World No Tobacco Day: Is the ‘safer tobacco’ belief putting more people at risk of cancer?

Despite decades of public health campaigns and growing awareness about the dangers of tobacco, it remains one of the world's leading causes of preventable cancer and premature death.

As the world observes World No Tobacco Day on May 31, health experts are raising concerns not only about cigarette smoking but also about the widespread use of smokeless tobacco products such as gutkha, khaini, zarda and pan masala, which continue to be consumed by millions across India.

This year's World Health Organisation (WHO) theme, "Unmasking the appeal – countering nicotine and tobacco addiction," focuses on exposing the tactics that continue to attract new users, particularly young people, to tobacco and nicotine products.

According to the WHO, tobacco use kills more than 8 million people globally every year, while India bears one of the world's highest burdens of oral cancer, much of it linked to chewing tobacco and areca nut products.

More from Health

"Tobacco-related cancers are highly preventable, yet we continue to see patients reaching hospitals at advanced stages because early warning signs are ignored," said Dr Tarang Krishna, Managing Director, Cancer Healer Center.

He said that tobacco contains carcinogenic chemicals that damage healthy cells and trigger abnormal cell growth, increasing the risk of cancers affecting the mouth, throat, lungs, food pipe, pancreas, bladder and cervix.

While cigarette smoking is widely recognised as harmful, experts say misconceptions surrounding smokeless tobacco remain a major challenge.

"The biggest problem is that many people believe smokeless tobacco is safer than smoking, which is medically incorrect," Dr Krishna said. "Whether it is smoked or chewed, tobacco damages cells and significantly increases cancer risk."

The concern is particularly relevant in India, where chewing tobacco products often remain in direct contact with the lining of the mouth for prolonged periods. According to the International Agency for Research on Cancer (IARC), smokeless tobacco and areca nut use account for a substantial share of oral cancer cases globally. A 2024 IARC assessment found that nearly one-third of oral cancer cases worldwide are linked to smokeless tobacco and areca nut consumption.

Experts also warn that delayed diagnosis continues to undermine treatment outcomes.

Oral cancer often begins with seemingly minor symptoms such as a non-healing ulcer, burning sensation, swelling, unexplained bleeding, difficulty swallowing, changes in voice or a lump in the neck. However, many patients dismiss these signs or rely on home remedies until the disease has advanced.

"Early-stage cancers are often manageable and associated with better outcomes, whereas advanced cancers may require extensive surgery, reconstruction and prolonged recovery," Dr Krishna said.

Oncologists say the burden is increasingly visible among younger populations.

"Every day without tobacco is a day closer to reducing your risk of cancer," said Dr Kanuj Malik, Senior Consultant, Surgical Oncology, Yatharth Hospital (Noida Extension). "We frequently see how years of tobacco use silently damage the body before symptoms become apparent. Cancers of the mouth, throat, lungs and food pipe are increasingly being diagnosed, including among younger people exposed to smoking and smokeless tobacco products."

The encouraging news, doctors say, is that the body begins repairing itself soon after tobacco use stops.

"If one stops smoking tobacco at any age, the risk of tobacco-associated diseases reduces significantly," said Dr Neeraj Gupta, Clinical Director, Pulmonology, Respiratory Critical Care and Sleep Medicine at Marengo Asia Hospitals (Gurugram). "Lung cancer remains one of the leading causes of death worldwide, and smoking continues to be one of its most important risk factors because burning tobacco releases numerous carcinogenic substances."

Health experts stress that awareness alone is not enough. They are calling for stronger tobacco-control measures, routine oral screenings, early medical consultations and greater support for tobacco cessation programmes.

"There is no safe form of tobacco," Dr Malik said. "The decision to quit today can help prevent serious health problems tomorrow and protect future generations from avoidable cancers."

As India continues to battle a growing cancer burden, doctors say one message remains unchanged: whether smoked or chewed, tobacco remains one of the most preventable threats to public health.