The challenge of oral cancer

An 'organized' corruption from top to bottom in the import and trade of betel nuts and other by-products is said to have triggered Oral Cavity Cancer (OCC) epidemic in Pakistan. Following the non-existence of any national level cancer registry programme, there is no updated information about the number of OCC patients in Pakistan but this correspondent through interviews, hospitals' websites, research journals & institutional databases has made an attempt to depict how the menace of corruption in the import and sale of betel nuts and other by-products has made OCC a widespread pathological killer in the country.
Although the betel quid (Pan) is a socially and culturally supported habit in Pakistan, majority of lower, middle and upper-middle class population is now switched to other chewing tobaccos during last one and a half decades, due to financial constraints.
These chewing tobaccos - Gutka, Mainpuri, Mawah, Panparag, etc, are manufactured with inferior quality betel nuts to make it affordable for these segments of Pakistani society. In 2001, the customs department under civil society pressure had completely banned betel nuts import but the decision was challenged in the court and later it was reversed in July 2004 with some clarifications.
Commenting on it, Dr Mubarik from Department of Plant Protection (DPP) said prior to the restriction on betel nuts import; the DPP certificate was mandatory for the clearance of its consignments. However, this requirement was omitted through amendments to import policy in 2004 and since then, only Phyto-sanitary certificate from the exporting country is required for its import. Resultantly, inferior quality betel nuts are being imported with impunity. Meanwhile, customs department shrugged the responsibility, claiming that examiners inspect betel nut consignments with naked eye and if infestation is found the consignment is rejected.
The department was of the view that clearance of betel nut consignments was subjected to the Phyto-sanitary certificate issued by Quarantine Department of the exporting country. However, the customs department has no mechanism to verify the veracity of Phyto-sanitary certificate from exporting countries, following the myriad volume of such documents.
The inability of the customs department what the sources said being exploited by the importers, getting cleared the betel nut consignments, which are unfit for human consumption, on fake documents. Needless to mention, Former Director General Pakistan Council of Scientific Industrial Research (PCSIR) Dr Zuzzer Ali Shamsuddin and his colleagues conducted research study on betel nuts imported to Pakistan.
He and his team during study detected high value of Aflatoxin B1 (AFB1), a substance that develops cancer, in betel nut consignments imported to Pakistan. The research found AFB1 in betel nut consignments imported to Pakistan with the range 3.3-262.0 µg per kg and a mean value of 13.1 µg per kg. AFB1 contamination in all positive betel nuts samples was higher than the ML of 2 µg per kg as set by the European Union. Thus, AFB1 level in betel nuts samples imported from South Asian (India, Indonesia, Sri Lanka and Thailand) countries currently present a potential risk to human heath.
Insiders in customs department claim that department was hand in glove with clearing agent of betel nut consignments and had established a pool to collect 'speed money' for the clearance of substandard quality of betel nuts. The speedy money is later distributed among customs and its subdivisions - Examination, Appraisement and Custom Intelligence Department.
An ENT specialist Dr Qaiser Sajjad, who is also an office-bearer of Pakistan Medical Association (PMA), said: "It is proved that betel nuts are itself 'Carcinogen', a substance or agent that causes OCC. He apprised that around 122 different products of betel nuts are available in the market that made OCC as widespread disease in Pakistan.
Research Communication (RC) of Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) published in Asian Pacific Journal of Cancer Prevention revealed majority of OCC patients are between the age group of 31 to 60 years. The apparent reason for this exponential increase is the growing use of chewing tobacco and areca nuts in Karachi.
In KIRAN the most frequent malignancy recorded in males are OCC, which is 32.62 percent of total male cancers. Similarly it is second most frequent cancer reported in females also 15.12 percent of total female cancers. The RC indicated that 36 percent of the males and 21 percent females in Karachi chew betel quid or other chewing tobaccos.
An official in customs department on a condition of anonymity confirmed that the clearance of betel nut consignments was continued for years with immunity. "The customs department despite imposing high rate of duty and taxes remains unable to generate substantial revenue from its imports, due to high corruption," he said. Therefore, the government should either impose ban on its imports or enforce strict procedure to avert the clearance of substandard quality of betel nuts, he exhorted.
He said that authorities could make laboratory tests mandatory under 'Post Importation Checks' in order to avoid examination of each betel nut consignment and for the purpose; suitable amendments should be made in the Import Policy. "Human life is more important than anything but there are some unscrupulous elements involved in the clearance of unfit betel nuts, said Arshad Jamal senior vice chairman All Pakistan Customs Agents Association (APCAA). He urged the authority concerned to take responsible persons either from government side or from clearing agents' fraternity this task.