This refers to the report 'PCSIR study finds toxic trace of metals in Gutka, Supari' (April 25). We must congratulate Faiza Ilyas for the in-depth report and the PCSIR for conducting a study for making the public aware about it.

Being an ENT surgeon, I would like to add a few clinical points for everybody's knowledge. Fungal-infected betel nuts of the cheapest variety are being imported in our country. This infected nut is then marketed in different ways after mixing them with hazardous so-called edibles. There are at least 22 brands of sweet aniseed and sugary betel nut and their mixtures easily available in the market apart from 'gutka' and 'mainpuri'.

In 2003, Custom officials seized 300 imported containers at the Karachi sea port. Each container contained 2,700 tons of fungal-infected betle nuts. On demand of the PMA Karachi, the Supreme Court ordered that the consignment be sent back as it was not fit for human consumption.

It has been proved that the juice of even good quality betel nut contains carcinogen (which causes cancer) when mixed with other hazardous items like artificial colours, metals, chemicals, etc. This increases the chances of producing serious diseases like oral cancer, mouth ulcer, sub-mucous fibrosis, etc. Besides, there are pretty good chances of maggots being formed in the mouth.

Oral cancer and sub-mucous fibrosis are increasing geometrically in Pakistan. Cancer of the tongue, cheek, gum and lips are quite common in our society; even in children and youths ranging between the age of 10 and 25. After breast cancer, the highest number of people that are affected is by oral cancer.

More than 55 per cent of the people are involved in eating betel leaf etc. in Pakistan. Between 20 and 25 per cent of teenagers suffer from sub-mucous fibrosis which is a pre-cancerous disease. A patient suffering from sub-mucous fibrosis can not open his/her mouth completely.

The mouth burns during eating as a result of which some patients only depend on liquid diet. Investigation, diagnosis and treatment of cancer are all costly and problematic.

Most of the staff at government and private offices, educational institutions, hospitals/clinics, newspaper offices and TV stations is found eating betel nuts, aniseed and 'gutka' during duty hours.

The government should ban the import of betel nut also its manufacture and sale to control the number of people suffering from oral cancer. The government should also ban the selling of betel nut, aniseed, 'gutka', 'mainpuri', etc., in the premises of all educational institutions.

People should not distribute these hazardous items during celebrations of any kind. Do not allow your children to eat betel nut in any form as it can cause sudden death by being stuck in their wind pipes. Last but not the least I call paan shops as 'cancer/death shops'.

DR S. M. QAISAR SAJJAD
ENT Surgeon

Health Care Hospital
Karachi