An alarming study from Karachi has revealed that up to 42 percent of women aged 30 to 45 regularly consume smokeless tobacco products like gutka and paan — a dangerous trend that is now fueling Pakistan’s exploding burden of head and neck cancers.
The data paints a grim picture of how cultural habits, unchecked addiction, and policy inaction are feeding a preventable public health catastrophe across the country. According to the Global Cancer Observatory, Pakistan reported over 185,000 new cancer cases and 118,000 cancer-related deaths in a single year.
Among them, head and neck cancers—primarily cancers of the oral cavity, pharynx, and larynx—now make up roughly 21 percent of all male cancers and 11 percent among women. These numbers are no longer just statistics as they reflect a crisis being fed by easily available, socially accepted carcinogens like gutka, betel nut, naswar, and paan.
Experts believe one in every five adults in Pakistan regularly uses smokeless tobacco as these substances are cheap, unregulated, and sold freely in colorful sachets across every street corner and general store. While traditionally associated with men, their growing use among urban women has shocked health experts.
Karachi’s rising trend among females has raised the alarm that the gender gap in tobacco-related cancer risk is quickly narrowing. Once considered a male-dominated behaviour, smokeless tobacco use is becoming increasingly normalized among younger and middle-aged women, particularly in low-income neighborhoods.
Oral cavity cancer is now the most common cancer among men in the country, accounting for about 12 percent of male cases. Lung cancer remains among the top five, but the tobacco-induced damage to the head and neck is spreading faster and hitting harder.
Between 2021 and 2024, the Aga Khan University Hospital (AKUH) diagnosed and treated 2,101 patients with head and neck cancers—78 percent of them male—reinforcing the gendered but shifting landscape of this public health emergency.
The carcinogenic properties of these products are well known, yet the substances remain largely unregulated. Public health campaigns have failed to confront the cultural normalization of gutka and paan.
Their use is often brushed off as tradition or dismissed as harmless, especially when compared to smoking, despite scientific evidence proving their lethal potential. Many users are unaware of early warning signs like persistent mouth ulcers, difficulty in chewing or swallowing, or restricted mouth opening. As a result, diagnoses are often delayed until the cancer has advanced, making treatment more invasive, costly, and less effective.
Dr. Yasmin Rashid, assistant professor at the AKUH’s Department of Oncology, attributes this delay to low awareness, limited trust in formal healthcare systems, and widespread reliance on traditional healers. Poverty, illiteracy, and stigma surrounding cancer only worsen the situation, pushing patients into silence and suffering.
Pakistan’s cancer care infrastructure remains dangerously underprepared for the rising tide. With only around 260 certified oncologists serving a population of over 229 million, the country has roughly one oncologist for every 880,000 people.
Radiation therapy—an essential treatment modality—is available at only 37 hospitals across the country. Patients in remote and underserved areas have little to no access to timely, specialized care, leaving them with fewer chances of survival.
Even those who make it to a hospital often struggle to afford treatment. Surgery, chemotherapy, and radiation are financially out of reach for many. In some cases, institutional support steps in.
One such case is Bilal, a 45-year-old resident of Lyari, who developed tongue cancer due to years of gutka use. By the time he sought help, the disease was already in an advanced stage. Supported by the Patients’ Behbud Society at AKUH, he completed treatment and has since become a vocal advocate against smokeless tobacco in his community.
But such success stories are rare, and for every patient who receives help, many more fall through the cracks. Experts warn that without bold policy shifts, increased investment in cancer prevention, and strict enforcement of tobacco control laws, the crisis will deepen. Public awareness campaigns must be launched at scale.
They say schools should be equipped with health education programs that address the dangers of smokeless tobacco. Survivor-led advocacy and peer education can play a transformative role in changing public perceptions and encouraging early consultations.
Experts say cancer epidemic is expanding, both geographically and demographically. Pakistan stands at a critical juncture: it can either confront the toxic gutka culture head-on or continue to let lives be lost to an entirely preventable killer.
