Daijiworld Media Network - New Delhi

New Delhi, Oct 19: Smokeless tobacco may account for more than half of mouth cancers among men in India, according to a new study that highlights the continuing public health burden of tobacco use despite a decline in reported individual consumption.

The findings come as two other assessments present contrasting trends: the latest National Family Health Survey (NFHS-6) recorded a decline in tobacco use among individuals, while a government working paper found that the proportion of households purchasing tobacco had increased over the past decade.

The cancer study, published in the Indian Journal of Medical Research, estimated that smokeless tobacco accounted for 57.3 per cent of mouth cancers among men. Among women, tobacco in any form was estimated to account for 73.4 per cent of mouth cancers.

The researchers stressed that these estimates represent the proportion of cancers that could potentially be prevented if tobacco exposure were eliminated, assuming the observed associations are causal. They do not establish that tobacco definitively caused every individual cancer included in the estimates.

Guruprasad Vinod and his colleagues analysed records of 11,285 patients diagnosed with head and neck cancers and 7,154 people with non-cancerous conditions who visited the Regional Cancer Centre in Thiruvananthapuram, Kerala, between 2019 and 2024. The researchers used the findings alongside state-level tobacco-use prevalence data to estimate population attributable fractions.

Among men, smokeless tobacco was estimated to account for 61.8 per cent of lip cancers and 30.7 per cent of tongue cancers. Smoking was associated with an estimated 40.2 per cent of cancers involving the base of the tongue, tonsils and oropharynx, 45.7 per cent of hypopharyngeal cancers and 38.4 per cent of laryngeal cancers.

The hospital records also revealed differences in tobacco-use patterns across cancer types. Among men with mouth cancer, 55.3 per cent used smokeless tobacco, compared with 17.5 per cent in the comparison group. Among men with hypopharyngeal cancer, 85 per cent smoked.

The researchers suggested that direct and prolonged contact between smokeless tobacco and oral tissues could help explain its association with cancers of the mouth and tongue. They noted that the widespread use of smokeless products in India could explain why the estimated proportion of mouth cancers attributable to these products was higher than in several international studies.

Among women, smokeless tobacco accounted for an estimated 68.8 per cent of lip cancers and 68 per cent of mouth cancers. Smoking was estimated to account for 41 per cent of oropharyngeal cancers and 34 per cent of hypopharyngeal cancers.

NFHS-6 reported tobacco use among 8.4 per cent of women aged 15 and above, compared with 36.3 per cent of men. The study also found that the estimated odds of mouth cancer among women who used smokeless tobacco were 17.6 times those among non-users. Among men, the corresponding odds ratio was 5.5.

However, the researchers cautioned that some estimates for women had wide confidence intervals, indicating considerable uncertainty about the precise magnitude of the associations. They called for further research to improve the reliability of these estimates.

The national figures also concealed substantial regional differences. Among men, the estimated proportion of mouth cancers attributable to smokeless tobacco reached 71 per cent in Jharkhand and 70.3 per cent in Odisha. Several Northeastern states recorded estimates close to 70 per cent.

In southern India, the estimated proportion of mouth cancers attributable to smokeless tobacco among men was 50.2 per cent in Karnataka, 35.1 per cent in Tamil Nadu, 33.9 per cent in Telangana, 25.6 per cent in Andhra Pradesh and 25.1 per cent in Kerala.

Among women, the corresponding estimates were 63.1 per cent in Karnataka, 60.7 per cent in Tamil Nadu, 59.9 per cent in Telangana, 52.3 per cent in Andhra Pradesh and 37.5 per cent in Kerala.

The researchers cautioned that their cancer risk estimates were derived from hospital-based data in Kerala and applied across India because state-specific risk estimates were unavailable. Consequently, the state-level figures reflect differences in tobacco-use prevalence combined with risk estimates assumed to be uniform nationwide, rather than direct measurements of differences in cancer risk between states.

The latest NFHS-6 findings offer a separate perspective on tobacco consumption. Released in May 2026, the survey recorded a decline in reported tobacco use compared with NFHS-5.

Among men aged 15 and above, prevalence fell from 38 per cent to 36.3 per cent, while among women it declined from 8.9 per cent to 8.4 per cent.

In Karnataka, reported tobacco use among men fell from 27.3 per cent to 24.2 per cent. Andhra Pradesh recorded a decline from 22.6 per cent to 18.8 per cent, Tamil Nadu from 20 per cent to 17.7 per cent, Telangana from 22.3 per cent to 21.1 per cent and Kerala from 16.9 per cent to 15.9 per cent.

The rural-urban gap remained substantial. Across India, 41.1 per cent of rural men reported tobacco use, compared with 26.2 per cent of urban men. Among women, the figures were 10 per cent and 4.6 per cent, respectively.

However, NFHS-6 did not distinguish between smoked and smokeless tobacco in the figures cited, and small changes between survey rounds need to be interpreted cautiously.

A February 2026 working paper by the Economic Advisory Council to the Prime Minister (EAC-PM) reported a contrasting trend in household purchases. Titled Rise in Tobacco Consumption and Policy Implications, the paper by council member Shamika Ravi and Partha Protim Barman compared household consumption surveys from 2011-12 and 2023-24.

The proportion of rural households reporting tobacco purchases during a seven-day recall period increased from 59.3 per cent in 2011-12 to 68.6 per cent in 2023-24. In urban areas, it rose from 34.9 per cent to 45.6 per cent.

Monthly per-capita spending on tobacco increased from Rs 21 to Rs 61 in rural areas and from Rs 19 to Rs 63 in urban areas. After adjusting for inflation, spending rose by 58 per cent in rural India and 77 per cent in urban India.

The paper also highlighted a sharp increase in purchases of gutkha. The proportion of rural households reporting gutkha purchases rose from 5.3 per cent to 30.4 per cent, while the urban figure increased from 3.1 per cent to 16.8 per cent.

The share of urban households reporting cigarette purchases also increased, from 8.4 per cent to 18.1 per cent. In contrast, the proportion of rural households reporting bidi purchases fell from 26.9 per cent to 23.2 per cent.

In Karnataka, the share of rural households reporting tobacco purchases increased from 51.7 per cent to 65.6 per cent, while the urban share rose from 29 per cent to 46.5 per cent. Rural household purchases of gutkha increased from 1.1 per cent to 25.5 per cent.

The EAC-PM paper did not establish that individual tobacco users had switched from bidis to cigarettes or gutkha. Nor did the household data show how many people in a household consumed the tobacco purchased. Differences in survey methodology between the two rounds also mean that the comparisons require caution.

The paper called for stronger tobacco-control measures, including taxation and enforcement. It discussed proposed changes to excise duties on various tobacco products and highlighted differences in GST rates between bidis and other tobacco products.

The authors also argued that tobacco expenditure placed a disproportionate burden on poorer households. In rural India, 70.2 per cent of households in the bottom 40 per cent by monthly per-capita consumption expenditure reported tobacco purchases, compared with 63.4 per cent among the richest 20 per cent.

The cancer researchers called for stronger cessation services, routine screening for tobacco use and wider access to evidence-based support. They also emphasised the need for effective implementation of the National Tobacco Control Programme, better cancer registry data and further research into regional differences.

Taken together, the findings highlight three distinct aspects of India's tobacco problem: declining individual use, rising household purchases and a substantial estimated contribution of tobacco exposure to certain cancers. While the studies do not establish a direct link between household purchasing trends and cancer rates, they underline the need for prevention strategies that address both smoking and smokeless tobacco, alongside accessible cessation support.