Impact of chewing betel-nut (Areca catechu) on liver cirrhosis and hepatocellular carcinoma: a population-based study from an area with a high prevalence of hepatitis B and C infections

Abstract

Background: Chewing betel-nuts (Areca catechu) is carcinogenic but the risk for hepatocellular carcinoma (HCC) and liver cirrhosis (LC) is little considered. Worldwide 600 million people chew betel, including emigrants from palmgrowing countries. Objective: We aimed to assess the relationships and dose-response effects of betel chewing on LC and HCC risks, since habit cessation could reduce the increased risks of HCC and LC found in such communities. Subjects: Screening 60 326 subjects aged 30-79 years in a population-based study in Taiwan identified LC in 588 and HCC in 131 subjects. Demographic features, hepatitis B/C infections, other risk factors and betel chewing were noted. Multiple Cox regression models were used to assess independent relationships, interactions and synergisms between age, betel chewing and hepatitis B/C. Results: Betel chewing increased LC and HCC risk 4?25-fold (95 % CI 2?9, 6?2) in current chewers and 1?89-fold (95 % CI 1?13, 3?16) in ex-chewers v. neverchewers, with dose effects for quantity, duration and cumulative exposure in chewers. Subjects without hepatitis B/C infections had 5?0-fold (95 % CI 2?87, 9?03) increased risk of LC/HCC v. never-chewers, and betel chewing had an additive synergistic effect on hepatitis B/C-related risks. Risk reduction with betel habit cessation could exceed that expected from immunization programmes for hepatitis B and C. Conclusion: Increased risks of cirrhosis and hepatocellular cancer were found in betel chewers free of hepatitis B/C infection, and these risks were synergistically additive to those of hepatitis B/C infections. Estimated risk reduction from effective anti-betel chewing programmes would be sizeable.

Cancer risks from betel quid chewing beyond oral cancer: a multiple-site carcinogen when acting with smoking

“…Other HRs were adjusted for age, education, and drinking for most cancers, while for liver cancer, HBsAg and anti-HCV, two hepatitis carrier status were additionally adjusted (Table 3; Figs. 1, 2) [13,14].…”

Areca-nut extract modulates antigen-specific immunity and augments inflammation in ovalbumin-sensitized mice

“…(2,3) In addition to oral disorders, AQ chewing has been linked to chronic kidney disease, diabetes, hepatocellular carcinoma, hyperlipidemia, hypertension, and liver cirrhosis, indicating a broad spectrum of the systemically detrimental effects caused by chewing AQ. (4)(5)(6)(7)(8) AQ is generally comprised of areca nut, betel leaf, and slaked lime with or without tobacco. (1) Areca nut, the seed of Areca catechu, is the main component of areca quid.…”

Cancer in Guam and Hawaii: A comparison of two U.S. Island populations

“…[15, 22] There is some evidence that betel nut chewing may act synergistically with HBV and HCV to increase the risk of liver cancer. [22, 24-26] Chamorros have a high prevalence of obesity [27], which has been increasingly recognized as a risk factor for liver cancer contributing to the rising rates in the U.S. [28] Notably, betel nut chewing is linked to obesity. [29, 30]…”