Oral smokeless tobacco consumption pattern among rural Indian cancer patients: A prospective survey

Avinash Pandey; Anjana Singh; Shivkant Singh; Amit Kumar; Anshuman Das; Heena Shahi; Aishwarya Singh

doi:10.4103/sajc.sajc_40_19

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ORIGINAL ARTICLE: Epidemiology of Cancer and Cancer Screening

09 (

); 17-19

doi:

10.4103/sajc.sajc_40_19

Oral smokeless tobacco consumption pattern among rural Indian cancer patients: A prospective survey

Avinash Pandey^1,, Anjana Singh¹, Shivkant Singh², Amit Kumar¹, Anshuman Das¹, Heena Shahi¹, Aishwarya Singh¹

1 Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar

2 Department of Medical Oncology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar

*Corresponding author: Dr. Avinash Pandey. dr.avinashp9@gmail.com

Published: 2020-12-14

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

Bacground: Oral tobacco consumption predisposes to cancer. The pattern of its use in rural Indian cancer patients is unknown. Aim: The aim of this study is to estimate the prevalence of oral tobacco consumption in cancer patients. Objectives: To identify oral tobacco consumption pattern with respect to demographic variables and clinical profiles in adult Indian rural cancer patients. Materials and Methods: All consecutive individual adult (age >18 years) patients diagnosed with any cancer and registered in the Medical Oncology Outpatient department were enrolled for questionnaire-based survey on oral tobacco consumption between July 2017 and October 2017. Demographic variables were also recorded, including income, education, and occupation. Frequency distribution and cross-tabulation were used for statistical analysis using SPSS version 17. Results: Of 517 cancer patients enrolled, 456 (88%) were rural. 230/517 (44%) consumed several forms of oral tobacco. Out of 230, 179 (78%) of them had dried tobacco leaves, whereas 23 (10%) and 26 (11%) had Gutkha and pan (betel leaves) alone, respectively. 63 (27%) consumed tobacco leaves and gutkha both. 163 (91%) of tobacco chewers were male, whereas 65% of pan chewers were male and 35% of females. About 48% of tobacco chewers were addicted since >20 years, whereas 13% started in the past 5 years. 47/179 (26%) of tobacco chewers were illiterate, whereas 13/179 (7.2%) were graduates. 106 (59%) had monthly income of between Rs. 5000–10,000. 57 (32%) and 40 (22%) were farmers and laborers, respectively. 25/215 (12%) housewives were addicted. 41/58 (70%) of the head-and-neck cancer patients consumed tobacco products, where 29/41 (70%) used dried tobacco leaves to chew. Conclusion: More than 40% of adult Indian rural cancer patients consume oral smokeless tobacco products. Dried tobacco leaves are the most common form of smokeless tobacco consumed.

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References

Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: A cluster-randomised controlled trial. Lancet 2005;365:1927-33.
Sharma S, Satyanarayana L, Asthana S, Shivalingesh KK, Goutham BS, Ramachandra S, et al. Oral cancer statistics in India on the basis of first report of 29 population-based cancer registries. J Oral Maxillofac Pathol 2018;22:18-26.
Boffetta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and cancer. Lancet Oncol 2008;9:667-75.
Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: Prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob Control 2003;12:e4.
Global Adult Tobacco Survey. India; 2016-17. Available from: https://www.who.int/tobacco/surveillance/survey/gats/GATS_India_2016-17_FactSheet.pdf. [Last accessed on 2019 Jan 31].
Cancer Patient Aid Association. Available from: http://www.cpaaindia.org/activities/projects.htm#gutkha. [Last accessed on 2019 Jan 31].
IARC. Betel-Quid and Areca-Nut Chewing. IARC Monographs on the Evaluation of Carcinogenic risks to Humans. Betel-Quid and Areca-Nut Chewing and some Areca-Nut-Derived Nitrosamines. Vol. 85. Lyon: IARC Press; 2004. p. 39-278.
Merchant A, Husain SS, Hosain M, Fikree FF, Pitiphat W, Siddiqui AR, et al. Paan without tobacco: An independent risk factor for oral cancer. Int J Cancer 2000;86:128-31.
Boffetta P, Aagnes B, Weiderpass E, Andersen A. Smokeless tobacco use and risk of cancer of the pancreas and other organs. Int J Cancer 2005;114:992-5.
Hecht SS. Tobacco smoke carcinogens and lung cancer. J Natl Cancer Instit 1999;91:1194-210.
Subramanian SV, Nandy S, Kelly M, Gordon D, Davey Smith G. Patterns and distribution of tobacco consumption in India: Cross sectional multilevel evidence from the 1998-9 national family health survey. BMJ 2004;328:801-6.
Bhawna G. Burden of smoked and smokeless tobacco consumption in India – Results from the global adult tobacco survey India (GATS-India)- 2009-201. Asian Pac J Cancer Prev 2013;14:3323-9.
Thankappan KR, Thresia CU. Tobacco use & social status in Kerala. Indian J Med Res 2007;126:300.
Agrawal S, Karan A, Selvaraj S, Bhan N, Subramanian SV, Millett C, et al. Socio-economic patterning of tobacco use in Indian states. Int J Tuberc Lung Dis 2013;17:1110-7.
Sinha DN, Gupta PC, Pednekar MS. Tobacco use in a rural area of Bihar, India. Indian J Community Med 2003;28:167-70.
Pal R, Tsering D. Tobacco use in Indian high-school students. Int J Green Pharm 2009;3:319-23.
Bala DV, Bodiwala IN, Patel DD, Shah PM. Epidemiological determinants of tobacco use in Gujarat state, India. Indian J Community Med 2006;31:346-4.
Mohan S, Pradeepkumar AS, Thresia CU, Thankappan KR, Poston WS, Haddock CK, et al. Tobacco use among medical professionals in Kerala, India: The need for enhanced tobacco cessation and control efforts. Addict Behav 2006;31:2313-8.
Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology 2003;8:419-31.

