Every year, World No Tobacco Day brings familiar warnings about cigarettes, cancer, and the dangers of nicotine. But, behind those warnings lies a reality that often goes unnoticed. Tobacco-related diseases do not always arrive dramatically. They build slowly, silently, and sometimes over decades.A persistent mouth ulcer that refuses to heal. Breathlessness that feels like aging. A cough dismissed as seasonal. A small white patch inside the cheek that does not hurt at all.Doctors say these are often the moments where lives could change course, if only people paid attention.According to the World Health Organization, tobacco use causes nearly 1.35 million deaths every year in India. The country is also home to around 267 million adult tobacco users, making it one of the largest consumers of tobacco globally.The numbers are staggering, but experts believe the deeper concern is how normalised tobacco has become across generations.
The cancer burden nobody talks about enough
For oncologists, the connection between tobacco and cancer is not an abstract statistic. It is visible every day in hospital corridors and operating rooms.“A quieter epidemic is still an epidemic. This is the generation that can end it,” says Dr. Shabber Zaveri, Chairman, HOD, and Consultant in Surgical Oncology & Robotic Surgery at Manipal Hospital Old Airport Road.“While we should keep up the important work of stopping the new generation from tobacco abuse, we also owe something to the people already affected, those still using and those living with the consequences of its exposure. The good news is, it is not too late for many of them. That part of the effort deserves equal focus,” he says.What makes tobacco-related cancers particularly tragic is that many are preventable.Dr Shailesh V. Shrikhande, Chief Executive of Tata Cancer Care Foundation, says the problem extends beyond health.“As a surgical oncologist, I have spent decades treating cancers that are, to a large extent, preventable. Tobacco continues to remain the leading cause of cancer in India, accounting for nearly 27% of all cancers, while also contributing significantly to other non-communicable diseases such as heart disease.”He adds that the economic damage is equally alarming.“WHO estimates suggest India loses nearly 1% of its GDP to tobacco-related diseases and premature deaths, making this not just a medical challenge, but a major social and economic concern.”
The five-minute check that could save a life
One of the most dangerous myths around cancer is the belief that it appears suddenly.Doctors say that is rarely true.Many oral cancers are preceded by warning signs that may exist for years before becoming life-threatening.Dr Zaveri explains that precancerous lesions such as leukoplakia, erythroplakia, and oral submucous fibrosis often appear long before cancer develops.“Catching it early is not optional, but essential. Early detection dramatically improves survival outcomes, treatment efficacy, and reduces burden.”He stresses that a simple oral examination performed by a trained clinician can identify many abnormalities before they become cancerous.“A simple oral examination by a trained clinician can be life-saving. Tobacco users should undergo screening at least once a year.”The challenge, however, is that many people ignore symptoms because they are painless.A white patch inside the mouth. Difficulty opening the jaw. Burning sensations while eating spicy food. A recurring ulcer.These signs are often brushed aside until the disease has progressed.
On World No Tobacco Day, experts are urging people to rethink not just smoking, but every form of tobacco and nicotine use, including chewing products, vaping, and e-cigarettes.
The dangerous myth of “safer” tobacco
Over the past few years, many users have shifted from cigarettes to chewing tobacco, flavoured nicotine products, vaping devices, and e-cigarettes believing they are making a healthier choice.Cancer specialists say this assumption is deeply misleading.Dr Saadvik Raghuram Y, Director – Medical Oncology & Hemato-Oncology at CARE Hospitals, says one misconception repeatedly surfaces in clinics.“Patients often say they stopped smoking cigarettes and moved to gutkha, paan masala, or flavoured chewing products because they thought these were a safer alternative. Unfortunately, that is not how cancer risk works.”He explains that the tissues inside the mouth remain exposed to carcinogenic substances through repeated use.“Many patients are surprised to learn that some of the oral cancers diagnosed today occur in individuals who have not smoked but have a long history of chewing tobacco or areca nut-based products.”He is equally concerned about vaping.“A similar misconception is increasingly being seen with vaping and e-cigarettes, where some individuals assume these products are harmless or significantly safer.”From an oncology perspective, he says, switching products often changes the form of exposure rather than removing the risk itself.The concern is echoed by pulmonologist Dr Anjali R Nath from HOSMAT Hospitals.“In respiratory practice, there is a growing tendency among some users to view vaping or alternative nicotine products as a complete escape from the harms associated with smoking.”She says many users continue smoking occasionally even after switching to vaping.“The lungs are still being exposed regularly and the nicotine dependence often continues.”Perhaps the biggest problem, according to respiratory specialists, is the false sense of security these alternatives create.“The focus frequently shifts from cessation to substitution. From a respiratory health standpoint, the goal should be reducing dependence itself rather than repeatedly moving between products that keep the cycle of nicotine use active.”
