The neoplastic impact of tobacco‐free betel‐quid on the histological type and the anatomical site of aerodigestive tract cancers

Abstract

Little is known about any consequences of swallowing tobacco-free betel-quid (TF-BQ) juice/remnants following chewing and its carcinogenic impact on the upper aerodigestive tract (UADT) to gastrointestinal tract (GIT). We investigated the neoplastic impact of TF-BQ on different anatomical locations along UADT and GIT, and differences according to their histological categories. We conducted a multicenter case-control study examining patients with 2,163 pathology-proven UADT and GIT cancers, comparing them with 2,250 control subjects. Generalized additive models, piecewise regression and polytomous logistic models were applied to identify possible dose-dependent structures and cancer risks. Contrary to nonsignificant GIT-adenocarcinoma risk (aOR 5 0.9), TF-BQ users experienced a 1.7-to 16.2-fold higher risk of UADT-squamous cell carcinomas than nonusers, with the peak risk discovered in oral neoplasms. We separately observed a curvilinear and linear TF-BQ dose-risk relationship in oral/pharyngeal/esophageal and laryngeal cancers. Chewers of betel inflorescence were generally at a greater UADT cancer risk. A higher first-piecewise increased risk of esophageal cancer was recognized among areca-fluid swallowers than among nonswallowers (continuous aOR 5 1.12 vs. 1.03). TF-BQ use accounted for 66.1-78.7% and 17.8-33.2% of the cases of oral/pharyngeal and esophageal/laryngeal cancers, respectively. However, a reduction from heavy TF-BQ consumption to low-to-moderate consumption only reduced 11.3-34.6% of etiologic fraction of oral/pharyngeal cancers. Alcohol supra-additively modified the risk of TF-BQ in determining the development of oral, pharyngeal and esophageal cancers. In conclusion, the interplay of TF-BQ and alcohol/tobacco use, combined with how chewing habit is practiced, influences carcinogenic consequences on anatomically diverse sites of UADT and GIT cancers, and histologically different types.

Smoking Cessation and Risk of Esophageal Cancer by Histological Type: Systematic Review and Meta-analysis

“…Publication bias was evaluated using Begg's and Egger's tests, as well as visual inspection of the funnel plots (35,36). In addition, exploratory meta-regression was performed to examine potential sources of heterogeneity using the same covariates as in the stratified analysis, where P-values of <.10 were regarded statistically significant.…”

A Comprehensive Analysis on the Association between Tobacco-Free Betel Quid and Risk of Head and Neck Cancer in Taiwanese Men

“…In South and South-East Asia, including Taiwan, where betel quid (BQ) chewing is common, BQ contributes to a large proportion of HNC cases [4]. The International Agency for Research on Cancer has classified BQ without or with added tobacco and areca nut as carcinogenic to humans (group 1 agent) [5, 6].…”

“…We conducted a comprehensive analysis to address these insufficiencies. In addition, a study by Lee et al reported that BQ chewing was associated with an earlier onset of HNC, suggesting that BQ chewing may be associated with a shorter tumor promotion period [4]. Therefore, we also conducted analysis to compare the age of HNC diagnosis between HNC patients who were BQ chewers and HNC patients who did not chew BQ.…”

Lip Cancer: Epidemiologic, Clinical, Evolutive, and Therapeutical Aspects

“…Squamous carcinomas of the lip (SCC) represent 10 to 20% of tumors of the oral cavity [3]. The exact incidence of carcinoma of the lip is difficult to assess because they are subject to a comprehensive epidemiological approach with cancers of the upper aerodigestive tract and cancer of the esophagus.…”