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[1] Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: A cluster-randomised controlled trial. Lancet 2005;365:1927-33.

[2] Sharma S, Satyanarayana L, Asthana S, Shivalingesh KK, Goutham BS, Ramachandra S, et al. Oral cancer statistics in India on the basis of first report of 29 population-based cancer registries. J Oral Maxillofac Pathol 2018;22:18-26.

[3] Boffetta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and cancer. Lancet Oncol 2008;9:667-75.

[4] Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: Prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob Control 2003;12:e4.

[5] Global Adult Tobacco Survey. India; 2016-17. Available from: https://www.who.int/tobacco/surveillance/survey/gats/GATS_India_2016-17_FactSheet.pdf. [Last accessed on 2019 Jan 31].

[6] Cancer Patient Aid Association. Available from: http://www.cpaaindia.org/activities/projects.htm#gutkha. [Last accessed on 2019 Jan 31].

[7] IARC. Betel-Quid and Areca-Nut Chewing. IARC Monographs on the Evaluation of Carcinogenic risks to Humans. Betel-Quid and Areca-Nut Chewing and some Areca-Nut-Derived Nitrosamines. Vol. 85. Lyon: IARC Press; 2004. p. 39-278.

[8] Merchant A, Husain SS, Hosain M, Fikree FF, Pitiphat W, Siddiqui AR, et al. Paan without tobacco: An independent risk factor for oral cancer. Int J Cancer 2000;86:128-31.

[9] Boffetta P, Aagnes B, Weiderpass E, Andersen A. Smokeless tobacco use and risk of cancer of the pancreas and other organs. Int J Cancer 2005;114:992-5.

[10] Hecht SS. Tobacco smoke carcinogens and lung cancer. J Natl Cancer Instit 1999;91:1194-210.

[11] Subramanian SV, Nandy S, Kelly M, Gordon D, Davey Smith G. Patterns and distribution of tobacco consumption in India: Cross sectional multilevel evidence from the 1998-9 national family health survey. BMJ 2004;328:801-6.

[12] Bhawna G. Burden of smoked and smokeless tobacco consumption in India – Results from the global adult tobacco survey India (GATS-India)- 2009-201. Asian Pac J Cancer Prev 2013;14:3323-9.

[13] Thankappan KR, Thresia CU. Tobacco use & social status in Kerala. Indian J Med Res 2007;126:300.

[14] Agrawal S, Karan A, Selvaraj S, Bhan N, Subramanian SV, Millett C, et al. Socio-economic patterning of tobacco use in Indian states. Int J Tuberc Lung Dis 2013;17:1110-7.

[15] Sinha DN, Gupta PC, Pednekar MS. Tobacco use in a rural area of Bihar, India. Indian J Community Med 2003;28:167-70.

[16] Pal R, Tsering D. Tobacco use in Indian high-school students. Int J Green Pharm 2009;3:319-23.

[17] Bala DV, Bodiwala IN, Patel DD, Shah PM. Epidemiological determinants of tobacco use in Gujarat state, India. Indian J Community Med 2006;31:346-4.

[18] Mohan S, Pradeepkumar AS, Thresia CU, Thankappan KR, Poston WS, Haddock CK, et al. Tobacco use among medical professionals in Kerala, India: The need for enhanced tobacco cessation and control efforts. Addict Behav 2006;31:2313-8.

[19] Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology 2003;8:419-31.

Oral smokeless tobacco consumption pattern among rural Indian cancer patients: A prospective survey

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