Betel quid without tobacco as a risk factor for oral precancers

Jacob, Binu; Straif, Kurt; Thomas, Gigi; Ramadas, K; Mathew, Babu; Zhang, Zuo‐Feng; Sankaranarayanan, Rengaswamy; Hashibe, Mia

doi:10.1016/j.oraloncology.2004.01.005

Cited by 134 publications

(92 citation statements)

References 17 publications

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“…About 2.5 million people are affected by oral submucous fibrosis, mostly in Indian subcontinent (Cox et al, 1996) with an incidence of oral cancer of 7.6% for a median 10 year follow-up period. The smokeless tobacco and betal quid chewing even (with or without tobacco) increases the risk of oral pre-cancers, as reflected by the dose response relationships for both frequency and duration (Jacob et al, 2004).…”

Section: Cancer Mouthmentioning

confidence: 99%

Head and Neck Cancer: Global Burden and Regional Trends in India

Mishra

Meherotra²

2014

Asian Pacific Journal of Cancer Prevention

153

100

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Section: Cancer Mouthmentioning

confidence: 99%

Head and Neck Cancer: Global Burden and Regional Trends in India

Mishra

Meherotra²

2014

Asian Pacific Journal of Cancer Prevention

153

100

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“…12 However, this study 12 did report unadjusted dose response data. The 5 remaining studies [7][8][9][10][11] were included in the review together with the results of our study. Table IV shows characteristics of the studies including the numbers of cases and controls and the proportion exposed to betel quid that did not contain tobacco.…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

“…Four studies, 5 Adjusted for alcohol and smoking, matched for age (63 years), sex, date of diagnosis (63 months).- 6 Adjusted for education, occupation, cigarette smoking, in nonalcohol drinkers, matched for age (63 years) and gender.-7 Adjusted for age, sex, education, BMI (kg/m 2 ) pack years smoking and years of alcohol.- 8 Adjusted for age, smoking and Human Papilloma Virus.- 9 Adjusted for age sex, census division and smoking. including the present one, reported on betel quid without tobacco chewing in non-smokers, with varying control for other potential confounding factors.…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

Betel quid not containing tobacco and oral leukoplakia: A report on a cross‐sectional study in Papua New Guinea and a meta‐analysis of current evidence

Thomas

Harris

Ness

et al. 2008

Intl Journal of Cancer

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Leukoplakia is an asymptomatic, potentially malignant change in the oral mucosa. Previous studies have reported that smoking and betel quid chewing are associated with increased risk of leukoplakia; few studies have reported on these associations in populations where betel quid does not contain tobacco. We conducted a casecontrol study nested in a cross-sectional study in Papua New Guinea and a systematic review of studies that included chewers of betel quid without tobacco. Our study recruited 1,670 adults. We recorded betel quid chewing and smoking. The prevalence of leukoplakia was 11.7%. In the nested case-control study of 197 cases and 1,282 controls, current betel chewing was associated with increased risk of leukoplakia with an adjusted odds ratio for current chewers of 3.8 (95% CI 1.7, 8.4) and in the heaviest chewers of 4.1 (95% CI 1.8, 9.1) compared to non-chewers. Current smoking was associated with an increased risk of leukoplakia with an adjusted odds ratio for current smokers of 6.4 (95% CI 4.1, 9.9) and amongst heaviest smokers of 9.8 (95% CI 5.9, 16.4) compared to non-smokers. The systematic review identified 5 studies examining risk of leukoplakia associated with betel quid chewing in populations where betel quid did not contain tobacco and that controlled for smoking. In studies that adjusted for smoking, the combined random effect odds ratio was 7.9 (95% CI 4.3, 14.6) in betel quid chewers. The results of this study and systematic review of similar studies provide evidence of the role of betel quid not containing tobacco and leukoplakia. ' 2008 Wiley-Liss, Inc.Key words: betel quid; smoking; oral leukoplakia; oral cancer; Papua New Guinea Melanesia has the highest incidence of oral cancer in the world 1 and it is the most common cancer in Papua New Guinea (PNG). Rates are also high in South Asia. 1 In these populations, oral cancer is related to smoking and betel quid use. We recently reported a case-control study and a systematic review of betel quid without tobacco and found an increased risk of oral cancer independent of smoking. 2 We report here studies of betel quid without tobacco and risk of oral leukoplakia.Oral leukoplakia is an asymptomatic, potentially precancerous lesion. In a 10-year follow-up study in India, oral leukoplakia preceded oral cancer in nearly 70% of cancer cases. 3 The association of risk factors with oral leukoplakia can offer insights into the causal pathway. Furthermore, investigations into the aetiology of oral leukoplakia may be less biased than cancer studies, as leukoplakia is asymptomatic and therefore unlikely to modify behaviour although recall of behaviour might be more related to time. Studies of oral leukoplakia show similar results for smoking and betel quid (that contains tobacco) to those of oral cancer in India 4 ; however, until recently there have been few studies of betel quid without tobacco and oral leukoplakia. We present here data from a previously unpublished study in PNG (where betel quid is tobacco free) and other recently published researc...

