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Smoking is the leading cause of preventable cancer and death worldwide. From heart disease to the deadliest cancers, tobacco has been the most acclaimed serial killer. According to the latest WHO fact sheet, published on 24e In May 2022, the quantum of tobacco-related deaths amounts to more than 8 million people, of which more than 1.2 million are passive recipients of deaths due to exposure to “second-hand smoke”. In India, the hospital registry shows that up to 33.3% of cancers are due to tobacco use, which is attributed to almost half of all cancers caused in Indian men. Lung cancer remains the leading cause of tobacco-related cancer deaths worldwide. In India, chewing smokeless tobacco is also one of the leading causes of cancer-related death, especially of the oral cavity. The economic burden is enormous, with India losing more than 1% of its GDP as an economic burden from tobacco, with tobacco-related diseases accounting for more than 5% of total annual private and public health expenditure.
Tobacco use in any form is extremely harmful. There are no safe limits and complete shutdown is the only answer. Tobacco causes a variety of cancers, the most common of which are those of the lung, larynx (voice box), throat, oral cavity, esophagus, bladder, kidneys, liver, gastrointestinal, pancreatic, cervical and even hematological (blood) malignancies like acute myeloid leukemia.
At SRL’s Mumbai Reference Laboratory, we see an average of 200 biopsies per day of which nearly 100 biopsies are cancerous. 30% of our total oncopathology burden comes from tobacco-related tumours. Of these, cancers of the lung, oral cavity and upper aero-digestive tract constitute the major part.
There is also a growing population of female smokers, which directly correlates to the increasing number of lung tumors we are seeing in female patients.
The adolescent and adolescent population remains the most vulnerable. Exposure to these habits in the formative years is long lasting and difficult to stop. Start-ups exposed to work and personal stress are another target consumer for tobacco companies. A huge prevalence of stores selling tobacco products near schools, colleges and corporate offices attests to this observation. The images of chocolates, caramels and sweets that are very often seen alongside tobacco product advertisements aimed at appealing to children and young people, is a finding that has come to light in the ‘Big Tobacco Tiny Targets’ survey. “.
Managing this threat requires a two-way approach. Although much research is being done to develop better and more robust treatment strategies for tobacco-related cancers, this will never be enough unless steps are taken to prevent tobacco use.
With new tests based on precision oncology and companion diagnostics, the paradigm of tumor management has changed dramatically. Biopsy evaluation is not limited only to diagnosing the presence and type of cancer, but ancillary tests to determine exploitable mutations that can be targeted by mutation-specific drugs and tests to select patients who will benefit from immunotherapy, have become the backbone of cancer management. Cessation of tobacco use even after the development of cancer is associated with better clinical course and better outcomes, contrary to what the story is typically seen with very aggressive and widespread disease showing a dismal response to treatment, which is invariably fatal.
Many measures have been taken to prevent tobacco use at the individual, societal, national and international levels. Many policies have been developed to reduce tobacco consumption and manage the burden of disease globally. But tougher policies are needed to create a tobacco-free society that generally meet strong resistance, given consumer demand and the size of the market in terms of income.
The Indian government has taken severe measures to mitigate this tobacco-induced catastrophe. The National Tobacco Control Program is committed to mitigating this crisis through a 5-pronged approach that aims to:
- Raising awareness of the harmful effects of tobacco consumption
- Reduce the production and supply of tobacco products
- Ensure the effective implementation of the provisions of the Cigarettes and Other Tobacco Products (Prohibition of Advertising and Regulation of Trade and Commerce, Production, Supply and Distribution) Act 2003 (COTPA )
- Help people quit smoking
- Facilitate the implementation of tobacco prevention and control strategies advocated by the WHO Framework Convention on Tobacco Control
Some other recent measures such as the nationwide ban on the promotion of electronic cigarettes and the inclusion of nicotine in the list of Class A poisons, under the Poisons (Possession and Sale) Rule, 2015 in Karnataka, are an exemplary example of the various measures taken at the political level. decision-making by central and state governments, respectively, to further strengthen tobacco control. E-cigarettes are notoriously responsible for acute lung injury through inhalation, although no definite relationship has yet been established between vaping and the cause of cancer. But these ultimately form a gateway that draws people back to smoking cigarettes due to cravings and are sometimes the first steps to more sinister forms of addiction and abuse.
In conclusion, tobacco is the most implicated and preventable cause of cancer-related deaths, which are on the rise worldwide. It also has various other adverse effects on the health of vital organ systems such as cardiovascular, pulmonary, etc., which further increases the disease burden and costs. Health related expenditure in India due to tobacco related diseases is not only the only impact on the economy, the youth lost early to this menacing habit is a more dangerous and hidden impact. The approach to countering this threat would require a committed effort from both sides – a) prevention of tobacco use and b) management of diseases caused by tobacco use. Prevention would require determined efforts at all levels, from the individual to the global, to formulate policies that completely limit tobacco production and consumption. These would also need more lucrative rehabilitation for the farmers who grow the crop and support for industries to diversify into other market channels. At the level of cancer management, the war is well supported with solid and continued steps towards the development of new and more potent therapies based on new exploitable and targetable mutations and immunotherapies.
Dr. Kunal Sharma, Associate Director and Head – Center of Excellence and Histopathology, Mumbai Ref Lab – SRL Diagnostics