India tops list of oral cancer cases caused by smokeless tobacco and areca nut in South Asia, says Lancet

According to a study, smokeless tobacco accounts for over 30 per cent of all oral cancer cases globally

4 min readUpdated: Oct 9, 2024 10:41 PM IST

According to a study published in The Lancet Oncology, smokeless tobacco accounts for over 30 per cent of all oral cancer cases globally. (File)

India has the largest number of oral cancer cases caused by smokeless tobacco (chewed, sucked on or sniffed) and areca nut (also called betel nut) use in South Asia, notching up 83,400 of the 120,200 cases globally in 2022, says a Lancet study.

According to a study published in The Lancet Oncology, smokeless tobacco accounts for over 30 per cent of all oral cancer cases globally. The regions that contributed the largest numbers of oral cancers caused by smokeless tobacco and areca nut use were South-Central Asia (a total of 105,500 cases, with 83,400 in India, 9,700 in Bangladesh, 8,900 in Pakistan and 1,300 in Sri Lanka), followed by South-East Asia (a total of 3,900 cases, with 1,600 in Myanmar, 990 in Indonesia, and 785 in Thailand) and East Asia (a total of 3,300 cases, with 3,200 in China).

Why is India among countries with the highest disease burden?

“Free accessibility with intense surrogate marketing of smokeless tobacco and areca nut have meant that India has one of the highest burdens of oral cancer in the world. While the revenue to the government is minimal, the health impact and associated healthcare losses are huge. The ban on gutkha was a courageous step that has been circumvented by the tobacco industry,” says Dr Pankaj Chaturvedi, Head and Neck Cancer surgeon and Director, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai.

One of the co-authors of the study, Dr Chaturvedi raised a red flag about the areca nut industry that has engaged Bollywood celebrities for advertising paan masala as a mouth freshener. “Areca nuts cause a painful disease called submucous fibrosis apart from mouth cancer that is incurable. Unfortunately that is affecting our younger population and destroying families emotionally and financially. We need to implement the existing laws and regulations effectively for control of smokeless tobacco and areca nuts,” he argues.

Why is this study significant?

An estimated 300 million people use smokeless tobacco and 600 million people use areca nut globally, with the highest rates of use in south-central Asia, southeast Asia and Melanesia.

What constitutes smokeless tobacco products?

Smokeless tobacco products are consumed without burning and can be chewed, sucked, inhaled, applied locally, or ingested. The most popular is gutkha, a mixture of tobacco, crushed areca nut, flavourings and spices. It is placed in the mouth, usually between the gum and cheek, and chewed. Khaini is made from sun-dried or fermented coarsely cut tobacco leaves. Paan masala is a mixture of areca nut, tobacco, lime, catechu and spices.

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“Smokeless tobacco and areca nut products are available to consumers in many different forms across the world,” wrote Dr Harriet Rumgay, a scientist at the Cancer Surveillance Branch at IARC and the first author of the study.

Also Read | New Lancet study: How banning sale of tobacco products can prevent 40% of lung cancer deaths

The gender burden: Men or women?

Globally, an estimated 77 per cent of oral cancer cases attributable to smokeless tobacco and areca nut use were among men (92,600 cases) and 23 per cent were among women (27,600 cases). Generally, the proportions of oral cancer cases attributable to smokeless tobacco and areca nut use were higher among men than among women, except in southern Africa and South-East Asia. Although men are the main consumers of smokeless tobacco or areca nut in most regions of the world, in these regions, the prevalence of smokeless tobacco or areca nut use among women is higher than that among men.

In India, consumption of areca nut (30 per cent) and betel quid with tobacco (28 per cent) were responsible for the most oral cancer cases among women, followed by gutka (21 per cent) and khaini (21 per cent). Among men, the products that caused the largest proportions of oral cancer cases were khaini (47 per cent), gutka (43 per cent), betel quid with tobacco (33 per cent), and areca nut (32 per cent).

Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

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