Source: Boston.com

By: Adi Narayan

MUMBAI — Safiq Shaikh was 13 when he began chewing a blend of tobacco, areca nut, and spices that jolted him awake when his job at a textile loom got too dreary. Five years later, doctors in Mumbai lopped off his tongue to halt the cancer that was spreading through his mouth.

Shaikh believed the fragrant, granular mixture he chewed, known in India as gutka, was a harmless stimulant and at first he ignored the milky lump growing inside his mouth. Now Shaikh is one of about 200,000 Indians diagnosed with a tobacco-related malignancy this year, said his surgeon, Pankaj Chaturvedi.

India now has the highest number of oral cancers in the world, after a group of entrepreneurs known locally as “gutka barons’’ turned a 400-year-old tobacco product hand-rolled in betel leaves into a spicy blend sold for 2 cents on street corners from Bangalore to New Delhi. Sales of chewing tobacco, worth $4.6 billion in 2004, are on track to double by 2014, according to Datamonitor, a branch of the international research firm based in Hyderabad, India.

The combination of tobacco and areca nut makes gutka and its hand-made ancestor, known as paan, addictive, scientists said. Areca nut is the fourth-most commonly used psychoactive substance in the world after tobacco, alcohol, and caffeine, according to the World Health Organization.

“Now you have an industrial version of a traditional thing’’ spurring demand, said Chaturvedi, who works at Tata Memorial Hospital in Mumbai, Asia’s largest cancer treatment center, and draws cartoons to warn of tobacco’s dangers in his spare time. “By the time you are experimenting with this product, you become the slave of the industry.’’

India had almost 70,000 diagnosed cases of cancers of the mouth in 2008, the highest in the world, according to statistics compiled by the WHO’s International Agency for Research on Cancer. The United States had 23,000 cases.

“I have seen many children who started chewing gutka when they were 8 or 10 years old and got cancer in their teens,’’ Chaturvedi said as patients with tubes protruding from their throats and swollen jaws awaited their turn outside his office.

Gutka is sold at street stalls across India in bright rectangular pouches. Once opened, the powder emits a spicy smell. Inside the mouth, it has the consistency of gravel and creates a tingling sensation on the tongue. It’s the abrasion of the mouth’s lining that can accelerate the effect of nicotine and other cancer-causing chemicals, according to Dhirendra Sinha, a technical officer for tobacco control at the WHO’s New Delhi office.

Street vendors crowd around schools, breaking Indian law, which prohibits the sale of tobacco products within 100 yards of educational institutions, said Devika Chadha, a program director at the Salaam Bombay Foundation, a nonprofit organization that works with schools to educate children about tobacco’s dangers.

Manufacturers like to keep gutka’s ingredients a mystery. Rajendra Malu, who owns the brand called “Jhee,’’ said a pouch contains three-fourths areca nut, 12 percent tobacco flakes and proprietary fragrances he won’t disclose.

A chemical analysis of gutka highlighted in a 2008 report from the WHO found that it contains chromium, nickel, arsenic, and lead as well as tobacco-related nitrosamines, all of which are known carcinogens.

Malu estimates he sold 250 million packets last year from his manufacturing plant in the western state of Gujarat. He shrugs at the mention of a link between gutka and cancer.

“I have been chewing tobacco for the last 37 years, and I am not suffering from anything,’’ he said.

While gutka is mostly used in India, Pakistan, Bangladesh, and Sri Lanka, its reach is worldwide because of migration, according to the International Agency for Research on Cancer.”