Oral Cancer Crisis In India

Oral Cancer Crisis In India: 5 Deaths Every Hour, What Is Causing The Rise Among Men Despite Awareness

The first official campaign against oral cancer began in 1975 under the National Cancer Control Programme. By the 2000s, the Cable TV Network Regulation Act banned cigarette and smoking advertisements on television. In 2023, OTT platforms also introduced similar anti-tobacco warnings, making them non-skippable. Despite all this, oral cancer cases among men in India continue to rise, with nearly five deaths every hour, amounting to around 48,000 to 52,000 deaths annually.

A recent study by the Indian Council of Medical Research found a 1.20% annual increase in oral cancer cases (113,000) among men in India. Similar rising trends were reported in countries like China (1.10%), Canada (0.94%) and the US (0.57%). The study also analysed data from other G20 nations, including Argentina, Germany, Italy, South Korea, Australia, France and Turkey.

“The incidence of oral cancer in men in India is on the rise due to a combination of lifestyle and systemic factors. The most significant factor is the consumption of smokeless tobacco products like ‘gutka’, ‘khaini’ and ‘paan’. The combination of tobacco products with smoking and alcohol can further increase this risk. Inadequate oral hygiene, persistent irritation within the mouth and malnutrition also contribute to the risk. Another significant risk is diagnosis at later stages, given the symptoms are often misinterpreted or overlooked, and cancer is detected later in the disease process, making it more difficult to treat," said Dr Minish Jain, Director of Medical Oncology at Ruby Hall Clinic, Pune.

What Factors Cause Oral Cancer

Tobacco use remains the leading cause of oral cancer, accounting for nearly 80% of cases, particularly among men over 40. However, recent years have seen a worrying shift, with rising cases among women and younger individuals. This is largely linked to the growing use of smokeless tobacco, often driven by peer pressure and imitation.

At the same time, changing lifestyles and sexual behaviour have introduced another major risk factor — human papillomavirus (HPV), particularly HPV-16. This sexually transmitted virus is now increasingly linked to oral and oropharyngeal cancers, even among people with no history of tobacco use. HPV is also known to cause cervical, penile and vaginal cancers.

Two decades ago, less than 10% of oral cancers were linked to HPV. Today, its presence is being detected more frequently. A lack of awareness about early symptoms means many cases are diagnosed late, reducing survival chances. Early detection can improve survival rates from around 50% to as high as 90%, while also lowering treatment costs. Notably, HPV-related oral cancers tend to respond better to treatment than those caused by tobacco.

Meanwhile, stricter rules on public smoking have unintentionally led to a rise in smokeless tobacco use, especially products like gutka. It is cheap, widely available and highly addictive. But in reality, it is a harmful mix of carcinogens.

Why Tobacco Remains The Primary Cause Of Oral Cancer

Nicotine habit is a major factor as many people start using tobacco when they are young; they find it hard to stop, said Dr Jain. “Social acceptance also makes usage more acceptable, particularly in the case of chewing tobacco, which is widely accepted in some parts of the country. Readily available and cheap, these products are within easy reach. Lack of effective regulation and low risk awareness further promote the habit, as people often fail to recognise the long-term risks of the habit," he added.

ICMR & Oral Cancer Task Force highlights the role of smokeless tobacco, and need for early multidisciplinary intervention.

Gutka contains a harmful mix of areca nut, tobacco, and lime, which irritates and damages the soft lining (mucosa) of the mouth.

Continuous chewing and holding gutka inside the cheek lead to chemical burns, causing pre-cancerous lesions over time.

Nicotine and areca nut release carcinogenic compounds that damage DNA in mouth cells, paving the way for cancerous growths.

Excessive alcohol consumption further worsens the risk by damaging the mouth tissues and increasing the absorption of carcinogens from tobacco.

The connection between alcohol and oral cancer is strong when both are used together; the risk multiplies several times.

Doctors warn that the effects of chewing gutka on oral health are not limited to cancer; they also include gum disease, bad breath, tooth loss, and jaw stiffness.

Can Vaping Cause Oral Cancer?

Research findings indicate that vaping is not free from dangers, especially oral cancers. The aerosols generated by electronic cigarettes have chemicals such as formaldehyde, acetaldehyde, and traces of heavy metals that may have adverse effects on the mucous membranes lining the mouth, causing cell damage when used repeatedly over an extended period.

Unlike traditional smoking, vaping is more likely to occur more regularly, leading to a higher exposure level of toxic chemicals to oral tissue cells.

“Vaping predisposes individuals to xerostomia, a condition where there is insufficient saliva production in the mouth. Saliva plays an important part in the protection against damaging factors," said Dr Amol Dumbre Patil, Oncologist, Ruby Hall Clinic.

