Kashmir’s love for kanger is cancerous

What makes the kanger so indispensable is Kashmir’s poor infrastructure and rising costs of heating. The kanger is not only affordable to most Kashmiris, it is filled with embers, the most reliable source of warmth during the region’s infamously frequent power outages.

What makes the kanger so indispensable is Kashmir’s poor infrastructure and rising costs of heating. The kanger is not only affordable to most Kashmiris, it is filled with embers, the most reliable source of warmth during the region’s infamously frequent power outages.

The coal-filled pot comes with wicker-covered handles arching over the pot and is carried close to the body inside pherans, traditional long woollen cloaks, or underneath blankets. The portable heater also has a flip side to it as its careless use often leads to burnt clothes and carpets.

Yet, the compulsion of affordable warmth in the harsh winter also has a serious drawback: the sudden appearance of dark patches called naare teit in Kashur — in other words: ‘kangri cancer’.

A rare cancer

Kangri cancer was first documented by William Elmslie, a British researcher in 1866 who found thirty cases of skin epithelioma and suggested its relationship with the use of kanger. Later, another British researcher, Theodore Maxwell, confirmed these findings in 1879.

The cancer is a rare type of squamous-cell carcinoma — a common form of skin cancer that develops in the squamous cells that make up the middle and outer layers of the skin — is found in Kashmir as a result of keeping the kanger closer to the skin for prolonged periods of time.

Over the years, when Nazir Ahmad Khan, a Professor at the Radiation Oncology department at Sher-i-Kashmir Institute of Medical Sciences, a leading hospital and medical college in Kashmir, witnessed patients with dark patches around their thighs and anterior abdominal wall, he knew that he is diagnosing an early stage kangri cancer.

A recent study published in the Indian Journal of Medical and Pediatric Oncology,  Changing pattern of common cancers in the last five years in Kashmir, India: A retrospective observational study,” conducted by a group of doctors including Khan suggests that kangri cancer has shown a decline amongst females and continues to be amongst the top ten cancers in males, accounting for 1.83 per cent of all male cancers in Kashmir.

“During 1980s, the number of kangri cancer cases in Kashmir was more than 100; in the 1990s, it declined to 50-100. In the 2000s, it was between 30-60,” said Khan. “Presently we get around 40-45 cases.”

Khan analyzed that this cancer is not caused due to the use of kanger but because of its temperature. “High temperature often results in thermal injury,” he said, referring to the habit of keeping kanger in direct contact with skin, leading to the formation of erythema ab igne – red patches that later turn black – a major indication of thermal injury.

For many years, erythema ab igne or these cutaneous rashes can seem harmless to a patient until one day, they start itching, usually as a result of ulcer formation. “These ulcers then turn into malignancy commonly called cancer,” said Khan.

Photo: Umar Asif

As per the study, among all sedentary habits, using hookah, a tobacco pipe with a long, flexible tube that draws the smoke through water contained in a bowl, and the use of kanger are considered to be the major risk factors for the digestive tract, lung, and skin cancers in this region.

“The kangri cancer is usually removed through surgery and followed up by radiation therapies. However, if it spreads, then this cancer can form nodes in the femoral or the thigh area of the patient that do not respond to the treatments if not taken care of at an early stage,” said Khan.

As kangri cancer continues to grow, the ulcers can fungate and later on become foul-smelling. Khan further informs that, “The life of the patient becomes miserable after this,” adding that cancer can spread to other parts of the body as well.

Cancer or warmth?

Even as the use of the kanger has declined over the years, particularly in Kashmir’s urban centers, it remains for many Kashmiris a matter of compulsion. The frequent and prolonged power cuts render electrical heating appliances unreliable if not unaffordable.

Photo: Umar Asif

The compulsion is stronger in rural areas, where not only a deep cultural affinity is there for the use of kanger but also necessitated by electricity outages that sometimes last days amid sub-zero temperatures.

“We receive most of the cases from these [far-flung] areas because kanger is used for around six months starting from October to April due to extreme cold and almost no power supply,” said Khan.

Due to the lack of awareness and alternatives, people still continue using kanger excessively leading to the formation of ulcers, eventually resulting in cancer.

For those with no alternatives, Khan suggests using a kanger wearing a thick layer of clothes, keeping it slightly away from the skin and keeping its temperature low. “The recovery rate of kangri cancer is high but it falls if the stage advances, and prevention is always better, especially when there is no cure.” he concludes.

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