TOBACCO: Health hazards

Dr. Srabana Misra Bhagabaty: In-Charge, Department of preventive oncology, Dr. B. Borooah Cancer Institute

Dr. Srabana M Bhagabaty

Dr. Srabana M Bhagabaty

• Gutka, a combination of arecanut, slaked lime, paraffin and katechu along with tobacco, is virtually poison. Promoted as a mouth freshener, this mixture is a combination of 4,000 chemicals of which at least 48 are carcinogenic compounds.

Around the world, nearly 5.4 million people every year die from tobacco related diseases.

If current trends continue tobacco will account for 13% of all deaths by 2020

Reference :Review Article Tobacco Control in India – Where are we now? Sonali Jhanjee National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi-110029 unit Dr. Srabana M

Bhagabaty

Global Deaths

4.9

10

0

1

2

3

4

5

6

7

8

2000 2030

mill

ions

of d

eath

s

Developed CountriesDeveloping Countries

Dr. Srabana M Bhagabaty

2.8 2.1 3

7

Tobacco abuse

AIDS +Alcohol abuse

+Other drug use

+Homicide +Suicide +Motor vehicle accidents +Fires combined

(CDC) Dr. Srabana M Bhagabaty

The slow poisoning of IndiaTobacco kills:•800,000 Indians in a year•2200 in a day •90 people per hour

India is the second largest consumer and third largest producer of tobacco

Dr. Srabana M Bhagabaty

PHYSICAL ill effects of tobacco

: CANCER :

40% of all cancers,50% cancers in males 25% cancers in

Females are tobacco related. 90% of the oral cancers are tobacco related

India reports the highest number of oral cancer in

the world

Dr. Srabana M Bhagabaty

TOBACCO RELATED CANCERS ACCORDING TO who guidelines2004 are

Cancers of Lip, Tongue,Mouth,Pharynx,Oesophagus,Larynx,Lung,Urinary bladder, Stomach, Colo-rectal, pancreas, Paranasal sinuses, kidney, Acute myeloblastic leukaemia and Cervical cancer

Dr. Srabana M Bhagabaty

Male : 1,57,461 newly detected TRCs ( AAR: 24.3)

Females : 56,767 newly detected TRCs (AAR: 9.3)

Globocon 2012 estimates for IndiaTobacco Related Cancers(TRCs)

Dr. Srabana M Bhagabaty

NORTH EAST PBCR AAR REPORTS 2009-11PBCRS MALE FEMALEMEGHALAYA 103 36

KAMRUP URBAN

92.3 45.3MIZORAM 79 45

CACHAR 60.2 23.9

DIBRUGARH 54.6 20.5

TRIPURA 45.4 12

NAGALAND 44.2 11.65

MANIPUR 29.1 17.4

SIKKIM 27.6 21.8

Dr. Srabana M Bhagabaty

WHAT OUR GUWAHATY HOSPITAL BASED CANCER REGISTRY AT BBCI SAYS

Dr. Srabana M Bhagabaty

Tobacco Related Cancer (2013-14)

TRC67%

Others33%

MaleTRC46%

Others54%

Female

Dr. Srabana M Bhagabaty

Male :Female=1:1.45

0

500

1000

1500

2000

2500

3000

3500

4000

2010:25402011:2637

2012: 2916

2013: 3374 2014: 3517

Dr. Srabana M Bhagabaty

LEUKOPLAKIA ERYTHROPLAKIASub mucosal fibrosis

Precancerous lesions often encountered during screening at BBCI OPD

Dr. Srabana M Bhagabaty

OTHER HEALTH HAZARDS

• Cardiovascular diseases• Lung diseases• Peripheral vascular diseases• Effects on reproductive health

Dr. Srabana M Bhagabaty

DAMAGING EFFECT ON REPRODUCTIVE HEALTH

INCREASED RISK OF MISCARRIAGE

PRE TERM DELIVERY

STILLBIRTH

INFANT DEATH

LOW BIRTH WEIGHT BABY

TOBACCO & WOMEN

Dr. Srabana M Bhagabaty

MAKING THE NEXT GENERATION UNWELL!

Dr. Srabana M Bhagabaty

Mental issues related

Nicotine is a potent parasympathomimetic alkaloid

Dr. Srabana M Bhagabaty

NICOTINE ADDICTION• A psychoactive drug affecting mood and

performance • Nicotine is:- - 1000 times more potent than alcohol - 10 – 100 times more potent than barbiturates - 5 – 10 times more potent than cocaine or

morphine•Within 10 seconds reaches brain.

Dr. Srabana M Bhagabaty

Stimulates release of two chemicals

Nicotine reaches brain

Dopamine ‘Good’ feeling

Nicotine is highly addictive

with its

The Vicious Cycle of ADDICTION

A tobacco user

takes tobacco NoradrenalineAlertness & energy

Social issues

The total social costs of tobacco products exceed the direct outlay on them, owing to morbidity, mortality and negative externalities associated with the consumption of tobacco products.

Tobacco cultivation has sustained despite social approval and domestic demand (beedi tobacco) and the international market

Culturally accepted, named as habit not an abuse

Economic impact : Where we are

India earns Rs 18,000 crores revenue per year from tobacco

India spent Rs 16,800 crore in 2011 to treat tobacco-related diseases

overall economic burden ( 16%direct treatment cost and 84% indirect cost) due to tobacco was Rs 1,04,500 crore. This was 1.6 per cent of the country's gross domestic product. It was 12 per cent more than the combined states' and Central government's expenditure on health.

CHANGING TRENDS IN DEVELOPED COUNTRIES

Realization of health hazards of tobacco by theGovernment

Planning

Massive public awareness efforts and stringent policy implementation

resulting in

Persistent decline in the prevalence of tobacco in these countries

Dr. Srabana M Bhagabaty

WHY SO….

UNFORTUNATELY…….

…. In developing countries like India prevalence of tobacco in various forms is increasing

Because ofMisleading advertising by tobacco companiesPoor awareness among general public Gaps in effective implementation of tobacco

control programs and lawsGaps in inte-rsecroral co-ordinationAbsence of sufficient no of tobacco de-addiction

centers for those who wish to quit their habit

Indicates the need for a more comprehensive approach to tobacco control within the country in terms of taxation trade economic policy and enforcement policy

Inter-sectorial co-ordination is mandatory

In a survey conducted by the Preventive Oncology Department, BBCI to perceive the effect of Gutkha ban randomly selecting 400 pan shops of

the metro in later part of this year, it was observed that 10% of the tobacco vendors were minors and were using pan masala with added

tobacco pouch into it which we namedINDIRECT SALE OF GUTKHA and AVAILABILITY

IN 96% OF PAN SHOPS WE OBSERVED INDIRECT SALE OF GUTKHA

Minors selling Gutkha in the city (Parents/Guardians counseled)

Birubari Noonmati Silpukhuri Hatigaon

Dr. Srabana M Bhagabaty

Dr. Srabana M Bhagabaty

THANK YOU Dr. Srabana M Bhagabaty