Reverse smoking leading to rise in palate cancer
There has been no drop in the unique form of cancer called ‘chutta’ or palate cancer, which occurs due to smoking with the ‘reverse’ lighted end of the cigarette inside the mouth. In India, it’s predominantly prevalent only in the north coastal districts of Andhra Pradesh, especially among the rural, tribal, agricultural and fisher-folk communities of Srikakulam, Vizag, Vizianagaram and West Godavari.
According to the data collected at various hospitals in the country by Tata Institute of Fundamental Research, the incidence of oral cancer of the palate was 48-50 per cent in areas where ‘chutta’ smoking was prevalent, while in areas where such smoking was very less or almost nil, the incidence was just 3-10 per cent.
The out-patient department of the state-run King George Hospital gets around 15-20 cases in their advanced stages every month, say oncologists. Despite efforts of NGOs and tobacco control cell to generate awareness, there’s no decline in cases of ‘chutta’ cancer due to reverse smoking or ‘addapoga’ as it is locally referred to.
Rather, migration of the rural and tribal communities to other districts are making more people addicted to reverse smoking. The word chutta is derived from the Tamil word ‘churutu’ which means ‘to roll or fold’. It is made of dried twigs of home-grown tobacco and is rolled crudely in a semi-dried tobacco leaf.
N Sujatha, head of the department of oncology in KGH, said, “Of all forms of cancer that we see at KGH, palate cancer accounts for about 40-50 per cent with 3-4 new cases every week. The age group of patients is usually between 45-55 years and they are mostly female. Patients turn up during the last stages when they are unable to eat or drink due to intense pain stemming from the ulcer. In the last two decades there have not been any signs of its coming down.”
“Reverse smoking has resulted in high incidence of oral cancer of the palate and a precancerous palatal change since the burning cigar is kept on the oral arch above the tongue for a prolonged period. The palatal mucosa is exposed to intense and direct heat due to the burning tobacco inside the mouth. The palatal changes prompted by this practice include malignant white patches, perforation of palate and ulcers. The cigars are homemade and the tobacco content is 10 times more than standard ones found in the market. Therefore, it’s not possible to provide any pictorial statutory caution on the packets,” added Sujatha.
Lavanya Reddy, dentist and senior lecturer at Panineeya Dental College, who has done an observational study while working at Vishnu Dental College in Bheemavaram of West Godavari district, said, “In 2010, we had collected 100 samples, 50 from conventional smokers and another 50 from reverse smokers. All the 50 reverse smokers showed signs of precancerous palatal mucosal change in different degrees depending on the nature, frequency and duration of tobacco usage. Their supporting tooth structure was also affected.”
“With the tobacco and heat (300-360 degree Celsius) acting as co-carcinogens, neo-plastic changes are accelerated by high alkaline pH, nitrogen and nicotine in the smoke,” the dentist said.
Elaborating on the factors behind women predominance in reverse smoking, Lavanya said, “Women resort to reverse smoking to hide it from their husbands, prevent ashes from scattering and falling on nursing children or clothes, as part of social tradition and to get relief from toothache as the heat provides a soothing sensation. Abstaining from ‘chutta’ smoking is an effective way to control palate cancer, which is usually asymptomatic,” she added.
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