Areca nut betel nut, paan and gutka

In addition to the risk factors of smoking and chewing tobacco, oral cancer occurs more frequently among African Americans than among Caucasians and among people who chew areca nuts, betel nuts, paan and gutka (a common practice among some people in India and Asia).

Paan tends to refer to the glossy heart-shaped betel (Piper betel) pepper spice leave, which is not botanically related to the betel nut palm (Areca catechu) which is added as slivers, to it along with some lime (calcium hydroxide) to better extract the alkaloids in the nut. Some people also chew tobacco with it. After about 20 minutes of chewing, the fibrous residue which remains of the nut is often spat on the street, where it remains visible due to its characteristic bright red colour. Regular betel chewing causes the teeth and gums to be stained red. In the past people chewed betel, paan or beeda to make their teeth look red which was considered a symbol of beauty. In Asia it has been considered a symbol of beauty and attraction and a measure of taste. According to botanists betel leaf first grew in Malaysia. It is believed that people of Northern Thailand chewed betel leaf with lemon and betel nut. From there the habit spread to other neighbouring countries and finally became an integral part of India's lifestyle. Betel chewing is addictive. Historically a betel quid (paan) was often formulated to an individual's wishes but nowadays readymade packets of these products are now available as a proprietary mixture known as paan masala. Paan masala tends to contain tobacco products. Read more...

People chewing tobacco in paan are over five times more likely to be at risk of oral cancer. The International Agency for Research on Cancer (IARC) now regards the betel nut itself to be a known human carcinogen. In making this new finding, the working group had available recent epidemiological studies from India and Pakistan which allowed to disentangle the effect of betel quid with and without tobacco, and studies from Taiwan (China), where tobacco is not added to the betel quid. Studies on betel quid without tobacco and areca nut without tobacco in experimental animals now also provide sufficient evidence of carcinogenicity.

The best way to avoid these cancers is to never start chewing tobacco, paan or betel nut.

India: Mouth cancer epidemic on the way

In India,  doctors are reporting a rise in pre-cancerous lesions in the mouth - which they're convinced are caused by chewing tobacco. They are worried about the surging popularity of chewable or smokeless tobacco, particularly among the young. Children started using gutkha six or seven years ago. Mouth cancer has a ten-year incubation period, so they fear a huge bout of oral cancer will hit India in a few years time.

Betel Quid (Paan) and Oral Cancer

British Asians have brought the use of areca from India (some via East Africa), Pakistan, Bangladesh, and other countries in the region and its use is thus firmly culturally bound. Historically a betel quid (paan) was often formulated to an individual's wishes but now readymade packets of these products are now available as a proprietary mixture known as paan masala. This article examines the relation between areca nut use and the development of mouth cancer.