Tobacco control is most cost-effective way to prevent cancer

- Special on World Cancer Day: 4 February 2011
Cancer is a leading cause of death around the world. The World Health Organization (WHO) estimates that 84 million people will die of cancer between 2005 and 2015 without intervention. Simple measures to prevent cancer are: no tobacco use; a healthy diet and regular exercise; limited alcohol use; and protection against cancer-causing infections. "Enforcing health policies like the tobacco control legislations in India, can have enormous public health benefits for people" said Professor (Dr) Rama Kant, who is a World Health Organization (WHO) Director-General's Awardee for tobacco control (2005). More than 5 million people die of causes that are attributed to tobacco use, said Prof Rama Kant.

Most public health programmes of the Government of India are directed towards communicable diseases such as malaria, filaria, polio, tuberculosis and leprosy etc. The occurrence of certain diseases due to lifestyle changes like diabetes, respiratory/cardiac diseases, tobacco related disease and cancer, has now been recognized, and public health programmes are also being initiated against them. But these are few and far between. Life style diseases have a peculiar "follow others" ingredient which becomes still more complicated due to ignorance, especially in families where the elders have addictions, wrong eating habits, or other risk elevating lifestyles; and the youngsters are exposed to the "role model" phenomenon.

In many situations elders tell children that tobacco is bad for children and the latter are confused as to how it is bad for them and good for others. This ambiguity, coupled with peer pressure proves to be disastrous for the youth.

Most important part of all this is that the diseases and death caused by these life style aberrations are preventable.

Smoking And Tobacco Related Cancers
Lung Cancer
Lung cancer is one fatal but preventable life-style disease. Smoking causes 90% of lung cancer. Non-smokers who breathe in other peoples’ tobacco smoke, known as second-hand smoke, are also at an increased risk of lung cancer. Children and teenagers exposed to second hand smoke may be particularly at risk of lung cancer later in life as well as an increased risk of asthma and other respiratory problems.

Mouth and Throat cancer
Oral cancer is the most common cancer in India. Smoking is a major cause of cancers of the oral cavity (tongue, lips, gums) oesophagus and larynx.

Majority of oral cancers occur because of chewing Tobacco, gutka etc.
According to Dr Geoff Craig "People are dying of oral cancer because of ignorance". There are about 7,00,000 new cases of cancers every year in India out of which tobacco related cancers are about 3,00,000. Cost of treatment of one oral cancer patient is about Rs 3.5 lacs. This can be completely prevented by simple changes in lifestyle and regular screening. About 2000 deaths a day in India are tobacco related.

Cancer of the pancreas, stomach and kidney
Smoking is also, at least a contributory and, may be, a causal factor in the development of cancer of the pancreas and of the kidney. When you inhale cigarette smoke, you will always swallow some of it , Consequently, the risk of developing stomach cancer is higher among smokers.

Cancer of uterus, cervix, colon and bladder
Apart from these, smoking has been found to increase the risk of uterine cancer, cancer of the cervix, cancer of the colon and bladder.

Other health hazards attributed to tobacco use
Smokers and tobacco chewers are also at an increased risk of developing myeloid leukaemia., especially oral sub mucous fibrosis.

This condition is characterized by limited opening of mouth and burning sensation on eating of spicy food. This is a progressive lesion in which the opening of the mouth becomes progressively limited, and later on even normal eating becomes difficult. It occurs almost exclusively in India and Indian communities living abroad. Tobacco when kept in mouth leaches out potent carcinogens. Habit of smoking is also equally dangerous. Treatment is surgery, and in advanced cases surgery followed by radiation therapy. 70% of the cases after treatment comeback with relapse and the ultimate result is death. The cost of the treatment is Rs.3.5 lacs on an average and in spite of this high cost there is no guarantee of total cure.

Therefore the most important aspect is PREVENTION. Use of tobacco in smoking or chewing or any other form must be stopped immediately.

Prevention initiatives need to have two thrusts: (1) school-based programs, and (2) community-wide approaches.

School-based programs encourage students who have yet to experiment with tobacco to abstain from use through (1) enforcement of anti tobacco policies (e.g., prohibitions against tobacco use and tobacco advertising on campus); (2) education about the adverse health and social consequences of tobacco use (e.g., cancer risk, exacerbation of asthma, stained teeth and foul-smelling breath and clothing, and ostracism by non smoking peers); (3) education regarding the reasons that adolescents smoke (e.g., peer acceptance, stress management) and about alternative methods for attaining such goals; (4) education concerning the social influences on smoking, such as media, adults, and peers, and strategies for resisting such influences (e.g., refusal skills, assertiveness); (5) the use of teachers and peer leaders as health counselors; and (6) support for students who abstain from smoking as well as for those students who have quit. A meta-analysis of school-based prevention studies showed that programs involving peer and social elements can reduce adolescent smoking rates by as much as 30%.

Community-wide smoking prevention programs involve approaches that include counter advertising (e.g., antismoking billboard ads) and anti tobacco policies (i.e., restricting access, raising taxes, instituting bans). Evaluations of the benefits of counter advertising media campaigns suggest that this approach can effectively reduce smoking initiation rates.

Finally, since current data indicate that optimal cessation programs can produce modest 20 to 40% cessation rates at best, a greater emphasis on evaluating more comprehensive, multi-component cessation interventions could greatly improve upon current efficacy. Counselling by clinical psychologists, of those addicted to tobacco along with pharmacotherapy can assist in this difficult task.

Bobby Ramakant - CNS 

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Hindustan Times, India
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