E-liquid flavours have also been shown to produce hazardous compounds after being heated. Initial findings indicate that users may experience gum swelling, sores on their gums, and slower wound healing all possible indicators. “Although more research is required to establish its impact over time, it is currently known that ‘less harmful’ is not synonymous with ‘safe'", stressed Dr Patil.

Why You Should Not Ignore The Early Warning Signs

Oral cancer has a better chance of “successful treatment" when it is caught early, but the early signs are easily missed, stressed Dr Jain.

Sores in the mouth that do not heal after two or three weeks are a frequent symptom, he added. Other key signs include red or white patches in the mouth, unexplained lumps or thickened area in the cheek or tongue, and trouble chewing or swallowing. Some people may also experience chronic sore throat and voice changes, unexplained bleeding or numbness. Early identification and medical consultation can be a key factor in increasing survival rates.

Dr Deepak Sarin, a head and neck surgeon at Medanta Gurugram, highlighted Dysphagia, which means trouble swallowing. He explained that people might feel food is stuck in their throat or chest, feel pain when they swallow, or even find they can’t swallow at all. Gum or mouth bleeding without any injury or rough brushing could point to oral cancer.

Dr Sarin notes that these symptoms may, in some cases, indicate oral cancer. Instead of self-diagnosing, it is important to consult a doctor for proper evaluation. Early detection plays a crucial role in improving treatment outcomes and survival rates.

Why Early Screenings Are Important

Early detection and prevention play a crucial role in improving survival rates, lowering treatment costs and maintaining a better quality of life. Identifying cancer at an early stage allows for more effective treatment, while preventive measures can significantly reduce the risk of developing the disease.

Routine dental check-ups are key to early detection. Dentists are trained to identify unusual lesions and can carry out detailed visual and physical examinations of the mouth during regular visits.

Oral cancer screenings, in particular, are vital as they help detect abnormal growths early, often before the disease spreads to other parts of the body.

“A targeted public health approach is essential to minimising the impact of oral cancer. Regular screening, especially among high-risk individuals like smokers, can contribute to early detection and improved prognosis," Dr Jain pointed out.

He further said public awareness programmes in local languages can increase awareness and promote change. School and college outreach programmes are crucial for early prevention of tobacco use. “Promoting access to programmes through mobile health units, incorporating oral cancer screening programmes into the primary health ones, particularly in rural settings, enhanced enforcement of tobacco control measures and continuous public awareness will play a crucial role in tackling the burgeoning burden of oral cancer in India."

A recent study by the Indian Council of Medical Research found a 1.20% annual increase in oral cancer cases (113,000) among men in India. Similar rising trends were reported in countries like China (1.10%), Canada (0.94%) and the US (0.57%). The study also analysed data from other G20 nations, including Argentina, Germany, Italy, South Korea, Australia, France and Turkey.

“The incidence of oral cancer in men in India is on the rise due to a combination of lifestyle and systemic factors. The most significant factor is the consumption of smokeless tobacco products like ‘gutka’, ‘khaini’ and ‘paan’. The combination of tobacco products with smoking and alcohol can further increase this risk. Inadequate oral hygiene, persistent irritation within the mouth and malnutrition also contribute to the risk. Another significant risk is diagnosis at later stages, given the symptoms are often misinterpreted or overlooked, and cancer is detected later in the disease process, making it more difficult to treat,” said Dr Minish Jain, Director of Medical Oncology at Ruby Hall Clinic, Pune.

What Factors Cause Oral Cancer

Tobacco use remains the leading cause of oral cancer, accounting for nearly 80% of cases, particularly among men over 40. However, recent years have seen a worrying shift, with rising cases among women and younger individuals. This is largely linked to the growing use of smokeless tobacco, often driven by peer pressure and imitation.

At the same time, changing lifestyles and sexual behaviour have introduced another major risk factor — human papillomavirus (HPV), particularly HPV-16. This sexually transmitted virus is now increasingly linked to oral and oropharyngeal cancers, even among people with no history of tobacco use. HPV is also known to cause cervical, penile and vaginal cancers.

Two decades ago, less than 10% of oral cancers were linked to HPV. Today, its presence is being detected more frequently. A lack of awareness about early symptoms means many cases are diagnosed late, reducing survival chances. Early detection can improve survival rates from around 50% to as high as 90%, while also lowering treatment costs. Notably, HPV-related oral cancers tend to respond better to treatment than those caused by tobacco.

Meanwhile, stricter rules on public smoking have unintentionally led to a rise in smokeless tobacco use, especially products like gutka. It is cheap, widely available and highly addictive. But in reality, it is a harmful mix of carcinogens.

