BETEL-QUID AND ARECA-NUT CHEWING - IARC Monographs

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80 under the age of 16 were able to purchase gutka easily (National Centre for Transcultural Oral Health, 2001). Only a few areca products give specific health warnings on the dangers of chewing areca nut, although most carry the statutory health warning regarding added tobacco. In 20 commercially processed and packaged areca-nut products on sale in the the United Kingdom, only three carried a health warning related to oral cancer; none warned about submucous fibrosis or potential addiction (Trivedy, 2001). (d) Limited bans in other countries In the late 1970s, the Public Services of Papua New Guinea issued a ban on betel-quid chewing in government offices (Burton-Bradley, 1978). Possession of areca nut in the California public school system is grounds for suspension (Croucher & Islam, 2002). In Singapore, spitting in public places can lead to a fine, indirectly discouraging the practice of betel-quid and areca-nut chewing (Cheong, 1984). 2.1 Oral cancer 2.1.1 India, Pakistan and Sri Lanka IARC MONOGRAPHS VOLUME 85 2. Studies of Cancer in Humans (a) Descriptive studies and case series In this section, the subsites included in oral cancer were rarely specified, but mostly included lip, tongue and mouth. The reports summarized in the previous monograph on betel-quid and areca-nut chewing (IARC, 1985a) are given in Table 33, which shows that the percentage of oral cancer among all cancers diagnosed in hospitals or groups of hospitals in Asia was always much higher than that usually found in western countries (3–5%; Parkin et al., 2003), where the habit of chewing betel quid, with or without tobacco, is virtually unknown. In many descriptive studies, investigators have obtained histories of chewing betel quid with tobacco from series of patients with oral cancer (Table 34). In most of these studies, the percentage of patients who practise chewing habits is extremely large. Several authors also commented that the cancer generally develops at the place where the quid is kept. A high incidence of oral, oro- and hypopharyngeal cancer is observed in regions of the world where a high proportion of the population practises betel-quid chewing (Parkin et al., 2003). Of the 267 000 new oral cancers estimated to occur around the year 2000 throughout the world, 128 000 (48%) occur in South and South-East Asia; of the 123 000 cases of oro- and hypopharyngeal cancer estimated to occur globally annually, 63 000 (51.2%) are accounted for in South and South-Easts Asia (Figures 3 and 4). In India, the age-standardized incidence rates (ASR) of oral cancer (ICD 9: 140–145) per 100 000 population are 12.8 in men and 7.5 in women (Ferlay et al., 2001).
Table 33. Chewing habit and percentage of oral cancer among all cancers Location Habit All cancers (years) Oral cancer Reference Papua New Guinea Betel quid without tobacco 1175 (1958–63) 209 (17.8%) Atkinson et al. (1964) Papua New Guinea Betel quid without tobacco 2300 (1958–65) (17.1%); 29 (9%) oral cancers were verrucous carcinoma Cooke (1969) Papua New Guinea Betel quid without tobacco 6186 (1958–73) 890 (14.4%) Henderson & Aiken (1979) Travancore, South India Betel quid with tobacco 1700 (5 years) 989 (58%) a Bentall (1908) Neyoor, South India Betel quid with tobacco 377 epithelial cancers (2 years) 346 (91.5%) b Fells (1908) Mumbai, India Betel quid with tobacco 2880 carcinomas (1941–43) 1000 (34.7%) c Khanolkar (1944) Mumbai, India (Parsees) Betel-quid chewing very rare 1705 (1941–65) 160 (9.4%) d Paymaster & Gangadharan (1970) Sri Lanka Betel quid 2344 (1928–48) 1130 (48.2%) e Balendra (1949) Thailand Betel quid 1100 155 (14.1%) f Piyaratn (1959) Malaysia (Indians) Betel quid with tobacco – 219 g Marsden (1960) Singapore Betel quid with tobacco 7131 (8%) h Muir (1962) Philippines Betel leaf, tobacco chewing, reverse cigarette smoking – (1957–61) 186 Tolentino et al. (1963) Malaysia Betel quid with and without tobacco 4369 (1961–63) 476 (10.9%) i Ahluwalia & Duguid (1966) Indians Betel quid with tobacco 912 306 (33.6%) Malays Betel quid without tobacco 777 74 (9.5%) Bangladesh Betel quid 3650 672 (18.4%) j Huq (1965) Pakistan Betel quid with tobacco, cigarette smoking 14 350 (1960–71) 2608 (18.2%) Zaidi et al. (1974) a Lip, tongue, buccal mucosa b Epithelial cancers of the buccal cavity c Lip, buccal mucosa, alveolus, tongue, palate d Lip, tongue, alveolus, floor of mouth, buccal mucosa, palate e Cheek, tongue, palate and tonsil, jaw, floor of mouth, pahrynx and larynx, lip f Lip, tongue, oral cavity g ‘Betel cancers’ h Buccal cavity and pharynx I Lip, tongue, floor of mouth, cheek, palate j Buccal cavity BETEL-QUID AND ARECA-NUT CHEWING 81
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Page 4 and 5: 42 It is recommended that, when the
Page 6 and 7: 44 IARC MONOGRAPHS VOLUME 85 Table
Page 12 and 13: 50 1.1.3 Betel leaf The most common
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Page 18 and 19: 56 In West Bengal, 1990 women aged
Page 22 and 23: 60 IARC MONOGRAPHS VOLUME 85 girls
Page 24 and 25: 62 A survey was conducted in a samp
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Page 28 and 29: 66 Table 26 (contd) Reference Chong
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Page 44 and 45: Table 34. Case series of oral cance
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Page 48 and 49: 86 A study from Mumbai, India, in 1
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134 IARC MONOGRAPHS VOLUME 85 Table
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144 IARC MONOGRAPHS VOLUME 85 infor
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188 IARC MONOGRAPHS VOLUME 85 (ii)
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192 (b) Areca nut Sinha and Rao (19
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196 (b) Genomic instability IARC MO
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Table 73. Analysis of cancer-relate
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Table 74. Genetic polymorphism and
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Table 76. Genetic and related effec
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Table 76 (contd) Test system Result
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Table 76 (contd) Test system Result
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Table 76 (contd) Test system Chromo
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222 to 2.1 (Patel et al., 1994b). E
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226 IARC MONOGRAPHS VOLUME 85 (viii
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228 assay, catechu extract (2-10 mg
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230 Continuous local irritation and
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232 Oesophagus The risk for cancer
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234 Areca nut with tobacco and slak
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236 IARC MONOGRAPHS VOLUME 85 Areco
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238 hamster ovary-K1 cells in vitro
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