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3.1 The unique burden of oral cancer in south Asia: smokeless tobacco South and Southeast Asia, which report the highest incidence and mortality rates for this disease, represent some of the strongest examples of how cultural practices and product types shape oral cancer risk ( Tobacco-specific nitrosamines (TSNAs), particularly N-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), which are present at high concentrations in most smokeless tobacco products, are classified as carcinogenic to humans (Group 1) by the International Agency for Research on Cancer ( Epidemiological studies consistently demonstrate strong associations between smokeless tobacco use and oral cancer ( Taken together, these findings illustrate how traditional smokeless tobacco and areca nut practices continue to drive a substantial share of the global oral cancer burden