Dentists may be facing bigger in Pakistan in war against oral cancer

With Pakistan displaying one of the highest rates of oral cancers in the region, the role falls on the dental surgeons to actively address this crisis. An initial step in the form of WHO National Coalition against Oral Cancer carried out on 18th August 2013 has set the pace for the cause. However, much still needs to be done.

Pakistan lacks proper infrastructure for diagnosis or oral histopathologies. Some recent positive changes were launch of Pathodont by Dr Joharia Saadat, who pioneered salivary diagnostics in Pakistan. On the ground level, dedicated oral histopathology labs are still missing. For initiatives such as this coalition by Dr Arif Alvi to succeed, infrastructure and strong health-government dialogue needs to be established.

Unfortunately, the role of government still seems to be missing in this growing epidemic. This was discussed in Lahore during a symposium held by Department of Oral and Maxillofacial Surgery, Mayo Hospital, Pakistan Association of Oral and Maxillofacial Surgeons, Pakistan Society of Oral and Maxillofacial Pathology and Pakistan Dental Association in January, 2014. The experts stated that while the government has been actively carrying out anti-narcotics drive, the same cannot be seen for tobacco, gutka, paan and chalia, which are causing such high rates of oral cancer in the country.

One factor may be the amount of revenue the government raises from companies making cigarettes and similar tobacco products. In the first quarter of 2014 alone, the Federal Board of Revenue received over Rs 17 billion FED, sales and income tax from a leading cigarette manufacturer, whopping 21 percent increase from the results obtained at the same time last year. Last year revenues obtained from the tobacco industry amounted to Rs. 76 billion in the form of taxes. Some of the biggest players include Pakistan Tobacco Company, British American Tobacco Company and John Player Gold Leaf to name a few.

This however refers only to the legal trade of tobacco. Leading tobacco companies in Pakistan claim the legitimate producers have lost over Rs. 80 billion to illicit trade during the past five years. This means that the market is even larger than that reported by the legitimate corporate factoid sources. Other sources of tobacco are direct from the farms or small industries producing cheaper forms of cigarettes, pans, chalia or gutka.

The current capacity of the 15 cigarette manufacturing factories is 96.187 billion cigarette pieces per annum of three shifts. Of these ten are located in Khyber Pakhtunkhwa, one in Sindh and 4 in Punjab respectively.

Here the role of dental surgeons and health professionals comes into play. There is lack of coordinated, well thought out and consistent public interaction, public awareness campaigns, and health campaigns by dental surgeons. As Dr Zahid Pervaiz in the symposium emphasized, there is a need to increase among the general public about this cancer and the causative agents leading to it.

The recent sheesha and smoking ban with a Rs. 50,000 fine is one step by the government to discourage use. Alongside Senior Minister for Education and Literacy Nisar Khoro has banned smoking at all schools, colleges and universities of Sindh. These steps must be appreciated and the government encouraged taking up stricter measures.

The problem may not resolve here. The tobacco farming industry in Pakistan is another reason why reduction let alone elimination of tobacco smoking may not be easy. This industry currently is a significant contributor to the economy of Pakistan with over 10 million people in direct farming of the product. Luckily or ironically, Pakistan is the only country having the only crop of tobacco yielding 2097 Kgs/hector which is 20% above the world average of 1752 Kgs/hector. Pakistan currently stands at tenth position in the world in terms of tobacco cultivation area at 0.514 million hectares.

The economic perspectives and insights reveal the tremendous task that dental surgeons and doctors’ face in trying to rid the nation of tobacco smoking and chewing habit. With the incidence as high as 40 percent, children are next in getting oral cancers.

Unless the government takes serious economic decisions and impose bans on the production of tobacco products and growth in the country, the battle for oral cancer may be a very distant reality.