The recent controversy surrounding the Vimal Elaichi advertisement and its prominent endorsements from actors such as Shah Rukh Khan, Ajay Devgn, and Tiger Shroff has spotlighted the significant health concerns linked to tobacco and areca nut consumption. While the advertisement itself promotes elaichi, its underlying association with tobacco products raises alarms regarding public health, particularly oral cancer.

India carries one of the largest burdens of oral cancer globally, with tobacco, smokeless tobacco, and areca nut recognised as major preventable risk factors. A recent GLOBOCAN analysis of 2022 indicated that India accounted for 81 per cent of new oral cancer cases within the WHO South-East Asia Region while making up about 68 per cent of the population. This alarming statistic underscores that the rate of oral cancer incidents in India exceeds the regional average by 33 per cent.

In total, around 143,759 new cases of lip and oral cavity cancer were reported in India in 2022. A significant proportion of these cases arises from preventable exposures, underscoring the critical need for effective public health strategies.

Understanding the Cancer-Causing Properties

When examining the factors contributing to oral cancer, both tobacco and areca nut require equal consideration. An analysis by researchers linked to the International Agency for Research on Cancer (IARC) estimates that approximately 120,200 oral cancer cases globally in 2022 resulted from smokeless tobacco and areca nut. Notably, India accounted for an estimated 83,400 of these cases, revealing the severity of the problem nationwide.

The IARC categorises areca nut as a Group 1 carcinogen, confirming sufficient evidence of its cancer-causing potential, even when consumed independently of tobacco. This finding highlights the necessity for oral cancer prevention efforts to address both products rather than focusing solely on tobacco use.

Furthermore, studies indicate that the prevalence of oral potentially malignant disorders is significantly higher in those using areca nut with smokeless tobacco compared to those who use tobacco alone. The manifestation of oral submucous fibrosis—increasingly common among users of areca nut—underscores its detrimental health effects.

The Progression from Precancerous Lesions to Cancer

Cellular damage from tobacco and areca nuts initiates a gradual process that may lead to oral cancer. This process begins with repeated injury to the mouth’s lining due to the harmful chemicals present in these products. These repeated exposures can create oxidative stress, inflammation, and DNA damage.

Dr. Sandeep Nayak, Chairman of Oncology at MACS Renova Oncology Institute, explains that the cumulative effects of these damaging chemicals may lead to genetic mutations in crucial genes responsible for controlling cell growth, such as TP53 and CDKN2A. Over time, this cellular damage can escalate and result in the development of abnormal cells, thus increasing the risk of oral cancer across various locations in the mouth.

Warning signs, including persistent white patches or lesions in the mouth, often manifest before cancer is diagnosed. Conditions such as oral leukoplakia or oral submucous fibrosis serve as indicators that should not be ignored, as they may signify an increased risk for eventual cancer development.

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