GPs must try to help patients give up smokeless tobacco products to reduce oral cancer

BMJ 2012; 345 doi: (Published 27 September 2012) Cite this as: BMJ 2012;345:e6535
  1. Ingrid Torjesen
  1. 1London

The National Institute for Health and Clinical Excellence (NICE) has published final guidance for tackling the use of smokeless tobacco products, particularly in South Asian communities.

Smokeless tobacco products, such as paan, gutka, shupari, and betel quid, are often seen as healthy or beneficial within these communities but are associated with serious health and dental problems, including oral cancer, heart attack and stroke, and problems in pregnancy.

Use of smokeless tobacco products is considered the main reason why South Asian women are nearly four times more likely to develop oral cancers than women from other ethnic groups in England. Older women of South Asian descent are most likely to use it, but in some parts of the UK a high percentage of young South Asians are also users.

The NICE public health guidance1 published on 26 September recommends that a range of services are commissioned to help South Asian people stop using smokeless tobacco in areas where its use is prevalent, and that these services should be integrated with other tobacco control, prevention, and cessation activities as part of a comprehensive local tobacco control strategy.

As with smoking, doctors should record in their notes whether patients use smokeless tobacco products, along with the patient’s response to any attempts to encourage or help them to quit, the guidance says. Doctors, dentists, and other health professionals, including pharmacists, should also receive training in the risks of smokeless tobacco, how it is used locally, and what it is called within the community. This training should enable practitioners to recognise the signs of smokeless tobacco use and ensure that they can deliver a brief intervention and refer people to appropriate services if they want to quit.

Meanwhile, health promotion materials for users should include the names of smokeless tobacco products that people are familiar with locally, provide information about the risks of smokeless tobacco, and challenge the perceived benefits, such as easing indigestion or dental pain, and freshening the breath.

Mike Kelly, director of the NICE Centre for Public Health Excellence, said: “This guidance is an important opportunity to highlight the range of serious health risks associated with smokeless tobacco products, such as paan or gutkha, which are used by some people of South Asian origin. Often the people using these products aren’t aware that they contain tobacco, nor that they could be at greater risk of oral cancers or cardiovascular disease.

“There’s also low awareness of the health problems caused by these smokeless tobacco products within mainstream NHS services. We hope that this guidance will inform health professionals of the risks posed by these products, so they can take action by asking patients of South Asian origin if they use smokeless tobacco, making sure they are aware of the health risks, and where appropriate referring people for support to help them stop using these products.”


Cite this as: BMJ 2012;345:e6535