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ABSTRACT Objective: To identify smokeless tobacco as a risk factor in the development of head and neck cancers and to assess the role of ethnicity in the use of smokeless tobacco in developing head and neck cancers. Study Design: Case-control study. Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Dec 2018 to Jun 2019. Methodology: Three hundred patients, aged 18-85 years of either gender were included in the study. Cases were the patients visiting Oncology OPD with biopsy-proven head and neck cancers (HNCs). Controls were patients presenting at the same hospital for a routine checkup. We interviewed participants by using a pre-designed proforma. Results: The mean age of the cases and controls were reported as 49.26±13.51 years and 40.12±14.89 years, respectively. Majority of the participants were consuming pan (37.0%), gutka (22.6%), tobacco (21.3%), betel nut (19.6%), naswar (12.0%) and mainpuri (9.0%). The participants who consumed tobacco (OR:2.95), gutka (OR:2.39), mainpuri (OR:4.89), pan (OR:2.06) and betel nut (OR:2.28) were times more likely to develop HNCs than those who did not consume tobacco, gutka, mainpuri, pan and betel nut (p<0.05). Among Urdu speaking, the participants who consumed tobacco (OR: 2.49), pan (OR:10.35), and betel nut (OR:3.34), had times more likely to develop HNCs than those who did not consume tobacco, pan and betel nut. Conclusion: Mainpuri, naswar, betel quid, and betel nut significantly affect the oral health of people and are potential risk factors for the development of risk factors. [ABSTRACT FROM AUTHOR]