Why Tobacco Remains The Primary Cause Of Oral Cancer

Nicotine habit is a major factor as many people start using tobacco when they are young; they find it hard to stop, said Dr Jain. “Social acceptance also makes usage more acceptable, particularly in the case of chewing tobacco, which is widely accepted in some parts of the country. Readily available and cheap, these products are within easy reach. Lack of effective regulation and low risk awareness further promote the habit, as people often fail to recognise the long-term risks of the habit,” he added.

ICMR & Oral Cancer Task Force highlights the role of smokeless tobacco, and need for early multidisciplinary intervention.

Gutka contains a harmful mix of areca nut, tobacco, and lime, which irritates and damages the soft lining (mucosa) of the mouth.

Continuous chewing and holding gutka inside the cheek lead to chemical burns, causing pre-cancerous lesions over time.

Nicotine and areca nut release carcinogenic compounds that damage DNA in mouth cells, paving the way for cancerous growths.

Excessive alcohol consumption further worsens the risk by damaging the mouth tissues and increasing the absorption of carcinogens from tobacco.

The connection between alcohol and oral cancer is strong when both are used together; the risk multiplies several times.

Doctors warn that the effects of chewing gutka on oral health are not limited to cancer; they also include gum disease, bad breath, tooth loss, and jaw stiffness.

Can Vaping Cause Oral Cancer?

Research findings indicate that vaping is not free from dangers, especially oral cancers. The aerosols generated by electronic cigarettes have chemicals such as formaldehyde, acetaldehyde, and traces of heavy metals that may have adverse effects on the mucous membranes lining the mouth, causing cell damage when used repeatedly over an extended period.

Unlike traditional smoking, vaping is more likely to occur more regularly, leading to a higher exposure level of toxic chemicals to oral tissue cells.

“Vaping predisposes individuals to xerostomia, a condition where there is insufficient saliva production in the mouth. Saliva plays an important part in the protection against damaging factors,” said Dr Amol Dumbre Patil, Oncologist, Ruby Hall Clinic.

E-liquid flavours have also been shown to produce hazardous compounds after being heated. Initial findings indicate that users may experience gum swelling, sores on their gums, and slower wound healing all possible indicators. “Although more research is required to establish its impact over time, it is currently known that ‘less harmful’ is not synonymous with ‘safe'”, stressed Dr Patil.

Why You Should Not Ignore The Early Warning Signs

Oral cancer has a better chance of “successful treatment” when it is caught early, but the early signs are easily missed, stressed Dr Jain.

Sores in the mouth that do not heal after two or three weeks are a frequent symptom, he added. Other key signs include red or white patches in the mouth, unexplained lumps or thickened area in the cheek or tongue, and trouble chewing or swallowing. Some people may also experience chronic sore throat and voice changes, unexplained bleeding or numbness. Early identification and medical consultation can be a key factor in increasing survival rates.

Dr Deepak Sarin, a head and neck surgeon at Medanta Gurugram, highlighted Dysphagia, which means trouble swallowing. He explained that people might feel food is stuck in their throat or chest, feel pain when they swallow, or even find they can’t swallow at all. Gum or mouth bleeding without any injury or rough brushing could point to oral cancer.

Dr Sarin notes that these symptoms may, in some cases, indicate oral cancer. Instead of self-diagnosing, it is important to consult a doctor for proper evaluation. Early detection plays a crucial role in improving treatment outcomes and survival rates.

Why Early Screenings Are Important

Early detection and prevention play a crucial role in improving survival rates, lowering treatment costs and maintaining a better quality of life. Identifying cancer at an early stage allows for more effective treatment, while preventive measures can significantly reduce the risk of developing the disease.

Routine dental check-ups are key to early detection. Dentists are trained to identify unusual lesions and can carry out detailed visual and physical examinations of the mouth during regular visits.

Oral cancer screenings, in particular, are vital as they help detect abnormal growths early, often before the disease spreads to other parts of the body.

“A targeted public health approach is essential to minimising the impact of oral cancer. Regular screening, especially among high-risk individuals like smokers, can contribute to early detection and improved prognosis,” Dr Jain pointed out.

He further said public awareness programmes in local languages can increase awareness and promote change. School and college outreach programmes are crucial for early prevention of tobacco use. “Promoting access to programmes through mobile health units, incorporating oral cancer screening programmes into the primary health ones, particularly in rural settings, enhanced enforcement of tobacco control measures and continuous public awareness will play a crucial role in tackling the burgeoning burden of oral cancer in India.”

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Source: News18
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