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Cancer epidemic on the way

The popularity of chewable tobacco, particularly among the young, is a growing concern for doctors in India. They are already reporting a rise in pre-cancerous lesions in the mouth. But what's the reason for this?
Are brightly coloured packets of Guthka targetting children?
Wrapped inside a betel leaf and placed in the side of the mouth, tobacco has been chewed for centuries in India. But it is only in the last decade that tobacco companies have started selling tobacco ready-packaged in small sachets.

Street vendor in Mumbai
Gutkha on sale


One brand of chewable tobacco, Gutkha, does not say it contains tobacco.

It can cost as little as half a rupee - which means one could buy 90 sachets for the price of US$1.

Some Gutkha are chocolate flavoured; others are sold as mouth fresheners.

In addition, some manufacturers package Gutkha as if it were a sweet - bright colours and children's faces decorate the wrappers.

In Mumbai, India's commercial capital, they are sold by street vendors virtually everywhere.

They are popular with street children and teenagers can go through up to 15 packets a day. According to health officials, some children like Gutkha because it's an appetite suppressant.


Doctors at the Tata Memorial Hospital are reporting a rise in pre-cancerous lesions in the mouth, which they are convinced are caused by chewing tobacco.

Mouth cancer has a 10-year incubation period. It is very hard to treat and spreads very quickly.

As health experts know that children started using Gutkha six or seven years ago, they fear an epidemic of oral cancer will soon hit India. They say 11 and 12-year-old children are getting pre-cancerous growths after just two years of chewing.

Dentists and trading standards officers in the United Kingdom are now trying to highlight the health risks involved in chewing tobacco as Gutkha slowly makes its way to Europe.


Another illness is sub-mucous fibrosis (SMF) brought on by Areca nut, a substance mixed with the tobacco. SMF produces a hardening of the mouth lining which can develop into oral cancer.

People suffering from this disease find it progressively more difficult to open their mouths. In the worst cases, patients are unable to eat and drink liquidised food through a small opening in their mouths.


Voluntary health warnings have started appearing on some packets of Gutkha but anti-tobacco campaigners want tougher Government action to control their sale - especially to the young.

Already phenomenally popular in the north western states of Maharashta and Gujarat, doctors fear Gutkha will penetrate all over the country.

Click to see more photographs
A patient with SMF

Guthka advert
This advert appeared on Independence Day

Mumbai's annual film festival - the Bollywood Oscars - is sponsored by one of the main producers of Gutkha.

Health campaigners are appalled that some big names in cinema and sport have promoted these products in TV adverts.

The problem, say campaigners, is that chewing tobacco has always been seen as socially acceptable in India.

Whole families, generally unaware of the danger, will share these products at the end of a meal regarding them as little more than mouth refreshers.

8-year-old rolling beedies. Photo: Dr. Surendra Shastri
A child rolling beedies

Smoking beedies - the traditional Indian hand-rolled cigarette - is less socially acceptable. Men and boys will not smoke in front of their elders, and women almost never smoke. It is a woman's job to roll them though.

There have also been reports that some beedie manufacturers use child labour.

On the streets of Mumbai billboards advertising cigarettes jostle for space with those promoting mobile phones and internet start-ups.

Promoting the western lifestyle
Cigarettes promote a Western lifestyle

A packet of twenty beedies costs about 5 Rupees (11 US cents); cigarettes are much more expensive. A western style brand will cost 65 rupees per packet.


"Tobacco entered India through Goa and it will leave through Goa," proclaimed the late Dr Sharad Vaidya, former cancer surgeon in Panjim, the capital of Goa state.

"It took us 100 years to free ourselves from British colonialism. It has taken us 400 years already to free ourselves from the colonialism that is tobacco".

 Tobacco entered  India through Goa  and it will leave  through Goa

Click to listen to Dr. Vaidya

In 1997, Dr Vaidya persuaded the Goan legislature to pass the toughest anti-tobacco laws in the world.

The Goa Prohibition of Smoking and Spitting Act prohibits smoking and spitting chewed tobacco in public places of work or use, including bus stands, beaches, and public transportation.

It bans all tobacco advertising in the state and the sale of tobacco products within 100 metres of a school or place of worship.

After a long-term public education campaign involving the state's school children, the law has generally been well-received although local tourism officials are worried about the impact of the ban on smoking on beaches.


Government officials say India accounts for nearly a third of an estimated three million tobacco-related deaths in the world (per year). In 2001, officials in Delhi, the Indian capital, banned the sale of cigarettes to people under the age of 18.

The Tobacco Products Bill 2001 prescribes jail sentences of up to three months to those who sell tobacco to children. It also requires companies to print the tar and nicotine content on the packaging.


In 2001, India's national cricket team secured a sponsor for the team. The global sports management firm, Trans World International (TWI), will pay the Indian cricket board about $218,000 for a three year period.

The previous sponsor, the Indian Tobacco Company (ITC), was forced to withdraw its sponsorship after government legislation banned sports funding by cigarette companies.


Tobacco was first brought to India by Portuguese merchants 400 years ago. Although there were already some strains of locally-grown tobacco in India these were outclassed by the new imported varieties from Brazil.

The trade boomed and tobacco quickly established itself as the most important commodity passing through Goa in the 17th century.

Virtually every household in the Portuguese colony took up the new fashion of smoking or chewing tobacco.

Later on the British introduced modern commercially-produced cigarettes.