In my OPD, we see mostly tobacco-related cancers, with patients chewing gutka or smoking bidis. The difference is that HPV-positive throat cancer is rarer here, reported in younger, non-smokers in journals, but I have no test to confirm it. My reality is a limited pathology lab; we treat based on clinical presentation and the patient's paan-stained teeth. Just last week, a young man, educated like my beta, came with a throat ulcer, and without the HPV test, I had to assume it was tobacco—this uncertainty is our daily truth.
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