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“…In South India chewing betel quid/ paan (betel leaf enclosing sliced areca nut, catechu, lime and various other spices which may or may not contain tobacco) (Warnakulasuriya et al, 2002;Rani et al, 2003;Aruna et al, 2011) is a common habit but the evidence for cancer occurrence due to this habit without tobacco is limited (Znaor et al, 2003;Lee et al, 2005). 'Quid' has been defined as ' a substance or mixture of substances, placed in the mouth or chewed and remaining in contact with the mucosa usually containing one or both of the two basic ingredients, tobacco and/or areca nut, in raw or any manufactured of processed form (Mehta , 1993;Jacob et al, 2004;Lee et al, 2005). Gutka is a mixture of powdered tobacco, areca nut, and slaked lime (aqueous calcium hydroxide).…”

Section: Introductionmentioning

confidence: 99%

“…Some other forms of smokeless tobacco products commonly used in the Indian subcontinent are khaini, zarda which are mixtures of powdered tobacco and slaked lime and mishri a powdered form of tobacco which is rubbed on the gums (Rani et al, 2003;Javed et al, 2010). According to a re-evaluation in 2004 by the International Agency for Research of Cancer both betel quid and areca nut have been considered to be Group 1 or 'carcinogenic to humans' (Jacob et al, 2004;Lee et al, 2005). In India tobacco is most commonly smoked in the form of cigarettes or bidis.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Correlation of Oral Lesions among Tobacco Smokers, Tobacco Chewers, Areca Nut and Alcohol Users

Sujatha¹,

Hebbar²,

Pai³

2012

Asian Pacific Journal of Cancer Prevention

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Introduction: The incidence of oral premalignant and malignant lesions is on the rise due to an increased number of people taking in tobacco and alcohol related habits. Material and Methods: 1028 patients with tobacco, alcohol and areca nut habits attending our Department of Oral Medicine and Radiology formed the study sample. An interviewer based questionnaire was used to record the habit details. All the patients were then examined clinically for the presence of lesions. Chi square and Fisher exact tests were used to assess the statistical significance of the study parameters. Results: Males had a higher prevalence and comprised 87.9% of the sample. The commonest habit in this study sample was smoking (39.2%) followed by smokeless tobacco use (28.1%). Out of the 1028 patients with habits 40% had no clinically detectable changes in their mucosa. Of the mucosal changes leukoplakia (14%) was the commonest. Conclusions: This study provided information about the habit trends in the patients visiting this institution. The study may serve as a useful tool in educating the patients about the deleterious effects of oral tobacco, alcohol and betel exposure.

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Betel quid without tobacco as a risk factor for oral precancers

Cited by 134 publications

References 17 publications

Head and Neck Cancer: Global Burden and Regional Trends in India

Head and Neck Cancer: Global Burden and Regional Trends in India

Betel quid not containing tobacco and oral leukoplakia: A report on a cross‐sectional study in Papua New Guinea and a meta‐analysis of current evidence

Prevalence and Correlation of Oral Lesions among Tobacco Smokers, Tobacco Chewers, Areca Nut and Alcohol Users

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