Bhopal continues to wotness a growing oral cancer crisis. Yet, its anti-tobacco efforts remain culturally misaligned, poorly enforced and structurally unsupported. On World No Tobacco Day, the gap between awareness and action is stark. Cultural tobacco use lies at the heart of the problem. A large section of Bhopals population traces its roots to Pashtun settlers, locally called Pathans. In South Asia, many Pashtun communities have long used tobacco—particularly in smokeless forms—as part of everyday life. In Bhopal, products like gutkha, zarda and betel quid are commonly used, especially by men. In many households, these items are normalised, and use begins as early as the teenage years. In older parts of the city, offering paan or gutkha is still seen as a gesture of hospitality. Despite numerous awareness drives, these habits remain deeply ingrained and stubbornly resistant to change. Gandhi Medical Colleges cancer registry reports that Madhya Pradesh has one of the highest oral cancer burdens in India. Bhopal ranks alarmingly high among Indian cities for mouth cancer cases. Among men in the state, oral cancer affects 25.1 per lakh, with 16.3 per lakh suffering from mouth cancer alone. Most are young patients. Among women, the trend is no less troubling. Bhopal reports one of the highest rates of tongue cancer among women in the country. A 2019 clinical study in Bhopal found that nearly 88 percent of patients with potentially malignant oral disorders used gutkha, betel nut or betel quid. Hospitals are responding. Jawaharlal Nehru Cancer Hospital and Krishna Cancer Hospital have dedicated oral oncology units offering chemotherapy, radiation and dental strengthening before treatment. JP Hospital screened over 1,200 people in April 2024 using Velscope and GOCCLES devices. Symptoms of oral cancer were detected in 291 individuals, proving how essential early detection is. Yet tobacco products remain widely available. Gutkha and paan are routinely sold near schools, often to minors. Enforcement of bans is weak and sporadic at best. In May 2023, Bhopal became the first Indian city to release a Voluntary Local Review of the UN Sustainable Development Goals, pledging to act under SDG 3. But action on the ground has been slow and uneven. The NITI Aayogs urban health vision calls for decentralised screening and prevention, especially for non-communicable diseases like oral and throat cancer. That vision has yet to translate meaningfully in Bhopal. The bigger problem lies in behavioural change. In some old city localities, tobacco is not just a product but part of identity. Any campaign that ignores this cultural context is bound to fail. Health messaging must shift from generic slogans to family-driven dialogue. Involving community elders, religious leaders and local influencers could help change perception without triggering stigma or resistance. Despite the severity of the crisis, Bhopal still lacks a government-run cancer hospital. Most patients depend on private care or general wards with limited oncology infrastructure. This absence hits low-income families hardest. Many delay or abandon treatment altogether—a devastating outcome in a city with such a high cancer burden. Bhopals fight against tobacco is not just a medical battle. It is a cultural reckoning and a policy challenge. Without urgent, empathetic intervention, awareness alone will not save lives.

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