A retired doctor, Sunil Handa, has warned the UK Asian community about the dangers of chewing the Betel Nut after being diagnosed with head and neck cancer.

Former Consultant haematologist Dr Handa, aged 58, has undergone four operations for abnormal cells or cancer in his mouth since 1998 – needing extensive facial reconstruction and debilitating radiotherapy after the last one in 2013 at Queen Elizabeth Hospital Birmingham (QEHB).

He believes that chewing the Betel nut in his younger days was a major factor in him developing the disease.

“As a teenager, before I came to the UK, I used to chew a nut called the Betel nut which is chewed by a lot of people in the Indian sub-continent” he said.

“Amongst the medical community it is a recognised cause of cancer in the mouth but the vast majority of people in the world who chew this nut are unaware of it.

“It’s a nut which is chewed predominantly in the Indian sub-continent and I had been chewing if for many years.

“It was only when I became a medical student in Leicester and developed a problem with my mouth that I learned about the association.”

Sunil stopped chewing the nut immediately after learning of the association with oral cancer but his problems began years later in 1998 when his dentist noticed an abnormal area on his tongue.

He was referred to the maxillofacial department, then on the Selly Oak Hospital site, who determined the lesion were “dysplastic” - the early form of cancer (pre-cancerous lesion) which pathologists can recognise - and removed them.

Four months later, further abnormal cells were discovered and still more in 2003 with further sections of Sunil’s tongue removed.

There was then a ten year interval until 2013 when a further lesion was noted on a routine follow-up outpatient visit and a biopsy at QEHB showed it to be full-blown cancer.

Within days Dr Handa was undergoing a 12-hour operation in which the affected areas of his mouth and jaw were removed and bone and flesh from his leg used to rebuild his face.

Pathology tests revealed that the cancer had spread into the lower jaw bone and so he had to undergo six weeks of radiotherapy treatment, with severe side effects including frequent & prolonged vomiting.

“It was a total nightmare,” he said. “The vomiting started mid-way through the radiotherapy & went on for several months. It was so bad that I almost didn’t finish the treatment. I lost almost three and a half stone in weight and was so weak that I fell and broke the first metatarsal bone in my foot – the same one David Beckham broke.”

Dr Handa is now free of cancer but has to live with the consequences of his surgery and radiotherapy daily.

He carries a bottle of water everywhere as the radiotherapy has destroyed most of his salivary glands, leaving him with a permanently dry mouth, and the facial reconstruction, although it has given him a near-normal appearance, makes eating problematic, especially in public.

Dr Handa, who worked at Sandwell General Hospital and New Cross Hospital, Wolverhampton during his 31-year NHS career, is now eager to raise awareness about head and neck cancers – and especially the dangers of chewing the Betel nut.

“The nut contains a chemical called arecoline which is a mild stimulant and is mildly addictive” he said.

“There’s a very large South Asian population in the UK and many of them are regularly chewing this nut without realising that they are laying themselves open to potentially developing cancer in the mouth.

“Usually there is a long time interval (not just years, but often decades, as in my case) between the exposure and any cancer developing.”

Head and neck cancer is now the sixth most common cancer worldwide following a significant increase in the global incidence of cases in the last decade, particularly among women, although men are still 2-3 times more likely to develop the condition.

And, while it is most common in people over the age of 40, there has been a recent increase in younger people developing the disease.

The risks are greater for people who smoke and drink, while the incidence of throat cancer is rising due to certain sub-types of the Human Papillomavirus (HPV) infection.

More than 30 to 40 types of HPV are typically transmitted through sexual contact. HPV infection is also a cause of nearly all cases of cervical cancer.

An audit by the Health and Social Care Information Centre (HSCIC) showed that 51.6% of oropharynx patients have a recorded HPV test, with 78.9% of these proving positive.

Individuals are encouraged to visit their GP if they have experienced one of the following symptoms for three weeks:

• sore tongue, non-healing mouth ulcers and/or red or white patches in the mouth
• pain in the throat
• persistent hoarseness
• pain and/or difficulty swallowing
• lump in the neck
• blocked nose on one side or blood discharge from the nose

For more information about the campaign, visit the Make Sense Campaign website (see below).