The smoke signal: Understanding tobacco’s deadly toll in India

Tobacco consumption is a grave public health challenge in India, claiming about 1.35 million lives annually. Tobacco is consumed in various forms: cigarettes, bidis (small, hand-rolled cigarettes), hookahs (water pipes), and smokeless forms like chewing tobacco, pan, and gutka. Additionally, newer forms such as e-cigarettes and vaping, though often perceived as safer, also carry significant cancer risks.Tobacco smoke harbors over 7,000 chemicals, with at least 70 established as carcinogens. These chemicals lead to cancer by mutating the DNA in our cells. For example, benzopyrene disrupts the crucial tumor suppressor gene p53, leading to lung cancer, while N-nitrosonornicotine, particularly prevalent in smokeless tobacco, is linked to esophageal and oral cancers. The connection between these carcinogens and various types of cancers is well-documented. Lung cancer is predominantly caused by cigarette and bidi smoking, while oral cancers are often linked to chewing tobacco, gutka, and pan. Esophageal cancer is associated with all forms of smoking and chewing tobacco, and bladder and pancreatic cancers are linked to the carcinogens found in tobacco. Gynecological cancers, including cervical and ovarian cancer, are increasingly tied to smoking.India sees high incidences of tobacco-related cancers, with lung and oral cancers being the most prevalent. In males, lung and oral cancers are particularly common, while in females, the rising trend of smoking has led to an increase in lung and gynecological cancers. These cancers predominantly affect socio-economically disadvantaged groups due to higher rates of tobacco use. Non-smokers also face significant risks, as passive smoking causes over 100,000 deaths annually in India. Additionally, if a mother smokes during pregnancy, it can result in fetal issues such as premature birth, low birth weight, and developmental problems.Contrary to popular belief, low-smoke cigarettes and e-cigarettes also pose cancer risks. They contain nicotine and other harmful substances that can cause cancers of the lung and throat. Quitting tobacco is the most crucial step towards cancer prevention. The body starts to repair itself immediately after quitting; for example, blood pressure and heart rate normalize within minutes. Within 20 minutes of quitting, heart rate and blood pressure drop. After 12 hours, carbon monoxide levels in the blood normalize. Within 2 weeks to 3 months, circulation and lung function improve, and after 1 to 9 months, coughing and shortness of breath decrease. After one year, the risk of heart disease is half that of a smoker, and after five years, the risk of mouth, throat, esophagus, and bladder cancer is halved. After ten years, the risk of dying from lung cancer is about half that of a person who is still smoking.Quitting tobacco can be challenging, but it is possible with the right support and strategies. Here are some effective ways to quit:Set a Quit Date: Choose a date within the next two weeks to quit, giving yourself time to prepare but not too much time to delay.Seek Support: Inform family, friends, and colleagues about your decision to quit and ask for their support. Consider joining a support group or seeking professional counseling.Use Nicotine Replacement Therapy (NRT): Options like nicotine gum, patches, lozenges, inhalers, and nasal sprays can help reduce withdrawal symptoms and cravings.Consult a Doctor or Psychiatrist: Professional medical help can provide medications and strategies to manage withdrawal symptoms effectively.Avoid Triggers: Identify situations that trigger your urge to smoke or chew tobacco and develop strategies to avoid or cope with them.Stay Active: Physical activity can help reduce cravings and withdrawal symptoms. Exercise, even in short bursts, can make a significant difference.Practice Stress Management: Engage in activities that reduce stress, such as yoga, meditation, deep breathing exercises, or hobbies you enjoy.Celebrate Milestones: Reward yourself for achieving milestones, such as one day, one week, and one month of being tobacco-free.The battle against tobacco is a collective societal challenge. Understanding the risks associated with various forms of tobacco and taking proactive steps to quit can significantly reduce the cancer burden in India. It’s imperative to clear the air, for our health and the health of future generations.(Dr. Dinesh Singh/Dr Babita Singh team Radiation Oncology, Andromeda Cancer Hospital, Sonipat)

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