Cancer risks from betel quid chewing beyond oral cancer: a multiple-site carcinogen when acting with smoking
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This cohort study is to assess the extent of cancer risks of betel quid chewing (without tobacco added) beyond oral cancer, as such information was limited from case–control studies.
The cohort, selected from participants in a medical screening program since 1994, consisted of 177,271 adult men with 19.2% chewers of betel quid. As of 2006, out of 4,840 deaths, 1,901 cancer deaths were identified. Mortality hazard ratios (HR) were estimated by Cox proportional hazard model. Life expectancy was calculated by life table method.
One-third of smokers chewed (33%) but most of chewers smoked (90%). Risk for all cancer doubled among chewers (HR = 2.00). Risks of at least six cancer sites were increased among chewers: oral cavity (HR = 12.52), esophagus (HR = 5.64), liver (HR = 2.27), pancreas (HR = 2.67), larynx (HR = 6.24), and lung (HR = 2.43) with risks increased with increasing betel quid amount consumed. All-cancer age-adjusted mortality rates in Taiwan increased 25%, including 223% increase in oral cancer, during the last 20 years when chewing rate increased five- to tenfolds. Chewing on top of smoking increased the risks synergistically, and these two were responsible for at least half (50%) of all cancer deaths among 2 million chewers in Taiwan. Life expectancy of chewers was shorter than non-chewers by 5.93 years at age 20 and 5.55 years at age 40.
In addition to oral cancer, significant increases were seen among chewers for cancer of the esophagus, liver, pancreas, larynx, lung, and all cancer. Chewing and smoking, as combined by most chewers, interacted synergistically and was responsible for half of all cancer deaths in this group. They were responsible for the recent increases in oral, esophageal, pancreatic, and liver cancer in Taiwan. Chewing and smoking shortened their life span by nearly 6 years.
KeywordsBetel quid Smoking Cancer Mortality Taiwan
Conflict of interest statement
We declare that we have no conflict of interest.
- 2.IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2004) Betel-quid and areca-nut chewing and some areca-nut-derived nitrosamines. IARC Monogr Eval Carcinog Risks Hum 85:1Google Scholar
- 6.IARC Working Group on the Evaluation of Carcinogenic Risks of Chemicals to Humans (1985) Betel-quid and areca-nut chewing, and some related nitrosamines. IARC Monogr Eval Carcinog Risks Hum 37:141Google Scholar
- 13.Wang LY, You SL, Lu SN, Ho HC, Wu MH, Sun CA, Yang HI, Chen CJ (2003) Risk of hepatocellular carcinoma and habits of alcohol drinking, betel quid chewing and cigarette smoking: a cohort of 2416 HBsAg-seropositive and 9421 HBsAg-seronegative male residents in Taiwan. Cancer Causes Control 14:241CrossRefPubMedGoogle Scholar
- 16.Chiang CL (1984) The life tables and its applications. Florida, FloridaGoogle Scholar
- 18.Bureau of Health Promotion, Department of Health, ROC (2007) Prevention strategies of oral cancer in Taiwan. Available from http://www.bhp.doh.gov.tw/bhpnet/portal/Them_Show.aspx?Subject=200712250032&Class=2&No=200712250186
- 21.Wen CP, Cheng CW, Cheng TY, Tsai MK, Chiang PH, Tsai SP, Chan HT, Chang YC, Chang HY (2009) Trends in betel quid chewing behavior in Taiwan- exploring the relationship between betel quid chewing and smoking, (In Chinese). Taiwan J Public Health 28:407Google Scholar
- 22.Department of Health Executive Yuan T (1986–2006) Age adjusted mortality from leading cancer causes of death by gender. Vital Statistics in Taiwan (In Chinese). Health Statistics in Taiwan, TaipeiGoogle Scholar
- 23.Directorate-General of Budget Accounting and Statistics (2007) Consumption of Tobacco, wine and betel nuts. Statistical yearbook of the Republic of China. Directorate-General of Budget Accounting and Statistics, TaipeiGoogle Scholar
- 29.Taiwan Bureau of Health Promotion Department of Health, ROC. Cancer Registration System. Available from http://www.bhp.doh.gov.tw/BHPnet/Portal/StatisticsShow.aspx?No=200911300001