At a small beer joint in Surulere, Chuka leans back, lights a cigarette, and lets the smoke drift lazily into the night. Beside him, a friend passes around a rolled blunt. The music is loud, the banter louder, and nobody is thinking about health or hospitals. Cancer is the last thing on their minds. Yet, hidden in that haze of tobacco and cannabis is a silent danger.

New research suggests that people who smoke both are more than six times more likely to develop oral cancer within five years. It feels distant when you are young and carefree, but for Nigeria, the warning is already close to home.

Ask the average smoker in Nigeria about the risks, and you will likely hear the usual answers: lung cancer, maybe heart problems. Rarely does anyone mention the mouth. But that is where the damage often begins. The chemicals in cigarettes and cannabis scorch soft tissues in the gums, tongue, and throat. Add poor oral care, a culture of self-medication, and the habit of delaying hospital visits, and you have a recipe for disaster.

This is not just theory. The National Drug Use Survey shows that about 10.8 percent of Nigerians use cannabis, the highest rate in Africa, while tobacco smoking hovers around four to 5five percent of adults. Put together, that means millions of Nigerians are exposed to a risk most do not even realise exists.

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Doctors at UCH, Ibadan and LUTH, Lagos, have raised alarms about a steady rise in mouth and throat cancers among young men, many of them regulars at joints where cigarettes and cannabis are smoked together or laced into shisha. A 34-year-old patient in Lagos ignored a sore on his tongue for months until it grew worse. By the time he saw a doctor, the diagnosis was oral cancer. Surgery saved his life, but left him with permanent speech changes. His story is not an outlier.

Across the country, smoking is still treated more like a pastime than a health threat. Cigarettes are sold in singles at roadside kiosks and bus stops. Cannabis is illegal but widely available under nicknames like “igbo,” “gbana,” and “loud.” Both substances are part of nightlife and campus culture. The danger is that oral cancer often creeps in quietly, starting as a sore that will not heal or a patch on the gums. By the time symptoms force attention, the cancer may already have spread beyond control.

Why Nigeria cannot afford to look away

The bigger challenge is silence. Cancer still carries stigma, and many families delay seeking proper treatment. Instead, they turn to herbal remedies, prayers, or self-medication, losing valuable time. By the time patients arrive at hospitals, the disease has advanced. Treatment is gruelling and expensive, wiping out savings and leaving scars both physical and emotional. Removing part of the tongue or jaw saves lives but can also take away speech and confidence, leaving survivors isolated.

And yet, the crisis is not without solutions. Early detection makes a huge difference. A simple oral check during routine dental visits could save lives, but many Nigerians do not see dentists until pain becomes unbearable. Public health campaigns have focused heavily on lung disease, while the link between smoking and oral cancer remains largely unknown. Tobacco control laws exist, but enforcement is weak, and shisha lounges keep drawing young people in with flavoured smoke. Cannabis is often dismissed as “natural” or harmless, which makes its dangers harder to communicate.

So what?

This is where government and civil society need to act. Awareness campaigns must speak in plain language and connect with cultural realities. It is not enough to say “do not smoke”. People must understand what it means when experts say that mixing tobacco with cannabis increases oral cancer risk by over 600 percent. Numbers like that are not just medical jargon; they are warnings that should feel personal.

At the individual level, awareness and vigilance are crucial. A sore in the mouth that refuses to heal after two weeks should never be ignored. Dentists and general practitioners need better training to recognise suspicious lesions early. Communities must also work to reduce stigma around cancer treatment, so that patients are not shamed into silence.

The national picture adds urgency. Nigeria already records more than 100,000 new cancer cases every year, according to the World Health Organisation, and oral cancers are a growing share of that burden. Many of those cases are preventable. If smoking trends continue, especially the rise in combined tobacco and cannabis use, the next decade could see an even sharper increase.

The warning that smokers addicted to both substances face a 624 percent higher risk of oral cancer should not be brushed aside. It is more than a statistic; it is a reflection of what is already happening in communities across Nigeria. Behind every percentage point is someone like Chuka, someone who believes cancer is a problem for tomorrow. But tomorrow comes quickly. And unless the country begins to act, through education, early screening, and stronger regulation, this crisis will keep growing quietly in the shadows.

Cynthia Nwanonyiri