ABSTRACT
Smokeless tobacco [ST], wtclefy used in Pakistan, poses a high risk for oral cancer. Our hospital-based data illustrate that oropharyngeal cancer [9.9%] is the second leading malignancy after breast cancer [16.1%], and is significantly higher than in other Member States of the World Health Organization's Eastern Mediterranean Region. Urdu-speaking communities had a proportionately higher rate of oropharyngeal cancer [20.4%], followed by Balochis [19.9%], Sindhis [16.8%], Punjabis [11.7%] and Pashtuns [9.6%]. Association of oropharyngeal cancer with ST use was four times higher relative to no history of tobacco use after adjusting for age, ethnicity and gender. Our findings also show a predominance of this cancer among males relative to females and one-third of the reported cases occurred among individuals under 40 years. These findings have significant social impact, indicating the need for urgent intervention against the use of ST