Why head and neck cancers are increasing among young Indians

In India, cancer cases are on the rise. According to GLOBOCAN 2020, the number of new cancer cases in India is projected to reach 2.1 million by 2040, marking a 57.5% increase from 2020. Mouth cancer is the commonest one amongst males and comprises over 20% of all cancers in them.

Types of Head and Neck Cancers
Head and neck cancers are not confined to a single type or location. They include cancers of the mouth, throat, thyroid gland, and parotid glands, among others. In India, mouth and throat cancers are the most prevalent forms of HNC. These cancers severely impact the quality of life by causing pain, disfigurement, and difficulty in essential everyday functions like eating and speaking, highlighting the importance of increased awareness and early prevention efforts. These cancers pose significant health challenges, particularly due to the widespread use of tobacco and alcohol, which are the primary lifestyle factors contributing to their occurrence.

Tobacco and Alcohol: The Major Culprits
Tobacco and alcohol are the leading risk factors for head and neck cancers. In India, tobacco use is pervasive and takes various forms, including smoking and chewing tobacco (gutka and paan). Especially concerning is the increasing prevalence of smoking, particularly among young women, often driven by a growing social acceptance of the habit. The combination of tobacco and alcohol consumption multiplicatively increases the risk of developing mouth and throat cancer. Studies have shown that while smoking increases the risk of cancer threefold and alcohol another threefold, the combined use of both raises the risk to nine times that of the general population.

Additionally, supari (areca nut), commonly consumed in products that may not contain tobacco, is now recognized as a pre-cancerous substance. This was previously debated, but current evidence suggests a clear link between supari consumption and cancer risk. This makes India the HNC capital of the world, with the highest number of cases globally. Continued widespread usage of these and increasing adoption of smoking in the youth is likely to see continued high incidence of Head & Neck Cancers in India.

Emerging Threat: HPV-Related Throat Cancer
Beyond traditional risk factors, an emerging threat is the rise of HPV-related throat cancers in India. Human papillomavirus (HPV), a sexually transmitted virus, which can be transmitted through oral sex. Once infected, HPV embeds into the DNA of cells lining our throat, gradually transforming them into cancerous cells. This type of cancer typically develops in the throat, at the back of the tongue or the tonsil area. While this is already an epidemic in the West, where in some cities 90% of throat cancers are HPV-related, India is beginning to see an increase in these cases. Experts predict that HPV-related throat cancers will become significantly more prevalent in the next decade.

The Vaping Misconception
Vaping, often projected as a safer alternative to smoking, has become increasingly popular among the youth. However, the long-term health impacts of vaping are not yet fully understood. While vaping may be less harmful than smoking, it still involves inhaling numerous chemicals that can cause lung and brain damage and potentially lead to cancers. It is essential to recognize that vaping is not entirely safe, and its health risks will become clearer as more data becomes available over the coming years.

Permanent Damage and Prevention
Quitting tobacco or alcohol will significantly reduce the risk of developing head and neck cancers, but not eliminate it entirely. Some residual damage done by these carcinogens is often permanent. The body's ability to repair this damage is limited, meaning that even decades after cessation, individuals carry a residual risk of cancer.

Preventing head and neck cancers requires a multifaceted approach. Public health campaigns need to focus on discouraging the initiation of tobacco and alcohol use, especially among the youth. Awareness about the dangers of HPV and the importance of safe sexual practices should be promoted. Additionally, addressing misconceptions about vaping and highlighting its potential risks is crucial.

(Author: Dr. Deepak Sarin, Vice Chairman, Head & Neck Cancer Thyroid & Parathyroid Surgery, Cancer Care, Medanta, Gurugram)