Karachi: A startling study revealing that up to 42 percent of women aged 30 to 45 in Karachi regularly consume smokeless tobacco products such as gutka and paan has triggered alarm among public health experts, who warn that such habits are directly fueling Pakistan’s growing epidemic of head and neck cancers.
The study, highlighting an alarming trend among urban women, has shed new light on the depth of cultural entrenchment of smokeless tobacco use in Pakistan—where nearly one in five adults across all socioeconomic backgrounds routinely consume gutka, paan, naswar, or betel nut.
Experts say this widespread use is a key driver behind the country’s rising burden of oral cancers, which now account for some of the most common and deadly forms of the disease.
According to the Global Cancer Observatory, Pakistan records more than 185,000 new cancer cases and 118,000 cancer-related deaths annually.
Head and neck cancers, which include malignancies of the oral cavity, pharynx, and larynx, make up 21 percent of all cancers in men and 11 percent in women. Oral cavity cancer alone has become the leading cancer among Pakistani men, accounting for 12 percent of male cases.
Lung cancer remains among the top five, but it is smokeless tobacco that is increasingly being blamed for the majority of preventable cancers in the country.
Health experts estimate that up to 90 percent of oral cancers in Pakistan are directly caused by the use of smokeless tobacco products. These items are easily accessible, cheap, and marketed without significant health warnings. More troubling is their deep-rooted social acceptance, which has allowed them to be normalized across generations, even as cancer cases rise in both urban and rural settings.
Between 2021 and 2024, the Aga Khan University Hospital (AKUH), one of the country’s leading tertiary care institutions, diagnosed and treated 2,101 patients with head and neck cancers.
An overwhelming 78 percent of those were men, underscoring a longstanding gender pattern in tobacco use. But the Karachi study suggests the gap may be narrowing, particularly among younger urban women who are now developing the same risky behaviors, often under the misconception that these substances are harmless.
Despite the well-documented carcinogenic properties of gutka, betel nut, naswar, and paan, public awareness remains dangerously low. Many people do not recognize early warning signs such as persistent mouth sores, unexplained oral bleeding, or difficulty opening the mouth. As a result, patients often seek treatment only after the disease has advanced.
Dr. Yasmin Rashid, Assistant Professor at the Department of Oncology at AKUH, noted that delays in diagnosis are frequently due to low health literacy, poverty, mistrust in hospitals, or reliance on traditional healing methods.
In one such case, Mr. Bilal (name changed), a 45-year-old resident of Lyari, was diagnosed with tongue cancer after prolonged gutka use. By the time he reached a hospital, his cancer had already progressed to a critical stage.
With the help of the Patients’ Behbud Society at AKUH, he underwent surgery, chemotherapy, and radiation. Today, he is cancer-free and works to raise awareness in his community about the risks associated with smokeless tobacco.
Pakistan’s healthcare system is under immense strain in addressing the growing cancer burden. The country has only about 260 certified oncologists to serve a population of over 229 million—roughly one for every 880,000 people.
Access to radiation therapy, a key component of cancer treatment, is also limited to just 37 hospitals across the country, making it inaccessible for many patients, especially those living in rural and underserved regions.
The high cost of treatment poses yet another challenge. Many families are unable to afford prolonged cancer care, often forcing patients to forgo treatment altogether. While philanthropic programs like the Patients’ Behbud Society have stepped in to fill some of the gaps, the scale of the crisis demands systemic policy change.
Experts are calling for urgent nationwide interventions. These include stricter regulations on the manufacturing and sale of smokeless tobacco products, large-scale public awareness campaigns, school-based health education, and widespread cancer screening services.
There is also a strong push for community-based advocacy efforts, led by survivors and peer educators, to challenge social norms and encourage early health-seeking behavior.
The link between smokeless tobacco and cancer in Pakistan is no longer a hidden truth. It is a public health emergency unfolding in plain sight. With women now increasingly at risk—as the Karachi study starkly illustrates—the urgency to act has never been greater.
Without decisive action, the country will continue to lose thousands of lives each year to a crisis that is both preventable and profoundly tragic, experts warn.
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