57-year-old Jyoti had a close brush with oral cancer six years ago and survived to tell the tale. Jyoti recalled that she picked up the betel nut habit from her parents at a young age. “Many people chewed it all the time, even my mother. We children always copied what the elders would do. So by age 17 or18, I was chewing betel nut whenever I was bored,” she explained.

Betel quid chewing (called supari in some places in India) is an old practice in the subcontinent and many parts of Southeast Asia. It is widespread, has religious significance in some places, and even perceived health benefits in others. India sees many cases of addiction to betel quid, inadvertently making it acceptable among all sections of society, including women and children. This problem is so pervasive that the World Health Organisation (WHO) and the International Agency for Research on Cancer classified betel nut as a group 1 human carcinogen, making it extremely urgent for healthcare professionals to educate the public about the harmful effects of betel quid.

At an outreach dental camp organised by Biocon Foundation, Jyoti and her daughter Pallavi were examined for common oral health problems. What they found startled them. Dr Praveen, the dental surgeon at the clinic, said, “She had no known medical history. After a lot of questioning, she revealed that she been chewing betel quid for the last 30 years – in the morning and after meals. On examination, she was diagnosed with oral pre-cancerous lesions on her inner cheeks.” A biopsy confirmed the diagnosis.

Pallavi said, “You never think it will happen to you or your family. I wanted to cry, but the doctor told me we had caught it early. Pre-cancerous, he called it. With some strict changes, amma could still be okay.”

Jyoti was advised to quit betel nut. She said, “It is a 30-year-old habit. How is one supposed to give it up in one day? I told them it was not possible. But they didn’t listen.” Pallavi recalled, “Amma tried for a few days but became very short-tempered. She started complaining of headaches and had to be taken to a doctor who said she had high BP. Her headaches and restlessness did not go away until she was given betel nut again.

At the follow-up consultation six months later, Jyoti was provided counselling on her habits and its serious repercussions. She was asked to continue the medication three more months, and given her dependency, was monitored closely for another six months. She was under rigid follow up. Because of her awareness of the condition, her compliance for follow up was good.

Dr Praveen said, “Since we are struggling with de-addicting the patient, we are closely monitoring her for any intra-oral changes. Areca nut chewers are very innocent and are unaware of the negative consequences.” Dr Sanjana of Biocon Foundation explained, “It is important to focus on socially accepted habits along with tobacco products in line with patient needs and their perspective. This case has been a learning for us – six years of following up on the dependence of the patient on a habit affecting her general physical health, and her struggle to change that life-long habit. Given such circumstances, our community health workers play a vital role in monitoring such patients and our doctors provide timely referral.”