From rising oral cancers to nicotine addiction among younger generations, this story explores what doctors are witnessing inside clinics, why early screening can save lives, and how breaking nicotine dependence remains one of the most powerful health decisions a person can make.
Why quitting feels so difficult
Many people still view tobacco addiction as a question of willpower.Experts say science tells a different story.According to Dr Zaveri, nicotine is as addictive as heroin.“The nicotine present in tobacco releases dopamine in the brain’s reward centre, creating powerful feelings of pleasure, alertness, and excitement.”Over time, the brain begins to depend on those dopamine spikes.That is where the struggle begins.Ms Bincy Mathew, Psycho Oncologist and Tobacco Cessation Expert at Manipal Hospitals, says the psychological grip of tobacco is often underestimated.“The physical dependence on tobacco is real, but the psychological hold is equally powerful. Quitting means fighting both at once.”One technique she frequently teaches is called “urge surfing.”“It is a technique where tobacco users learn to observe a craving like a wave. It rises, peaks, and falls, typically within 20 minutes, whether they use tobacco or not.”Instead of fighting the craving, people are encouraged to observe it, breathe through it, and allow it to pass.“Repeated practice weakens the craving response over time, rewiring the brain’s relationship with tobacco.”She also reminds users that withdrawal symptoms are temporary.“Withdrawal is not a crisis. It is chemistry.”Research shows withdrawal symptoms usually peak around the third day after quitting and gradually improve over the following one to two weeks.To manage cravings, she recommends what she calls the “Four D’s” deep breathing, distraction, delaying techniques, and drinking water.“Each one targets a different part of the craving response and gives people a practical toolkit they can use immediately.”
A generation that can end the cycle
World No Tobacco Day is often framed as a campaign against cigarettes. But doctors say the conversation needs to become much broader.It is about protecting children from nicotine addiction before it begins.It is about helping long-term users access treatment without judgment.It is about recognising that gutkha, paan masala, smokeless tobacco, vaping products, and e-cigarettes are not harmless alternatives.Most importantly, it is about understanding that prevention remains more powerful than treatment.Dr Shrikhande warns that nicotine addiction is increasingly being repackaged for younger users.“What is particularly worrying today is how nicotine addiction is being repackaged for a younger generation through sleek, easily accessible products like e-cigarettes and synthetic nicotine devices that are often perceived as safer alternatives.”“In reality, these products risk normalising addiction early and obscuring the long-term health consequences associated with nicotine dependence.”The message from cancer specialists, psychologists, and lung experts remains remarkably consistent.The goal is not to find a safer tobacco product.The goal is to break free from tobacco altogether.Because the most powerful health decision is not switching products. It is ending the dependence that keeps them all connected.Medical experts consultedThis article includes expert inputs shared with TOI Health by:Dr Shabber Zaveri, Chairman, HOD, and Consultant in Surgical Oncology & Robotic Surgery at Manipal Hospital Old Airport Road.Ms Bincy Mathew, Psycho Oncologist, and tobacco cessation expert at Manipal Hospitals, Old Airport Road.Dr Saadvik Raghuram Y, Director – Medical Oncology & Hemato-Oncology, CARE Hospitals, Banjara Hills, Hyderabad.Dr Anjali R Nath, Pulmonologist, Department of Pulmonology & Chest Medicine – HOSMAT Hospitals.Dr Shailesh V. Shrikhande, Chief Executive, Tata Cancer Care Foundation, seeded by the Tata Trusts.Inputs were used to examine how tobacco continues to fuel preventable cancers and chronic diseases, why many warning signs are overlooked, and what individuals can do to break nicotine dependence.
