A substantial proportion of the world's population is engaged in chewing areca nut and the habit is endemic throughout the Indian subcontinent, large parts of south Asia and Melanesia. A large variety of ingredients, including tobacco, may be used along with areca nut constituting a betel quid. The composition and method of chewing can vary widely from country to country and these population variations are described in this review. Some populations are known to use areca nut without tobacco providing good opportunities to further research the carcinogenecity of areca nut. Some interesting trends on chewing patterns have emerged from recent data, suggesting a decline in the habit in some countries such as Thailand while the prevalence of areca nut use is rising in India and Taiwan.

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Pindborg JJ, Murti PR, Bhonsle RB, Gupta PC, Daftary DK, Mehta FS: Oral submucous fibrosis as a precancerous condition. Scand J Dent Res 1984; 92: 224-9.Abstract -An evaluation of the malignant potential of submucous fibrosis, based on observations of 89 patients with the disease in Ernakulam District, Kerala, India was done. Out of the 89 patients, 12 were referred patients and 77 were diagnosed in population based studies. At the time of first examination oral cancer was found to be coexistent in nine (10%) cases. For 66 patients follow-up observations ranging from 4 to 15 yr (median 8 yr) were available. During this period malignant transformation was observed in three patients (4.5%). Considering malignant transformation and coexistence together, oral cancer was observed in 13% of the present material. Leukoplakia was found in 26% of the patients with submucous fibrosis. Out of 42 submucous fibrosis patients biopsied, 12% showed squamous cell carcinoma, 26% epithelial dysplasia, and 76% atrophic epithelium. These findings reinforced the hypothesis that submucous fibrosis is a precancerous condition.

The paper presents the results of an epidemiologic house‐to‐house survey of oral cancer and lcukoplakia among 50,915 adult villagers in 4 states of India which were selected according to various types of chewing and smoking habits. Twenty‐six oral cancer cases were found in the survey. The prevalence of leukoplakia ranged from 0.2 to 4.9%. There was a predominance of men. Leukoplakias were already observed in the 15‐ to 24‐year age group, and a considerable number were in the 25‐ to 34‐year age group. Intra‐oral locations of the leukoplakias were found to vary within the 4 states depending upon the chewing and smoking habits prevailing. The leukoplakias were analyzed with regard to intra‐oral locatios and correlation with habits. Special habits like hookli smoking and reverse smoking are associated with leukoplakias on the labial mucosa and on the palate, respectively. The histologic analysis of biopsies from 723 leukoplakias showed variations in the type of hyperkeratosis which may depend upon habits. The prevalence of epithelial atypia ranged from 3.0% to 12.4% in the 4 states. Epithelial atypia was seen in 8.4% of homogeneous leukoplakias but in 59.1% of speckled leukoplakias.

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