Opinion: Dr Shona Nag
You may have quit smoking, but your risk of cancer stays!
Wednesday, May 31, 2017

World Health Organisation has named May 31st as World No Tobbaco Day. This year’s focus is “Tobacco – a threat to development” which demonstrates the threats that the tobacco industry poses to the sustainable development of all countries, including the health and economic well-being of their citizens. So, it is all about pushing both governments and citizens to take measures to promote health and development by confronting the global tobacco crisis.
I am a strong proponent of banning tobacco and its products. While it provides jobs and revenue, it also kills millions due to cancer, heart disease and lung disease. A lot of people are chronic sufferers and lose their jobs. I think it is our social responsibility as citizens of the world to fight the anti-tobacco battle and win!
I have a personal reason to fight the menace. My parents both smoked and passed away due to lung cancer. In fact, I lost my father to cancer, at the same time that the hospital where I worked at, requested me to train in medical oncology. It seemed like a sign. It’s also what pushed me to change the mandate of my mom-in-law’s NGO Nag Foundation started in Pune to support the arts – into a movement for cancer awareness and cancer treatments after we had lost 3 out of the 4 parents in the house to cancer.
Smoking increases risk factors of cancer. In India, lung cancer accounts for 7% of all the new visible cancer cases. It also impacts more women as it increases their risk of breast cancer. Smoking and tobacco also result in Chronic Obstructive Pulmonary Disease (COPD), which takes more lives than heart attacks and lung cancer put together. But because the impact is spread over a decade or more, it is, unfortunately, not a subject of discussion. Most patients of COPD find it difficult to breathe, need constant attention impacting professional and personal lives.
Passive smoking also hampers lives of millions of innocent people. So many patients ask us when they are diagnosed with cancer. “Why me? I don’t smoke or drink? Why do I have cancer?” It is a result of pollution, exposure to cigarette smoke, at home or at work. The carcinogens in a cigarette are similar to those found in car batteries and rocket fuel, and the damage they cause is unimaginable. 

The government's ban on smoking in public places is a welcome sign and just this has reduced the incidence of lung cancer. What one must remember is once you are a smoker – the risk never comes down to zero. Which is why, if you have ever smoked, getting yourself checked every year once you are 40 is mandatory. A low dose CT scan can help. This will help you identify the disease at its early stages. The other alternative is never to touch the cigarette stick at all – one that will save you financially and physically! 
India is also the only country which has smokeless tobacco with sopari, paan etc. Across different regions of the country, this tobacco is consumed in different ways. Be it in Andhra Pradesh, which has a reverse smoking and the burning end is placed on the tongue or in the north, where post a meal paan is now a habit. Betel nut, betel leaf and lime – all contain carcinogenic making this a little time bomb! Even those who chew tobacco sometimes keep the quid in their mouth for a while – some even falling asleep with it. The area where the cud stays gives rise to cancers.

The tobacco chewing affects the system faster with a cancer detected within 5 years of its regular consumption, unlike smoking whose effect may take years to show up. A study conducted for five years by Tata Memorial Hospital found that only 10% of oral cancer cases were in 1st or 2nd stage. We get a lot of references for cancer checks from our dentistry department as the white and red patches surface in the mouth. While some get away with it, it also serves us as a perfect way to scare them off tobacco.  
The gutkha ban has made tobacco inaccessible to young adolescents and children. The only way to stop it is to ban tobacco completely. Awareness is the key. To inform patients of what their habit or minor daily stimulant could cause them is important. We are also funding research on the treatments via the Surabhi Nag Research awards. This year, we at the Nag Foundation have funded Dr Chatterjee of Tata Memorial Center in Kolkata to encourage their work in the field of head and neck cancer.


Dr Shona Nag is head, medical oncology, at Jehangir Hospital, Pune and also a trustee at Nag Foundation which works in the area of cancer care, research and education  

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