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Journalism of Courage
Ahead of World No Tobacco Day (May 31), Dr Jatin Shah, head and neck cancer surgeon at Memorial Sloan Kettering Cancer Center, USA, says tobacco consumption in any form — smoking or chewing — is a human tragedy in India, leading to 1.3 million lives lost each year. “Let us resolve to stamp out tobacco from our society, focus on targeted screenings for high-risk individuals, promotion of oral self-examination, and engagement of village health workers in spreading awareness and facilitating early detection of head and neck cancers,” Dr Shah told The Indian Express.
In an email interaction, Dr Shah, who holds the Elliott W Strong Chair in Head and Neck Oncology and chaired the Department of Head and Neck Surgery at Memorial Sloan Kettering Cancer Centre, also pointed out that the increasing use of e-cigarettes amongst the younger population, as a safe alternative to smoking, remains to be proven. “In addition to the risk of nicotine addiction and exposure to harmful chemicals, it also increases the risk of lung and heart diseases,” he said.
Head and neck cancer (HNC) is a significant health concern worldwide, ranking as the sixth leading cause of cancer-related mortality. Globally, over 650,000 new cases are reported annually, with approximately 330,000 deaths due to this cancer.
In India, a country with a population of around 1.38 billion, the incidence of head and neck cancer is particularly high, largely due to the habit of tobacco consumption. Over 200,000 cases of head and neck cancer are reported annually in India, with nearly 80,000 of them in the oral cavity, attributed to the habit of chewing tobacco, betel nut and “paan”.
Head and neck cancers are especially prevalent among men and rank as the most common cancer type in this demographic, and the fourth most common among women in India. GLOBOCAN 2020 data projects a significant surge in new cancer cases in India by 2040, with an estimated 2.1 million cases, marking a substantial 57.5% rise from 2020.
Findings from Indian population-based cancer registries (PBCRs) highlight concerning upticks in HNC incidence, particularly among males, across various regions such as Aurangabad, Delhi, Chennai, Bhopal, and Nagpur. This upward trend underscores the need for focused efforts, including extensive educational campaigns, especially emphasising the risks associated with tobacco and alcohol use, to mitigate the occurrence of head and neck squamous cell carcinoma (HNSCC).
Advancements in technology have led to the adoption of techniques such as robotic surgery and intensity-modulated radiation therapy (IMRT), which offer improved outcomes and reduced side effects for patients. Early diagnosis and appropriate surgery, with or without adjuvant treatments, remain the mainstay of treatment of head and neck cancers.
While aggressive surgery has been practiced for decades, modern-day surgery focuses on preservation of function and aesthetics, which impact upon the quality of life. Although surgery, when possible, remains the best option for locally advanced or recurrent cancers, systemic therapies with or without radiation remain the best option for metastatic disease.
Efforts are underway to integrate comprehensive supportive care interventions, including nutritional support, pain management, and psychosocial support, into treatment protocols to enhance overall patient well-being and treatment tolerability.
At the Department of Head and Neck Surgery of MSK, various programmes of education and training have been conducted in collaboration with national societies over the past four decades in various parts of India. In India, MSK extends its expertise through a concierge care model, allowing patients nationwide to benefit from the expertise of MSK in New York through remote consultations. Various annual campaigns organised by international and national bodies are dedicated to increasing public awareness of head and neck cancer and related health issues in India.
