Gutka, Naswar and Paan: Mouth Cancer Risk

Chewing gutka, naswar, chalia or paan is part of daily life for many people in Pakistan, and it is often treated as a harmless habit. The evidence says otherwise. These products cause cancer in the mouth and throat, and they are addictive.

What counts as smokeless tobacco?

Smokeless tobacco is tobacco that is chewed, sucked or held in the mouth or nose instead of being smoked. WHO lists paan, naswar, chalia or supari, and gutka as the common forms used in Pakistan and the wider Eastern Mediterranean Region. Gutka is a factory-made chewing tobacco that is sweetened and flavoured. Betel quid is a mix built around areca nut, wrapped in a betel leaf, with or without tobacco added.

Do these products really cause cancer?

Yes. The International Agency for Research on Cancer (IARC), which is WHO's cancer agency, reviewed the evidence and found:

• Betel quid with tobacco causes cancer of the mouth, the pharynx (throat) and the oesophagus (food pipe).
• Betel quid without tobacco still causes cancer of the mouth.
• Areca nut on its own is cancer-causing in humans, and causes oral submucous fibrosis.

That last point matters, because plain chalia and supari are often sold as the safe option. They are not. WHO separately reports that smokeless tobacco raises the risk of cancers of the head, neck, throat, oesophagus and mouth, and causes dental disease.

What is oral submucous fibrosis?

Oral submucous fibrosis is a disease of the lining of the mouth. IARC describes it as a pre-cancerous condition, which means cancer can grow out of it. WHO calls it severe and incurable, and says gutka has been strongly linked to a rise in cases, increasingly among young people.

How big is the problem in Pakistan?

WHO reports that smokeless tobacco use in Pakistan is higher than cigarette smoking, that oral cancer rates in Pakistan are among the highest in the world, and that oral cancer is the second most common cancer in the country after breast cancer.

Across the region, among 13 to 15 year olds, 14% of boys and 9% of girls use non-cigarette tobacco products, which is more than use cigarettes (7% of boys and 2% of girls). Worldwide, IARC estimated about 390,000 mouth and throat cancers a year, of which 228,000 (58%) occur in South and South-East Asia.

How do I lower my risk?

• Stop using paan, betel nut, chalia, gutka, naswar and chewing tobacco. There is no safe amount.
• Stop smoking as well. The risks add up.
• Cut down on alcohol, which the NHS lists as a mouth cancer risk factor.
• Protect your lips from strong sun, which raises the risk of lip cancer.
• Go for dental check-ups. A dentist can spot early changes you cannot see or feel.
• Do not let children start on sweetened areca-nut products. IARC notes that children often begin with these and then add tobacco as teenagers.

Is quitting worth it if I have chewed for years?

Yes. WHO and the NHS both list stopping tobacco, betel nut and paan as the main way to lower the risk of mouth cancer, and there is no point at which stopping stops helping. Quitting also ends the daily damage to your teeth and gums.

When to see a doctor

Most mouth problems are not cancer. But the NHS says these changes should be checked by a doctor or a dentist:

• A mouth ulcer that has lasted more than three weeks
• A red or white patch inside your mouth
• A lump inside your mouth or on your lip
• Pain inside your mouth that does not settle
• Difficulty swallowing
• Difficulty speaking, or a hoarse voice that lasts
• A lump in your neck or throat
• Losing weight without trying

Do not wait to see whether it clears up by itself. If you have heavy bleeding from the mouth, or you cannot breathe or swallow, call Rescue 1122 where available, or go to the nearest hospital emergency department.