Nilesh J Jain, Samir Vinchurkar, Reena C Jhamtani, Shilpa Gupta and Mahienoor Z Attarwala
Background: One of top 3 tobacco producing and consuming nations, India accounts for 80% of global Smokeless Tobacco (SLT) users which is twice the number of smokers. Oral cancer mortality rates in South Asia are more than double the global average and highly correlated to the consumption of SLT products. Yet, these remain very accessible across countries like India in the form of flavored chewing products with or without tobacco priced 3 to 5 rupees (US$ 0.05).
Methods and findings: Tobacco Harm Reduction (THR) initiatives for these countries face challenges mainly concerning affordability, acceptability, and usability of alternatives. Additionally, disease and substance use data can be vital for establishing region-specific THR objectives. This study presents historical data on the prevalence of a) smoking and lung cancer, and b) Smokeless Tobacco (SLT) and oral cancer for India. Further, data is presented for Tobacco Specific Nitrosamines (TSNAs) found in popular SLT products from different locations across India. As an indication of causation, use of SLT products which showed a much higher prevalence (%) relative to smoking contained 10-fold the maximum TSNAs reported for American SLT products.
Conclusions: This study emphasizes the urgent need for targeted THR strategies to alleviate the immense health burden from oral cancer in India and neighboring South Asian countries.
