The only disability in life is a bad attitude, says Scott Hamilton. Indeed, this is a golden statement and you will be more than willing to endorse this quote, when you read on further.
It was the usual monsoon time in Mumbai and intermittent downpours thwarting the people. As we were all waiting for the local train in the crowded Dadar Station, a young guy in his twenties suddenly started skidding in front of us and almost went inside the approaching train.  We realized something bizarre had happened... The guy did not notice that someone had spit paan right on the already slippery platform and the boy started skidding. Had it not been for few good samaritans he helped him back on his feet, we all would have a witnessed a person dying in front of us. The reason: Spitting paan (life threatening too) – Anywhere and everywhere!

It's needless to emphasize the fact that India is the 5th largest exporter of tobacco and accounts for almost 6 per cent of the International Trade. Obviously this gives the government the much needed exchequer, but at the cost of unimaginable health hazard. As per the World Health Organization, Tobacco use and excessive alcohol consumption have been estimated to account for about 90 per cent of cancers in the oral cavity; the oral cancer risk increases when tobacco is used in combination with alcohol or areca nut.

The evidence that smokeless tobacco causes oral cancer was confirmed recently by the International Agency for Research on Cancer. While the incidence of cancer of the oral cavity ranges from 1-10 per 100,000 population, India has a whopping incidence of 12.6 per 100,000.

They chew or smoke tobacco while cancer chews them slowly and surely! It must be emphasized here that mostly this is largely a preventable disease if only the government and all the concerned people come together and take action.

While the government has done well to control public smoking of tobacco in the form of cigarettes and bidis, nothing much has been done to curb the menace of tobacco chewing and paan spitting in the public places.

Statistics
Look at this statistics: Only 20 per cent of the total tobacco consumed in India is in the form of cigarettes, about 40 per cent is in the form of bidis and the remaining 40 per cent is consumed as chewing tobacco, paan masala, snuff, gutkha, masheri and tobacco toothpaste. The smoked tobacco and the slaked lime in the Indian “paan” are the two important carcinogenic agents. Tobacco contains as many as 4000 toxic chemicals and atleast 50 carcinogenic substances.

Oral cancer is the most common cancer in India and according to Dr Geoff Craig “People are dying of oral cancer because of ignorance”.

“There are about 7,00,000 new cases of cancers diagnosed every year in India out of which tobacco related cancers are about 3,00,000; cancer of uteri are 1,00,000 and breast cancers are 80,000. Cost of treatment of oral cancer is about 3.5 lakh. This is over and above the cost of resources due to loss of man hours. This can be completely prevented by simple changes in lifestyle and regular screening and even have health benefits that reach beyond cancer”, says Dr Surendra Shastri, head of preventive oncology at Tata Memorial Hospital.

The reason for such high prevalence of oral cancer in India was primarily because of the most common form of tobacco consumption is keeping the tobacco in mouth. Be it in the form of gutka, tobacco quid and mava, betel leaf with tobacco (paan), snuff or misri and so on.

As evident from the data, the picture is really alarming! Nearly 50 per cent of the cancer is perhaps preventable i.e., Tobacco related cancers. All this is because of one simple reason. Bad attitude! The miserable attitude of tobacco chewing and smoking in a huge chunk of population who are in their most productive age group, including students. Most people have no idea that consuming smokeless tobacco is as dangerous as smoking.

It's true that the Indian government is earning huge revenue from tobacco business. But at the same time, it's imminent to realize that huge resources get wasted due to the loss of manhours when these people start developing the Leukoplakia and finally, the cancer lesions. Besides, most of the anticancer drugs are the result of the research effort of the pharmaceutical MNCs and India will have to pay back from whatever revenue has been earned from the tobacco business.

It would be worthwhile for the Indian government to focus on the root cause of the tobacco related cancer and evolve solutions rather than fighting for compulsory licensing of newer anticancer drugs.

Perhaps it may not be inappropriate here to quote the adage, 'prevention is better than cure.'

Finally if people continue to be reluctant in changing their attitudes, then this would apply: 'If you're going through hell, keep going'  - Winston Churchill.

Suggestions
Following are few suggestions that the concerned people and the Indian government can take note of, so that the beginning of the end of oral cancer can actually begin:

• Ban chewing of tobacco and paan completely in all public places, as in the case of cigarettes
• Conduct educational camps in schools and colleges to prevent the future generation falling victim to this deadly menace
• Stage road shows to improve awareness about tobacco harm in the society
• Motivate governement officials with attractive incentives to promote cleanliness and hygeine in hospitals, establishments, offices, transport services and various other public places like park, gardens, etc.
• Ban sales of paan, gutka, etc., in railway platforms and in bus depots
• Run continuous 'anti-tobacco campaign' on TV and Radio
• Charge 4-5 times the normal fare in transport service for reluctant tobacco chewing people
• Adopt strategy similar to DOTS Therapy in the successful treatment of TB
• Pharmaceutical companies: Why not plan some budget on educational campaigns and camps to drive the 'anti-tobacco campaign?'
•  Tobacco companies: Do some 'Alfred Nobel' type of noble service. Create corpus fund to recognize and reward Indian drug discovery to prevent or treat cancer.