A cheap chewing tobacco product in India, popular among children and young people, has made India the world's leader in oral cancer – and the product's spread may pose a worldwide health risk, Bloomberg News reported Nov. 29.

Indian entrepreneurs transformed paan, a 400-year-old tobacco product rolled in betel leaves, into “gutka,” a blend of tobacco, areca nut, and spicy fragrances sold for two cents on street corners across the country. Sales are expected to increase from $4.6 billion in 2004 to twice that amount in 2014.

Paan and gutka are both addictive because of tobacco and areca nut, which the World Health Organization (WHO) says is the fourth-most popular psychoactive ingredient in the world, after alcohol, caffeine, and tobacco. Other ingredients in gutka include additional known carcinogens such as chromium, nickel, arsenic, and tobacco-related nitrosamines, the WHO reported in 2008.

The same year, nearly 70,000 cases of mouth cancer were reported in India; in comparison, 23,000 cases of mouth cancers were reported in the United States.

Gutka is frequently sold near schools. “I have seen many children who started chewing gutka when they were 8 or 10 years old and got cancer in their teens,” said Pankaj Chaturvedi, a surgeon at Tata Memorial Hospital, the largest cancer treatment center in Asia.

Gutka powder smells spicy and has a gravel-like consistency. As a result, it abrades the lining of the mouth, which speeds up the effects of nicotine and cancerous chemicals, said Dhirendra Sinha in New Dehli, who works for the WHO as a technical officer for tobacco control.

Areca nut causes muscles in the mouth to thicken and become less flexible, leading to oral submucous fibrosis, a pre-cancerous condition that India's Ministry for Health and Family Affairs and the WHO reported in 2004 had become an “epidemic mainly among the youth.” According to Bloomberg News, “[p]atients who previously could grab a sizable chunk of an apple in a single bite are able to open their mouth to just about the size of a grape.”

Experts are concerned that gutka and its effects may become more than a regional health threat. Researchers at the University of British Columbia in Vancouver wrote in a commentary published last year that, “The practice of areca nut chewing and the presence of oral precancerous lesions are spreading from South Asia to the Western countries, with the potential of becoming a major public health issue.”

As smoking bans have spread, tobacco companies like Philip Morris International Inc., Altria Group Inc., and British American Tobacco Plc have turned to smokeless tobacco products and report rising sales worldwide.