Consumption of tobacco products, primarily in the form of smoking is one of the leading causes morbidity and mortality in India and worldwide. Over 90% of preventable cases of oral cancer in India are attributed to tobacco usage in some form. Tobacco abuse affects almost all the organs and tissues causing morbidity and premature deaths. The major sites affected in the body include cancer of mouth and lungs. The direct and indirect tobacco-illness and deaths rates are rising at an alarming rate.

Tobacco is one of the major causes for preventable and premature deaths globally. According to the recent reports provided by World Health Organization (WHO), Past five year data suggest that over 22.58 lakh patients are already battling between life and death, suffering from some form of cancer.  India accounts to 20% of the global morbidity rate due to tobacco consumption.

As per the recent data provided by Globocon 2018 India fatchsheet, around 11.57 lakh new cases of cancer were registered last year. Out of which 5.7 lakh were males and 5.8 lakh were females. The mortality rate accounted for over 8 lakh cases that lost their lives were fighting against some of cancer.

Among the most preventable cases of cancer in India last year includes cases of Oral, oesophageal, pharynx, larynx, salivary glands and lung cancer. With oral cancer having the maximum number of cases registered in 2018, chewable tobacco and smoking both equally attributes to the number of cases. Around 3 lakh cases of oral and digestive tract cancer have been registered in India last year accounting for a mortality rate of 12%. As most of these conditions are preventable, immediate cessation of smoking (tobacco products) and chewing tobacco will help to curb down the burden of cancer cases caused due to tobacco consumption.

Tobacco Harm reduction strategy – ENDS

E-Nicotine Delivery System (ENDS) or commonly known as vapes, are one of the recently trending products which in some countries have been introduced as a tobacco harm reduction strategy. According to several studies conducted by Public Health England (PHE), vapes have been proven to be at least 95% less harmful than conventional cigarette smoking. ENDS also remain a good way to communicate the large difference in relative risk unambiguously so that smokers are encouraged to make a switch from smoking to vaping.

ENDS- a misconception among Indians

Though accepted throughout UK and US, misconceptions related to the use of Vapes instead of conventional cigarettes are high and are considered to be equally harmful. ENDS contain heated nicotine content from heated tobacco, variety of flavours and other additives. These are the devices that heat a solution to create an aerosol (Contains Nicotine), which frequently has flavours usually dissolved in Glycol or Glycerin. The main constituents of the solution, in addition to nicotine are propylene, glycol, with or without Glycerin and other flavouring agents.

Nicotine is one of the harmful agents present in the tobacco that leads to addiction. Most of the smokers trying to quit are recommended for Nicotine Replacement Therapy (NRT) that curbs down the urge to smoke and gradually quit. The therapy provides nicotine in the form of gums, patches, sprays eliminating the other carcinogenic products present in a conventional cigarette or any tobacco product. Though this therapy is widely accepted and practised in India, but various major health organisations in UK and other developed countries prefer a better ‘tobacco harm reduction strategy, commonly known as e-cigarettes.

The American Cancer Society has issued a statement that the use of e-cigarettes is less harmful than smoking conventional cigarettes. The study further elaborated that despite the clinical advice to quit smoking and follow cessation medications, 85% of the smokers did not adhere to it. While in such cases the only option left is to reduce the harmful effect of the carcinogenic compounds present in the tobacco products.  Thus, smokers should be encouraged to switch onto e-cigarettes over continuation of smoking combustible tobacco products.

How ends less harmful than Tobacco smoking?

Conventional cigarettes involve combustion that generates significant levels of tar, Carbon monoxide and other carcinogenic compounds which is not present in the e-cigarettes and ENDS. Second-hand smoking or passive smoking increases the risk of developing Cancer by around 25-30% same as the level of a smoker, but also elevates risk of other serious ailments like respiratory infections, asthma, ear infections etc. Vaping products on the other hand do not result in nicotine delivery and as a result do not generate harmful toxins at the level of conventional cigarettes.

How ENDS helps in quitting smoking?

E-cigarettes present an equal and viable option to significantly decline the smoking rates which gradually will curb the morbidity and mortality caused due to it. Electronic cigarettes contain less harmful toxins than tobacco products and smokers trying to quit smoking are advised to discuss the methods to control the urge and alternatives which are less harmful with the specialists.

Many medical practitioners have always supported smokers in their efforts to quit smoking regardless of the approach giving their mental and physical well-being paramount importance. Though it is observed that many smokers are now increasingly switching to vaping products to quit smoking or to reduce harm done by same, it is recommended that the best option is to quit smoking altogether and use available cessation products coupled with behavioural counseling. But if a smoker finds it tough then should start using vaping products to avoid the harm caused by combustible cigarettes.

About the author- Dr Sameer Kaul, Sr Consultant Surgical Oncology & Robotics,

President, bcpbf-The Cancer Foundation