World No Tobacco Day: In Pakistan, the cancer continues to spread

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KARACHI: Farhan, 32, has lost his father and his grandfather to cancer. Both died in their early 50s. Despite this, Farhan smokes nearly two packets a day. “I started when I was barely 13. It was just about being part accepted into the group,” he recalls. “From a cigarette or two I didn’t even realise when I hit the two-packs-a-day mark.”

The National Health Survey of Pakistan says there are 30 million smokers in the country, nearly half of whom are 25 to 44 years old. In Pakistan, smoking mostly leads to cancers of the oral cavity, voice box, lungs and upper digestive tract. “You do not see many oral cancer cases in developed countries any more but it is  tenfold and creating havoc in the sub-continent,” says Dr Sameer Qureshi, who is an associate professor for ear, nose and throat and head and neck surgery at Jinnah hospital.

Smoking in public eating places is partly to blame. Professor Javaid Khan at the Aga Khan University Hospital (AKU) studied this. According to his findings, tobacco smoke pollution in cafes, restaurants and food courts in Islamabad, Rawalpindi and Karachi is extremely high.

Tobacco smoke pollution levels are assessed by measuring pollutants in the air, particularly fine particles called PM2.5. In non-smoking venues, the average PM2.5 value was 101 micrograms per square metre (ìg/m2), in hotels and restaurants it was six times higher and in sheesha-smoking places it was 1,745 ìg/m2. Under WHO guidelines, they can’t be over 250 ìg/m2.

First, we need an immediate ban on these imports. Second, we need a pictorial awareness and education campaign that doesn’t just target doctors.

Qureshi advises people who smoke, chew tobacco or eat chalia and gutka to seek help when they notice any small ulcer, feel the slightest irritation or see a discolouration. Qureshi has encountered people who have been told by hakeems that if they let any metal touch their ulcers it will result in cancer. Thus, many of them avoid biopsies which is essential to determine cancer.

Raising taxes will raise tobacco prices 10 per cent and would hopefully lower buying by eight per cent in low- and middle-income countries, says Ziauddin University’s Dr Abbas Zafar. The Sindh Assembly recently banned sheesha smoking. As a result, Empress Market shops have been opening early and selling hookahs at double the price. “Since the ban was passed on sheesha use in public places, people have started buying them for their homes,” said a shopkeeper. The small hookahs used to cost Rs500 but are going for Rs1,500 and people are willing to pay.

According to a survey by Prof. Rehana Anees Yakoob, a psychologist and family counsellor at the Karwan-e Hayat psychiatric facility under the management of the Karachi Port Trust, every single drug user interviewed said that they began with cigarettes.

Meanwhile, Farhan who is expecting a son, says he will quit soon. “I want to be around for my boy and certainly do not want him to smoke, at least not as much as I do.”

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