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Many Indians like to chew paan — meetha or khatta — after a good meal. It aids digestion, freshens the breath and acts as a mild stimulant. The soporific effects of the heavy meal are counterbalanced. Best of all, it is also believed to have aphrodisiac properties when mixed with the right spices in the right proportion. This may be the reason why it is often offered after a traditional wedding feast to the newlyweds and departing guests.
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Paan may be prepared at home or bought from the ubiquitous paan shop. Making a good paan involves smearing mineral slaked lime (calcium hydroxide) on betel leaves, and then adding spices, flavouring substances and pieces of supari or areca nut. After that, the leaf is folded around these ingredients and held together by a clove. Tobacco may also be added. Some habitual paan consumers push the prepared leaf into the cleft between the cheeks and the gums and leave it there. Chewing paan is dangerous, but when the stuff is mixed with tobacco, it is lethal.
Sometimes tobacco may be flavoured and chewed alone without a betel leaf. Such stuff is known by various names such as paan masala and gutka. Pieces of supari may also be sweetened and eaten separately.
Supari, paan and chewing tobacco are often considered harmless and non-addictive. Nothing could be further from the truth. Such stuff suppresses appetite and produces a “high”. What’s more, the nitosamines (cancer causing chemicals found in tobacco, betel leaves and supari) released can precipitate type 2 diabetes.
The lime in paan acts to keep the active ingredients (polyphenols, alkaloids and tannins) in the betel nut in its freebase form. The tobacco contains nicotine and polycyclic aromatic hydrocarbons. Paan may also contain sugar. One of the chemicals in the nut — called arecoline — promotes salivation. This facilitates rapid absorption of this chemical cocktail from under the tongue.
Paan turns the saliva orange red which stains the lips and teeth. Also, the sugar and various other chemicals destroy the enamel of the teeth. They eventually turn black and get ground down to the gums.
The chemicals released while chewing paan irritate the lips and cheeks. They cause changes in the cells, leading them to become precancerous. The lining of the inner cheek turns white (leukoplakia). It may start to bleed or form an ulcer that eats away into the flesh and opens out into the cheek. A tumour may form and protrude into the mouth. As the carcinogen-laden saliva proceeds towards the stomach through the esophagus (tube leading to the stomach), its lining becomes affected and cancer can occur there as well.
Chewing paan is an ancient tradition. The habit leads to cancers of the mouth or esophagus, which set in when the consumer is between 50 and 60 years. Generally, such people also follow an unhealthy lifestyle, a diet with little or no fresh fruits and vegetables, and inadequate exercise. Such cancer is the most commonly diagnosed cancer in males in Assam. For Indian women in general, it is the second biggest reason for cancer. Mouth and esophageal cancer is relatively rare in other parts of the world.
Esophageal cancer is difficult to diagnose in the early stages as the symptoms are often vague and non-specific. Tiredness and fatigue may make the person lethargic. There may be chest pain or unexplained loss of weight which may make the person appear ill. Later, as the tumour grows, it blocks the lumen of the esophagus causing difficulty in swallowing solids.
Treatment of mouth and esophageal cancer involves surgery, radiation and chemotherapy. Stents may have to be placed to prevent blockage. In the case of esophageal cancer, a part of the intestine may be used to replace the esophagus. Sometimes a feeding tube may have to inserted through the stomach to bypass the esophagus. Treatment is expensive and long-drawn. Results are fairly good if the ailment is diagnosed early. Unfortunately, this is often not the case.
An expert committee formed by the government in September 1997 recommended a blanket ban on the manufacture, distribution and sale of all forms of chewing tobacco like paan masala, gutka and zarda. Unfortunately, supari was left out of the committee’s purview. However, despite legislation these products are openly sold. What’s worse is that teenagers too are becoming addicts.
The government has been dragging its feet over enforcing legislation to regulate use of these carcinogenic and addictive products. This is partly because the paan, supari and zarda industries collectively employ over 50 million people in its raw material procurement, manufacture and distribution networks. These people constitute a large vote bank which successive governments are reluctant to lose. But this is a very dangerous situation for millions and millions other common people.
The choice is therefore yours — a healthy and happy life or harmful substances that may lead to cancer.
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Cultural Aspects of Smokeless Tobacco Use and the Impact of Chewing Pan Masala in the Oral Cancer Scenario :
Source: The Telegraph (Kolkata, India)