A study in Mumbai, India, (88) indicated a
decreasing trend in oral cancer incidence among
Indian men, which may be due to a decrease in the
use of betel quid ⁄ pan and associated oral smokeless
tobacco over this period (123). However, there continues
to be a high prevalence of smokeless tobacco
use among young adult men and women, especially
in the form of pan parag ⁄ gutka-type products, and
cigarette smoking is increasing. Overall, therefore,
upper aero-digestive tract cancers may not decrease