Association of Betel Nut with Carcinogenesis: Revisit with a Clinical Perspective

Abstract

Betel nut (BN), betel quid (BQ) and products derived from them are widely used as a socially endorsed masticatory product. The addictive nature of BN/BQ has resulted in its widespread usage making it the fourth most abused substance by humans. Progressively, several additives, including chewing tobacco, got added to simple BN preparations. This addictive practice has been shown to have strong etiological correlation with human susceptibility to cancer, particularly oral and oropharyngeal cancers.The PUBMED database was searched to retrieve all relevant published studies in English on BN and BQ, and its association with oral and oropharyngeal cancers. Only complete studies directly dealing with BN/BQ induced carcinogenesis using statistically valid and acceptable sample size were analyzed. Additional relevant information available from other sources was also considered.This systematic review attempts to put in perspective the consequences of this widespread habit of BN/BQ mastication, practiced by approximately 10% of the world population, on oral cancer with a clinical perspective. BN/BQ mastication seems to be significantly associated with susceptibility to oral and oropharyngeal cancers. Addition of tobacco to BN has been found to only marginally increase the cancer risk. Despite the widespread usage of BN/BQ and its strong association with human susceptibility to cancer, no serious strategy seems to exist to control this habit. The review, therefore, also looks at various preventive efforts being made by governments and highlights the multifaceted intervention strategies required to mitigate and/or control the habit of BN/BQ mastication.

Distinct Involvement of 9p21-24 and 13q14.1-14.3 Chromosomal Regions in Raw Betel-Nut Induced Esophageal Cancers in the State of Meghalaya, India

“…Of several factors that are implicated for these cancers, consumption of raw betel-nut (RBN; Areca catechu L.), instead of dry betel-nut, appears to be highly relevant besides the use of tobacco and alcohol (IARC monograph 1985). In the State of Meghalaya, the variety of Areca nut, locally called 'kwai', is raw, unprocessed with higher contents of alkaloids, polyphenol and tannins as compared to the dried one (Sharan, 1996). The betel-quid used in Meghalaya contains RBN, lime paste and small portion of betel-leaf without tobacco and other constituents.…”

Influence of the CYP1A1 T3801C Polymorphism on Tobacco and Alcohol-Associated Head and Neck Cancer Susceptibility in Northeast India

“…Epidemiological studies from the northeast India reported tobacco smoking as one of the strongest risk factor for HNC (Yadav et al, 2010;Talukdar et al, 2013;Choudhury and Ghosh, 2014;Ghosh et al, 2014a) . Moreover, it was seen that tobacco-betel quid chewing also had a very high impact on HNC risk (Sharan et al, 2012;Choudhury et al, 2014) . Tobacco in any form generates free radicals that deplete antioxidants and cause oxidative damage to DNA, proteins and lipids resulting in cancers.…”

“…Human cytochrome P450, family 1, subfamily A, polypeptide 1 (CYP1A1) is one of the major phase I enzymes, involved in the activation of carcinogens related to head and neck cancers, such as polycyclic aromatic hydrocarbon (PAH), heterocyclic amines, N-nitrosamine, alkaloids, polyphenols and tannins present in tobacco smoke and betel quid (Wu et al, 2004;Sharan et al, 2012). Ethanol and acetaldehyde of alcoholic drinks are important chemical agents related to various cancers (Lachenmeier et al, 2012).…”

Head and Neck Squamous Cell Carcinoma: Prognosis using molecular approach

“…Alkaloids, polyphenols and tannins are the active components of betel nut. Habituated or prolonged use of betel nut may lead to carcinogenic transformation of cells, and there is much evidence to suggest that these effects are associated with increased risk for the development of oral squamous cell carcinoma (OSCC) [108].…”

“…Earlier epidemiological studies reported that habituated use of betel nut or betel quid with or without tobacco (such as "gutkha") is directly linked with increased HNSCC risk, more particularly oral carcinoma [108]. Zhou et al [109] in New England conducted a population based case control study to evaluate the relationship between smokeless tobacco use and the risk of HNSCC for a total of 1046 cases and 1239 frequency matched controls, and reported that individuals who used smokeless tobacco for more than ten years had high risk of developing HNSCC [109].…”