Understanding Betel Quid Chewing as a Modifiable Risk Factor for Oral Cavity Cancer

BACKGROUND: Intentional consumption of carcinogens contributes substantially to the worldwide cancer burden. Millions of people chew areca nut (also called betel nut), predominantly in Asia and the Pacific Islands, which has been directly associated with the development of oral cavity cancer. METHODS: A scoping literature review was conducted to characterize the drivers of betel nut use and barriers to cessation, particularly among affected ethnocultural groups. Retrospective analysis of all referrals seen by an otolaryngologist on the island of Saipan within a five-year span was included. Data were configured in Microsoft Excel and PSPP. RESULTS: Betel nut chewing is highly influenced by a complex interplay of sociocultural factors, education and literacy, addiction, and systemic determinants. Thousands of years of tradition reinforce betel nut as a cultural identifier, which is often used to facilitate social connections and stress management. Generally, the practice is less regulated and stigmatized than smoking; one in four people who use betel nut are unaware of the cancer risk in some geographic areas. Pharmacologic therapies for cessation including muscarinic agonists and antidepressants are under investigation. CONCLUSIONS: Asian and Pacific Islander communities are disproportionately impacted by the effects of betel nut. The introduction of culturally conscious public health interventions to lower the prevalence of betel nut chewing represents a major opportunity in global health.