Experimental Oral Carcinogenesis
Samuel Dreizen, Barnet M. Levy in Handbook of Experimental Stomatology, 2020
It has been shown that when tobacco tar is applied to the external skin of mice, it can initiate a neoplastic response. However, in most of the studies, tobacco tar that has been applied to the oral mucosa of mice and rats failed to initiate a neoplastic response. The question, of course, was whether this failure was due to some innate resistance of the oral mucosa of mice and rats to the mild carcinogens in tobacco or whether the saliva might have produced some kind of protection. As we shall see later, the saliva may play an important role in the carcinogenesis of the oral mucosa. In an interesting corollary study,39 uncured raw areca nuts, active shell lime, and chewing tobacco, mixed in almost the same proportions as the product used for chewing, were made into a soft paste by grinding, and placed in the vagina daily. Some 40 animals survived from 324 to 380 days after the beginning of the experiment. Raised papillomatous growths were present in three animals, in which the histologic examination revealed malignant changes. In four animals there was thickening of the mucous membrane with definite malignant changes in the vaginal epithelium. Metastases were present in four animals. Apparently the vaginal mucosa is highly susceptible to the carcinogenic activity of “pan”.
Neoplasia
C. Simon Herrington in Muir's Textbook of Pathology, 2020
There are striking regional variations in cancer incidence throughout the world. Many of these variations appear to be due to environmental factors such as carcinogens rather than genetic factors. In south-east Asia and Africa, hepatocellular carcinoma is common due to the high prevalence of hepatitis B virus infection and environmental exposure to carcinogens, e.g. aflatoxins present in mouldy groundnuts. Chewing betel-quid and areca-nut, a practice common in Asia, is recognized to be carcinogenic. Malignant melanoma is mainly a disease of white-skinned people and is especially common in sunny climates such as Australia, where many of the population are fair-skinned individuals of northern European extraction. Exposure to high levels of ultraviolet light can cause cancer. Gastric carcinoma is common in the former Soviet Union, Japan, and China, whereas its incidence in western countries has progressively fallen, perhaps due to altered dietary habits and the decline of infection with Helicobacter pylori. Breast and colorectal carcinoma are far more common in western countries than in Asia.
Global Oral Health and Inequalities
Vincent La Placa, Julia Morgan in Social Science Perspectives on Global Public Health, 2023
Prevalence of severe periodontal disease also remains largely unchanged since 1990, although there has been a slight improvement. In 1990, prevalence was estimated at 11.2%, and by 2010, this had decreased to 10.8% of people, worldwide (Kassebaum et al., 2014). Epidemiological studies of periodontal disease are a challenge due to the various measurement tools used globally, and problems of coverage, and, as a result, figures are estimates. Incidence of cancer of the lip and oral cavity was 500,550 in 2018, with 177, 384 total deaths, of which 67% were males. The major risk factors for oral cancers are tobacco and alcohol consumption and areca nut (betal quid) chewing (Jethwa and Khariwala, 2017; Mehrtash et al., 2017). Oral cancer has the highest incidence of all cancers in Melanesia and South Asian males (Bray et al., 2018). It is the leading cause of cancer-related mortality for males in India and Sri Lanka. For males in LMICs, with a low HDI, oral cancer is the fourth highest of all cancers (Bray et al., 2018). In many HICs, the human papilloma virus infection is responsible for increasing oropharyngeal cancers (Mehanna et al., 2013) and prevalence is greater among men and older age groups from poorer backgrounds (Conway et al., 2015).
Metabolism of the areca alkaloids – toxic and psychoactive constituents of the areca (betel) nut
Published in Drug Metabolism Reviews, 2022
There are an estimated over 600 million people worldwide that chew the areca nut1 (AN) in some form, a practice that has existed since antiquity (Garg et al. 2014). Consumption is widely prevalent among citizens in many parts of the Asian continent, especially Southeast Asia (e.g. India, Pakistan, Taiwan, Malaysia, Sri Lanka, and Myanmar), and Tropical-Pacific regions. Chewing of AN is also common among Asian-migrant communities elsewhere in the world, including South Africa, France, Italy, Australia, UK, and Canada (Vilmer and Civatte 1986; Hardie 1987; Oliver and Radden 1992; Vora et al. 2000; Gupta and Ray 2004; Bissessur and Naidoo 2009; Furber et al. 2013; Petti and Warnakulasuriya 2018; Wood et al. 2019). A growing set of data suggest that AN consumption in the USA is frequent among immigrant and refugee populations, in which various unprocessed and commercialized products are poorly regulated and freely available for retail purchase (Oakley et al. 2005; Changrani et al. 2006; Pobutsky and Neri 2012; Milgrom et al. 2013; Do and Vu 2020; Tungare and Myers 2021).
Betel quid chewing and cessation in the sociocultural context of Paiwan people from Taiwan: a qualitative study
Published in Journal of Ethnicity in Substance Abuse, 2021
The elderly believed chewing betel quid helps to prevent bad breath and enhance mental alertness. For example, the old shaman P14 said, “My mouth seems less smelly after chewing betel quid … like brushing teeth … Chewing betel quid is like an exercise and nonstop chewing is good for our brains. People who rarely talk would become stupid. For example, quiet children are usually very stupid. People who always talk would become cleverer. Because of that, the elderly will chew betel quid, which feels like having a massage … chewing, massage, massage and like this …” P14 did not chew the areca nuts grown on the plains and preferred chewing only those picked by himself from the mountains. He did not add any lime or wrap them with betel leaf. He said that areca nut only was like chewing gum.
A Discourse Analysis on Betel Nut Chewing in Hunan Province, China
Published in Journal of Psychoactive Drugs, 2021
The debate continued. On April 25, 2013, National Business Daily reported a case about the traditional Chinese patent medicine Simotang (四磨汤) produced by Hansen Pharmaceuticals. It was said that this medicine contained the areca nut. On May 31, 2013, Economic Information Daily published the comment of the medical scientist Li Lianda that “there is the difference between chewing the betel nut and the medical use of betel nut. The two concepts should be clarified.” On July 14, 2013, the mainstream media Channel 13 Chinese Central TV (CCTV) reported with the title “Cancers caused by chewing” that “The betel nut is a Group 1 carcinogen, and 60% of oral cancers are associated with betel nut chewing.” This report was widely spread by local media and across the internet. On July 23, 2013, the newspaper Scientific and Technological News, quoting the words of the expert Zhong Kai from China National Center for Food Safety Risk Assessment, claimed that chewing betel nuts will easily cause oral cancer.
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