TOBACCO is the second major cause of death in the world and is currently responsible for the death of one in ten adults worldwide, which is almost five million deaths each year, according to the World Health Organisation (WHO).
The three most dangerous byproducts of tobacco are nicotine, tar and carbon monoxide but as many as four thousand other known chemicals are present in tobacco products. Some of them are acetone (a solvent thinner), ammonia (a household cleanser), formaldehyde (embalming fluid and preservative), hydrogen cyanide (poison), methane (a flammable gas and fuel), naphthalene (a dry cleaning fluid); nickel and cadmium (harmful metals) and vinyl chloride (plastic).
Many of these substances are present in pesticides and poisons and are carcinogenic. “Tobacco consumption by smoking and chewing tobacco is the primary cause for cancer of the oral cavity, lungs, throat, voice box, food pipe and stomach,” says Dr K A Dinshaw, Director,Tata Memorial Hospital.The poisons from cigarette smoke reach the brain within ten seconds of inhalation. Immediately afterwards the heart rate shoots up, oxygen flow is slowed down or displaced in the bloodstream, brain wave patterns change, the hands can become unsteady, and skin temperature drops.
Tobacco results in nicotine addiction, a weakened immune system, poor physical stamina, increased respiratory infections, deterioration of the sense of smell and taste and premature wrinkling. However these symptoms are usually ignored. Frequently, the early warning signs of cancer are ignored as well. “White or red patches and non healing ulcers in the mouth, a change in voice or a chronic cough and difficulty in swallowing are the early symptoms of cancer,” says Dr Surendra Shastri, Professor and Head, Department of Preventive Oncology at Tata Memorial. Breathlessness and excessive fatigue are some of the early signs of lung cancer.
It is when these problems exacerbate that the patient starts to worry. “As the disease progresses the patches in the mouth become ulcerative, the ulcers start bleeding and there is difficulty in opening the mouth and swallowing.There might be blood in sputum or in the cough,” says Dr Shastri.The sufferer then approaches the hospital but by then it could be too late. “By the time these cancers are clinically evident, they already are way too advanced for them to be cured,” admits Dr S V Almel, consulting medical oncologist at Hinduja Hospital.
Late detection is one the reasons for the high rates of mortality in tobacco related cancers. If patients experience any of the early warning signs a simple chest X-Ray and/or blood tests can rule out cancer. Sometimes Bronchoscopy (to test for tumors in the air passages) or a biopsy may be required. If cancer is detected, a CT scan can provide more information about how much the tumor may have spread. If head cancers are caught in the early stages, treatment can be very effective. “For head and neck cancers surgery remains the mainstay of treatment,”says Dr Almel. And depending on the stage/extent of the disease adjuvant concurrent chemoradiation becomes necessary.”Surgery, radiation and chemotherapy thus are used in combination depending on the stage and type of cancer.
Surgery may not always be possible in lung cancer. Some tumors cannot be removed because of their location or the tumor may have become too large to be operable. Chemotherapy also may not be the best option.“Lung cancer responds poorly to chemotherapy, as compared with other cancers,” says Dr Anuradha Sowani, a medical oncologist.
As per WHO statistics, tobacco consumption is increasing in the developing world and India and South Asia have the highest incidence of oral cancer. India has a serious problem with tobacco chewing. While tobacco is consumed in several ways – by smoking cigarettes and bidis, chewing gutkha, khaini or mishri or by sniffing, it is the ghutka problem which is endemic.
WHO statistics show that of the 400 million Indians aged 15 years and over, 47 percent use tobacco in one form or the other. The trend of the young taking to smoking is particularly disturbing as research has shown that people who start smoking in their teenage years run a higher risk of turning into life-long smokers.“Six thousand children are recruited into the tobacco habit every day in India,” points out Dr Almel.
The only solution is aggressive awareness campaigns against the evils of tobacco. That is why the World No Tobacco Day this year is focusing on the role of health professionals on tobacco control. Dr Dinshaw suggests that educational programmes should address both smoking as well as chewing forms of tobacco and should be tailormade to suit different target groups.“A simple oral examination for early signs of oral cancer by general practitioners and dentists will also lead to early detection of oral cancers,”
Finally, it’s a tobacco ban that oncologists not only in India but all over the world continuously lobby for. They believe that stopping the sale of tobacco is the only complete solution.
As long as tobacco is cheap and easily available, people will continue to use it as it gives them a high.
SOME SYMPTOMS OF ORAL/HEAD CANCER
1. Swellings, lumps, rough spots on gums or other places inside the mouth
2. White, red, or speckled patches in the mouth
3. Unexplained bleeding in the mouth
4. Unexplained numbness or pain in any area of the face, mouth, or neck
5. Persistent sores on the face, neck, or mouth that do not heal within two weeks
6. A soreness in the throat
7. Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
8. Hoarseness, chronic sore throat, or changes in the voice
9. Ear pain
10. Change in the way teeth or dentures fit together
11. Weight loss
SOME SYMPTOMS OF LUNG CANCER
1. Chronic cough.
3. Excessive fatigue.
4. Persistent pain in the chest.
5. Blood in the sputum.
6. Weight loss.
SOME CHILLING STATISTICS
1. Tobacco is the second major cause of death in the world, causing nearly five million deaths a year.
2. Every 6.5 seconds one person dies and many others fall ill or suffer diseases and disability due to tobacco use.
3. Tobacco is currently responsible for the death of one in ten adults worldwide.
4. By the year 2020, if current smoking patterns continue, some 10 million people will die of tobacco related diseases.
5. Half the people that smoke today will eventually be killed by tobacco.
6. At current rates, the total number of tobacco users is expected to rise to 1.7 billion by 2025 from 1.3 billion now.
7. 84% of the smokers live in developing countries.
8. 50% of tobacco related deaths occur in the developing world.
9. 75% of tobacco-related deaths will occur in the developing world by 2020 if current trends continue.
10. In India it is estimated that amongst the 400 million individuals aged 15 years and over, 47% use tobacco in one form or the other.
Update: February 2008: From mrc.ac.uk: India is caught in the midst of a catastrophic smoking epidemic, which is causing one in five of all male deaths in middle age and will cause about one million deaths a year during the 2010s. Seventy percent of these deaths (600,000 male and 100,000 female) will be between the ages of 30 and 69.
(This article, written by me, was published in The Times of India, Mumbai, in 2005)
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