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Study finds almost all Myanmar mouth cancer patients chew betel quid

Despite its health-damaging effects, betel quids are a popular custom in Asian countries. According to GLOBOCAN 2012—a project that aims to provide current estimates of the incidence, mortality and prevalence of major types of cancer—more than half of oral cancers in the world occur in Asia. (Photograph: Dory F/Shutterstock)
Dental Tribune International

Dental Tribune International

Thu. 30. November 2017


TOUNGOO, Myanmar: A study has found that almost all of the mouth cancer patients investigated used smokeless tobacco in the form of betel quid, researchers have reported at the European Society for Medical Oncology Asia 2017 Congress, held in Singapore from 17 to 19 November. Chewing betel quid—it generally contains betel leaf, areca nut and slaked lime, and may contain tobacco—typically starts in adolescence and is associated with smoking and drinking alcohol, which are also risk factors for oral cancer.

This observational study investigated the lifestyle behaviours of head and neck cancer patients that may have contributed to their disease. The cross-sectional study was conducted in the medical oncology unit of Toungoo General Hospital in 2016. All head and neck squamous cell carcinoma (HNSCC) patients who came to the hospital for treatment were included in the study. Participants were asked about their habits regarding betel quid chewing, smoking and alcohol consumption.

Of the 307 cancer patients who visited Toungoo hospital that year, 67 (22 per cent) had HNSCC and were included in the study. Of those, 41 were male and 26 were female. The mean age was 59.2 years (range: 36–81 years) for men and 58.7 years (range: 19–86 years) for women. The most common cancer site was the oral cavity (34.3 per cent), followed by the larynx (25.4 per cent), oropharynx (11.9 per cent), nasopharynx (11.9 per cent), hypopharynx (10.4 per cent), lip (4.5 per cent) and nose (1.5 per cent).

Regarding lifestyle habits of the entire study population, 20 patients (30 per cent) chewed betel only; 19 patients (28 per cent) chewed betel and smoked tobacco; 19 patients (28 per cent) chewed betel, smoked tobacco and consumed alcohol. Two patients smoked tobacco and drank alcohol, two smoked tobacco only, two had none of the risk factors, and information was unavailable for three patients.

All oral cavity cancer patients were betel quid chewers. In addition, 48 per cent smoked tobacco and 44 per cent consumed alcohol. The majority (87 per cent) of mouth cancer patients said they held betel quid in the buccal cavity most of the time.

Lead author Dr Khin Khin Nwe, a medical oncologist at the Toungoo General Hospital, said: “According to previous studies the incidence of oral cancer, also called mouth cancer, in Southeast Asia has been disturbingly high for many years. It has also been shown that smokeless tobacco use is common in this region—for example in Myanmar more than 50% of men use betel quid.”

Commenting on the topic, Dr Makoto Tahara, Chief of the Department of Head and Neck Medical Oncology at the National Cancer Centre Hospital East in Chiba in Japan, said: “Given the number of health issues associated with chewing betel quid, particularly oral cancer and precancerous conditions such as leukoplakia and oral submucous fibrosis, understanding ways to reduce betel quid chewing is of global public health importance. In the last decade, betel quid has been classified as a group 1 carcinogen by the International Agency for Research on Cancer.”

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