Islamabad: International cancer research and clinical evidence show that paan prepared with areca nut (chalia or supari), lime (chuna) and catechu (katha), with or without tobacco, is a proven risk factor for oral and throat cancers, with South Asia bearing a disproportionate share of the disease burden.
A population based analysis published in The Lancet Oncology estimates that more than 120,000 oral cancer cases diagnosed globally in 2022 were attributable to smokeless tobacco and areca nut use, accounting for around one third of all oral cancer cases worldwide. The study identified South and Southeast Asia as the regions with the highest number of cases linked to these products, with lower middle income countries carrying most of the burden.
The findings have gained renewed attention after the federal health minister Syed Mustafa Kamal recently stated that gutka causes cancer while paan is a safer alternative. Public health specialists and clinicians say this distinction is misleading because the core ingredient of paan, areca nut, is itself carcinogenic and widely consumed in Pakistan in various chewable forms.
An oncologist at a major public sector cancer hospital in Karachi said that cancers of the mouth, tongue and throat seen in clinics are frequently linked to long term use of gutka, paan, chalia and related chewable products. “Many patients believe that shifting from gutka to paan reduces their risk, but medically that is not correct. Areca nut is not a harmless mouth freshener and causes chronic injury to the oral lining,” the specialist said.
An ENT surgeon at a large teaching hospital in Karachi said outpatient departments are increasingly seeing young adults with pre cancerous lesions and restricted mouth opening linked to habitual paan and chalia use. “We are seeing oral submucous fibrosis and suspicious lesions at an age when people should not be developing such problems. These are conditions that significantly raise the risk of oral cancer,” the surgeon added.
The World Health Organization’s cancer research arm, the International Agency for Research on Cancer, has classified areca nut as carcinogenic to humans. Doctors explain that repeated chewing of areca nut mixed with lime causes long term inflammation and scarring of the inner lining of the mouth. Over time, this damage can progress to oral submucous fibrosis, a painful and disabling condition known to markedly increase the risk of cancer of the mouth and throat.
Research from Pakistan has also shown that paan without tobacco is not safe. A large Karachi based study found that people who chewed paan without tobacco had a significantly higher risk of developing oral cancer compared with non users, while paan with tobacco further increased the risk.
Public health specialists warn that messaging which presents paan as a safer substitute for gutka can create a false sense of security and weaken anti tobacco campaigns. They say awareness efforts should clearly state that no form of smokeless tobacco or areca nut based chewing product is safe for long term use.
In Pakistan, despite bans on gutka in some provinces, enforcement remains uneven, while paan and chalia continue to be widely available and socially accepted. Health professionals say the country needs a comprehensive national approach to discourage all forms of smokeless tobacco and areca nut use, backed by regulation of sales, sustained public education and routine oral screening of high risk groups to curb the growing burden of oral cancer.
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