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Br J Cancer. 2001 September; 85(5): 661–667.
PMCID: PMC2364125

Betel nut and tobacco chewing; potential risk factors of cancer of oesophagus in Assam, India


Cancer of the oesophagus is the most commonly diagnosed cancer in males in Assam, in north-eastern India, and ranks second for females. The chewing of betel nut, with or without tobacco and prepared in various ways, is a common practice in the region and a case–control study has been designed to study the pattern of risk associated with different ways of preparing and chewing the nuts. 358 newly diagnosed male patients and 144 female have been interviewed together with 2 control subjects for each case chosen at random from among the attendants who accompanied patients to hospital. There were significant trends in risk ratios associated with the frequency of chewing each day, with the duration of chewing in years and with the age at which the habit was started that were apparent for both males and females and which remained significant after allowance was made for other known risk factors, notably tobacco smoking and alcohol consumption. The adjusted ratios, in comparison with non-chewers, were 13.3 M and 5.7 F for chewing more than 20 times a day, 10.6 M and 7.2 F for persons who had chewed for more than 20 years and 10.3 M and 5.3 F for those who had started before the age of 20. Among the different combinations of ingredients that were chewed the adjusted odds ratios were highest for those who had been using fermented betel nut with any form of tobacco (7.1 M and 3.6 F). The risk associated with tobacco smoking and alcohol consumption, which are high in some parts of the world, were less in Assam than those associated with the chewing of betel nut. © 2001 Cancer Research Campaign

Keywords: oesophageal cancer, betel nut chewing, tobacco chewing, Assam

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Selected References

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  • Bhonsle RB, Murti PR, Daftary DK, Mehta FS. An oral lesion in tobacco-lime users in Maharashtra, India. J Oral Pathol. 1979 Feb;8(1):47–52. [PubMed]
  • Chatterjee A, Deb S. Genotoxic effect of arecoline given either by the peritoneal or oral route in murine bone marrow cells and the influence of N-acetylcysteine. Cancer Lett. 1999 May 3;139(1):23–31. [PubMed]
  • Chen CL, Chi CW, Chang KW, Liu TY. Safrole-like DNA adducts in oral tissue from oral cancer patients with a betel quid chewing history. Carcinogenesis. 1999 Dec;20(12):2331–2334. [PubMed]
  • Jussawalla DJ. Oesophageal cancer in India. J Cancer Res Clin Oncol. 1981;99(1-2):29–33. [PubMed]
  • Jussawalla DJ, Deshpande VA. Evaluation of cancer risk in tobacco chewers and smokers: an epidemiologic assessment. Cancer. 1971 Jul;28(1):244–252. [PubMed]
  • Kinjo Y, Cui Y, Akiba S, Watanabe S, Yamaguchi N, Sobue T, Mizuno S, Beral V. Mortality risks of oesophageal cancer associated with hot tea, alcohol, tobacco and diet in Japan. J Epidemiol. 1998 Oct;8(4):235–243. [PubMed]
  • LEVIN ML. The occurrence of lung cancer in man. Acta Unio Int Contra Cancrum. 1953;9(3):531–541. [PubMed]
  • Nair J, Nair UJ, Ohshima H, Bhide SV, Bartsch H. Endogenous nitrosation in the oral cavity of chewers while chewing betel quid with or without tobacco. IARC Sci Publ. 1987;(84):465–469. [PubMed]
  • Nandakumar A, Anantha N, Pattabhiraman V, Prabhakaran PS, Dhar M, Puttaswamy K, Venugopal TC, Reddy NM, Rajanna, Vinutha AT, et al. Importance of anatomical subsite in correlating risk factors in cancer of the oesophagus--report of a case--control study. Br J Cancer. 1996 May;73(10):1306–1311. [PMC free article] [PubMed]
  • Suri K, Goldman HM, Wells H. Carcinogenic effect of a dimethyl sulphoxide extract of betel nut on the mucosa of the hamster buccal pouch. Nature. 1971 Apr 9;230(5293):383–384. [PubMed]
  • Tuyns AJ, Péquignot G, Jensen OM. Le cancer de l'oesophage en Ille-et-Vilaine en fonction des niveaux de consommation d'alcool et de tabac. Des risques qui se multiplient. Bull Cancer. 1977;64(1):45–60. [PubMed]

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