Oral cancer, linked to tobacco and alcohol use, is among India’s most common cancers. In 2019, India accounted for 32.9% of global oral cancer deaths and 28.1% of new cases
Published May 31, 2025 | 6:21 PM ⚊ Updated May 31, 2025 | 6:21 PM
As per the global adult tobacco survey (GATS), 199.4 million adults in India consumed smokeless tobacco. (Shutterstock)
Synopsis: As the world marks World No Tobacco Day, a major study published in JAMA Network Open reveals that nearly one in three Indians with oral cancer dies within five years. With a national survival rate of just 37.2 percent, India bears a disproportionate global burden, accounting for over a third of all oral cancer deaths—largely driven by tobacco and alcohol use
As the world observes World No Tobacco Day on 31 May, a sobering new study has delivered a grim reminder of tobacco’s devastating toll in India: nearly one in three Indians diagnosed with oral cancer dies within five years.
Published in JAMA Network Open, the study—India’s largest to date on oral cancer survival—analyzed data from over 14,000 patients and found that the nation’s average five-year survival rate for oral cancer stands at a troubling 37.2 percent.
This means nearly two out of three patients don’t live beyond five years, with survival chances heavily shaped by where patients live, how early the cancer is caught, and their access to proper healthcare.
In 2022, India documented 14,13,316 cancer cases and 9,16,827 cancer-related deaths. Lip and oral cavity cancer ranks second — behind breast cancer — among prevalent cancers in India. In 2022 alone, 1,43,759 cases and 79,979 deaths were reported.
Oral cancer—which includes cancers of the tongue, mouth, gums, and palate—is among the most common forms of cancer in India. The high prevalence is closely tied to widespread use of tobacco in both smoking and smokeless forms, as well as alcohol. India accounts for over a third of all oral cancer cases globally, with the country alone accounting for 32.9 percent of global deaths and 28.1 percent of new cases of lip and oral cavity cancer in 2019.
While the national average paints a grim picture, survival rates vary dramatically across the country. In urban Ahmedabad, 58.4 percent of patients survived five years—a rate closer to those seen in higher-income countries. In stark contrast, Manipur reported the lowest survival rate at just 20.9 percent.
Southern cities like Thiruvananthapuram and Kollam in Kerala reported comparatively better outcomes, with five-year survival rates of 44.6 percent and 43.1 percent respectively. These figures are attributed to Kerala’s stronger public health infrastructure, more widespread screening programs, and higher public awareness. Notably, in Thiruvananthapuram, survival among young women aged 18 to 44 reached 77 percent.
The study confirmed a significant urban-rural divide. Patients in urban areas had a five-year survival rate of 48.5 percent, compared to just 34.1 percent in rural areas. This disparity is rooted in limited health literacy, fewer trained healthcare professionals, and weaker referral and diagnostic systems in rural regions. Many patients in these areas are diagnosed only after the disease has progressed.
Age emerged as another critical factor. Survival was noticeably better among younger patients, particularly those under 45. Among men in this age group, the survival rate was 54.1 percent, while it dropped to 39.1 percent for those aged 65 and older.
Timing of diagnosis made a profound difference. Patients whose cancer was detected at an early, localized stage had a five-year survival rate of over 70 percent. But once the disease had spread to other parts of the body, survival plunged to just 9 percent. Most cases—around 89 percent—were squamous cell carcinoma (SCC), the most common form of oral cancer.
“Unfortunately, individuals might tend to neglect these early signs, allowing the lesions to grow. If not addressed promptly, these ulcers can develop into more severe conditions, potentially spreading to the neck and even the lungs,” Dr L Rohit Reddy, Consultant Medical Oncologist at Yashoda Hospitals in Hyderabad, told South First.
“Primarily, oral cancer is associated with habits such as tobacco chewing and the use of gutka. In the case of gutka, individuals place them inside their mouths. This involves holding it with the thumb under the lip,” Dr AN Vaidhyswaran, Director and Senior Consultant Radiation Oncologist at Kauvery Hospital in Chennai, told South First.
Dr Vaidhyswaran added that placing a pan or gutka under the lip can lead to lip cancer. Gingival cancers, especially in the lower gingiva (gums), are also prevalent due to the common practice of placing it under the tongue.
