Chewing Habits and the Risks of Oral Cancer

Across Pakistan, chewing products such as paan, gutka, and supari remain common in everyday life. Whether shared after a meal, used during long working hours or consumed as a casual habit, these products are often viewed as harmless or socially acceptable. However, decades of research have linked their use to serious oral health risks, including oral cancer.

Areca Nut: A Known Carcinogen

Areca nut is a common ingredient in paan, gutka, and other chewing products, but its health risks are often overlooked. In 2004, the International Agency for Research on Cancer (IARC) classified areca nut, along with betel quid with or without tobacco, as a Group 1 carcinogen. This classification indicates sufficient evidence that the substance causes cancer in humans. The World Health Organization also highlighted that chewing betel quid without tobacco can cause oral cancer, challenging the common assumption that removing tobacco makes the habit safe.

Areca nut is also addictive due to its psychoactive properties. It is often described as the world’s fourth most commonly used psychoactive substance, after caffeine, nicotine and alcohol.

Pakistan’s Oral Cancer Burden

The scale of the problem is reflected in Pakistan’s cancer statistics. According to GLOBOCAN 2022 estimates, the country recorded 15,915 new cases of lip and oral cavity cancer, making it the second most common cancer overall after breast cancer. It ranked first among men and second among women. Pakistan also recorded approximately 10,181 deaths from mouth and oral cancer in 2022, the third-highest national total worldwide.

This burden reflects a wider regional pattern. According to the World Health Organization, smokeless tobacco and areca nut products are leading causes of oral cancer in South and South-East Asia and the Western Pacific, where they contribute significantly to the disease burden.

Why Early Detection Matters?

Oral cancer can develop without noticeable pain in its early stages, causing people to delay seeking medical attention. The FDI World Dental Federation identifies several warning signs that should not be ignored:

• Red, white or mixed patches or ulcers that do not heal within three weeks
• Difficulty or pain when swallowing
• Restricted movement of the tongue or jaw
• Hard or enlarged lymph nodes in the neck

Early detection can significantly improve outcomes. According to US National Cancer Institute data, the five-year relative survival rate for oral cavity and pharynx cancers is 88.4 per cent when the disease is diagnosed while still confined to its original site. However, only about a quarter of cases are detected at this stage. Although survival rates may differ in Pakistan, these figures highlight the importance of timely diagnosis.

An oral examination is a simple first step. The US National Institute of Dental and Craniofacial Research notes that the examination is painless, takes only a few minutes and can be performed during a routine dental visit.

Breaking the Habit

The International Agency for Research on Cancer (IARC) identifies avoiding or stopping the use of tobacco and areca nut, including betel quid with or without tobacco, as an important measure for reducing oral cancer risk. Since these products can cause dependence, quitting may require ongoing support rather than willpower alone. The World Health Organization highlights the importance of prevention and support in reducing oral cancer risk. Practical steps towards quitting include:

• Seeking guidance from a doctor or dentist
• Informing family and friends to build a support system
• Replacing habitual chewing, particularly after meals, with healthier alternatives

People who currently use or have previously used these products should also remain attentive to changes in their mouths. Persistent sores, patches or lumps should be examined by a dentist or healthcare professional. Avoiding these products and seeking timely medical attention can help reduce the long-term risks to oral health.

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