non-tobacco Hookah available too, but the smoke that reaches lungs has devastating effects be it from tobacco-based or non-tobacco based “only 5% nicotine” labeled Hookah flavors.

These habits of Gutkha-chewing, smoking cigarettes, hookah or direct chewing of tobacco have various consequences. The precancerous conditions are Oral Sub mucous Fibrosis (Mouth opening limitation and fibrosis of cheek), Leukoplakia (whitish discoloration of oral mucosa); both of these conditions lead to fatal oral cancer if left unchecked. The most common cancerous condition is Squamous Cell Carcinoma, which even if treated reduces the life expectancy upto 6 months to 5 years. Another common oral cancer is Carcinoma tongue which is caused by smoking and chewing tobacco and can lead to death. Apart from this there are many other benign and malignant oral cancers. A final mention would be about Lung Cancer which is caused by smoking of tobacco, through cigarettes, cigars or Hookah.

Having said all of this, if we stop short of just addressing this issue from the individual aspect then it would be very naive of us. Merely blaming those who are addicted, awareness campaigns to educate them to quit the habits, and merely addressing them to stop the use, all this does not comprise the permanent solution. How can we expect people to leave these habits when the catalysts like Gutkha, cigarettes, etc. are freely available to people of all ages in the market? How can we expect an end to this problem while TV and poster ads glorify the use of tobacco-chewing under the name of “Pan Masala- Pan Parag” or "Oonche log, Oonchi Pasand" etc. Our advice may affect sensible people who may come forward to leave these habits but on a large scale, the solution comprises of additional efforts.

The comprehensive solution to this problem must include the following efforts: 

1. Educating the people about the harms and dangers. 

2. Making parents aware of how their children get affected. 

3. Taking serious steps by involving the community, and by mobilizing the people to call for a ban on the sale of such detrimental products openly in the society. 

Finally, any comprehensive solution will require great efforts by responsible citizens, community elders, doctors and the ruling authority.