“Apart from smokeless tobacco, Human Papillomavirus and certain genetic predispositions are also responsible for this lip and oral cavity cancer,” Dr Reddy said. He added that smokeless tobacco not only causes lip and oral cavity cancer but also oesophagus, stomach, kidney, and intestine cancers.
When an individual chews gutka, the mixture is directly absorbed into the body through the oral cavity. Upon mixing with saliva, it turns a deep red colour and can produce a more intense “hit”.
“This can lead to a false sense of well-being, euphoria, a warm sensation in the body, sweating, increased salivation, palpitations, heightened alertness, tolerance to hunger, and increased capacity and stamina to work,” Dr Rajesh Sharma, Health Economist from National Institute of Technology Kurukshetra, told South First.
He added that when a person is working in brick kilns or similar tough environments where the worker has to suppress the urge to eat food for hours, he consumes gutka. It is easily available and can give euphoria and tolerance to hunger. Gutka is mostly consumed by lower middle-class or lower-class people.
“One watches their idols, such as cricket stars and Bollywood stars promoting these gutka brands and thinks that they also consume it. That’s the aspiration of low literate, low-income people. It’s not only bringing death to the people, but also burdening the health infrastructure of the country,” Dr Sharma said.
Dr Vaidhyswaran added that smokeless tobacco advertisements cleverly navigate around restrictions, promoting a different product while indirectly promoting their tobacco-related products.
“Regulating these advertising practices poses a challenge. Advertisers find ways to circumvent restrictions, making it difficult to prevent them from promoting tobacco-related products under the guise of something else. It becomes a complex issue, especially considering the powerful lobby supporting the tobacco industry,” Dr Vaidhyswaran stated.
As per the global adult tobacco survey (GATS), 199.4 million adults in India consumed smokeless tobacco. More than 50 percent of the oral cancer burden has been attributed to smokeless tobacco whose prevalence has grown in South Asia, including India.
Most of the time, studies come from the perspective of the US or European countries, where the consumption of smokeless tobacco is almost nil. So there is very little literature available on this,” Dr Sachin Marda, Senior Consultant Oncologist at Hyderabad’s Yashoda Hospital, told South First.
“Smokeless tobacco products, primarily consumed by lower-income groups, pose a substantial health risk. These individuals often lack the financial means for proper diagnosis and treatment,” said Dr Sharma.
Dr Marda emphasised that oral cancer has become more prevalent over the past two to three decades. Contributing factors include inadequate dental hygiene and preneoplastic conditions within the mouth that possess a risk of progressing to cancer.
Telangana tops South India in spending on pan, tobacco, and intoxicants, recent findings from the 2023-24 Household Consumption Expenditure Survey (HCES) show. Rural Telangana records the second-highest spending in the country on these products, only behind Sikkim.
The HCES data reveals that in rural Telangana, 7.29 percent of total household expenditure is allocated to pan, tobacco, and intoxicants. In rural areas, households allocate ₹396.06 per capita per month to these products – the highest among South India’s five states. Urban households spend ₹320.73 per capita.
This dwarfs the national averages of 3.84 percent (rural) and 2.37 percent (urban). Kerala, the lowest spender, records just ₹98.55 per capita in rural areas and ₹93.94 in urban areas. Telangana’s rural households spend nearly five times more on these items than Kerala’s.
Across Telangana, 5.6 percent of women and 22.3 percent of men use tobacco. In rural Telangana, 7.2 percent of women and 26.6 percent of men consume tobacco. Telangana’s rural numbers exceed national benchmarks, reflecting an intensified problem.
The findings raise concerns about the effectiveness of India’s current cancer control strategies. Despite initiatives like the National Cancer Control Programme, screening coverage remains critically low. According to the National Family Health Survey, fewer than 2 percent of Indian adults have ever been screened for oral cancer.
Regions with high rates of tobacco and alcohol use saw consistently lower survival rates, especially among men. The study found strong negative correlations between these habits and five-year survival.
“Amidst the high burden of smokeless tobacco-induced cancers, the smokeless tobacco control policies, such as taxes and regulatory mechanisms, seem to be either inadequate or poorly implemented in South Asia, resulting in the unabated burden of smokeless tobacco-induced diseases, including oral cancers,” the study noted.
“Celebrities endorsing these products through surrogate ads further exacerbate the issue. Profit-driven vendors capitalize on the huge consumer base in India, often selling harmful products at low margins, causing severe health repercussions for those affected,” Dr Sharma said.
(Edited by Ananya Rao)
