The precancer risk of betel quid chewing, tobacco use and alcohol consumption in oral leukoplakia and oral submucous fibrosis in southern Taiwan

C-H Lee, Y-C Ko, H-L Huang, Y-Y Chao, C-C Tsai, T-Y Shieh, L-M Lin, C-H Lee, Y-C Ko, H-L Huang, Y-Y Chao, C-C Tsai, T-Y Shieh, L-M Lin

Abstract

In areas where the practise of betel quid chewing is widespread and the chewers also often smoke and drink alcohol, the relation between oral precancerous lesion and condition to the three habits is probably complex. To explore such association and their attributable effect on oral leukoplakia (OL) and oral submucous fibrosis (OSF), a gender-age-matched case-control study was conducted at Kaohsiung, southern Taiwan. This study included 219 patients with newly diagnosed and histologically confirmed OL or OSF, and 876 randomly selected community controls. All information was collected by a structured questionnaire through in-person interviews. A preponderance of younger patients had OSF, while a predominance of older patients had OL. Betel quid chewing was strongly associated with both these oral diseases, the attributable fraction of OL being 73.2% and of OSF 85.4%. While the heterogeneity in risk for areca nut chewing across the two diseases was not apparent, betel quid chewing patients with OSF experienced a higher risk at each exposure level of chewing duration, quantity and cumulative measure than those who had OL. Alcohol intake did not appear to be a risk factor. However, cigarette smoking had a significant contribution to the risk of OL, and modified the effect of chewing based on an additive interaction model. For the two oral premalignant diseases combined, 86.5% was attributable to chewing and smoking. Our results suggested that, although betel quid chewing was a major cause for both OL and OSF, its effect might be difference between the two diseases. Cigarette smoking has a modifying effect in the development of oral leukoplakia.

Figures

Figure 1
Figure 1
(A) Adjusted ORs and CIs, and (B) population attributable risk proportions of OL and OSF combined associated with betel quid chewing, cigarette smoking and alcohol drinking, Taiwan.

References

    1. Banoczy J, Gintner Z, Dombi C (2001) Tobacco use and oral leukoplakia. J Dent Educ 65: 322–327.
    1. Bhonsle RB, Murti PR, Daftary DK, Gupta PC, Mehta FS, Sinor PN, Irani RR, Pindborg JJ (1987) Regional variations in oral submucous fibrosis in India. Community Dent Oral Epidemiol 15: 225–229.
    1. Blot WJ, McLaughlin JK, Winn DM, Austin DF, Greenberg RS, Preston-Martin S, Bernstein L, Schoenberg JB, Stemhagen A, Fraumeni Jr JF (1988) Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 48: 3282–3287.
    1. Bruzzi P, Green SB, Byar DP, Brinton LA, Schairer C (1985) Estimating the population attributable risk for multiple risk factors using case–control data. Am J Epidemiol 122: 904–914.
    1. Canniff JP, Harvey W (1981) The aetiology of oral submucous fibrosis: the stimulation of collagen synthesis by extracts of areca nut. Int J Oral Surg 10: 163–167.
    1. Chang YC, Tai KW, Cheng MH, Chou LS, Chou MY (1998) Cytotoxic and non-genotoxic effects of arecoline on human buccal fibroblasts in vitro. J Oral Pathol Med 27: 68–71
    1. Department of Health (ROC), E.Y., Republic of China (1998) Health statistics, Vol. II Vital statistics: 1972–1998. Taipei: Department of Health, E.Y., ROC.
    1. Evstifeeva TV, Zaridze DG (1992) Nass use, cigarette smoking, alcohol consumption and risk of oral and oesophageal precancer. Eur J Cancer B Oral Oncol 28B: 29–35.
    1. Gupta PC (1984) Epidemiologic study of the association between alcohol habits and oral leukoplakia. Community Dent Oral Epidemiol 12: 47–50.
    1. Gupta PC, Murti PR, Bhonsle RB, Mehta FS, Pindborg JJ (1995) Effect of cessation of tobacco use on the incidence of oral mucosal lesions in a 10-yr follow-up study of 12,212 users. Oral Dis 1: 54–58.
    1. Gupta PC, Pindborg JJ, Mehta FS (1982) Comparison of carcinogenicity of betel quid with and without tobacco: an epidemiological review. Ecol Dis 1: 213–219.
    1. Hashibe M, Sankaranarayanan R, Thomas G, Kuruvilla B, Mathew B, Somanathan T, Parkin DM, Zhang ZF (2000) Alcohol drinking, body mass index and the risk of oral leukoplakia in an Indian population. Int J Cancer 88: 129–134.
    1. Hashibe M, Sankaranarayanan R, Thomas G, Kuruvilla B, Mathew B, Somanathan T, Parkin DM, Zhang ZF (2002) Body mass index, tobacco chewing, alcohol drinking and the risk of oral submucous fibrosis in Kerala, India. Cancer Causes Control 13: 55–64.
    1. Hosmer DW, Lemeshow S (1992) Confidence interval estimation of interaction. Epidemiology 3: 452–456.
    1. IARC (1985) Betel-quid and areca-nut chewing. IARC Monogr Eval Carcinog Risk Chem Hum 37: 137–202.
    1. Ikeda N, Handa Y, Khim SP, Durward C, Axell T, Mizuno T, Fukano H, Kawai T (1995) Prevalence study of oral mucosal lesions in a selected Cambodian population. Community Dent Oral Epidemiol 23: 49–54.
    1. Ko YC, Chiang TA, Chang SJ, Hsieh SF (1992) Prevalence of betel quid chewing habit in Taiwan and related sociodemographic factors. J Oral Pathol Med 21: 261–264.
    1. Ko YC, Huang YL, Lee CH, Chen MJ, Lin LM, Tsai CC (1995) Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. J Oral Pathol Med 24: 450–453.
    1. Lee CH, Ko YC, Cheng LS, Lin YC, Lin HJ, Huang MS, Huang JJ, Kao EL, Wang HZ (2001) The heterogeneity in risk factors of lung cancer and the difference of histologic distribution between genders in Taiwan. Cancer Causes Control 12: 289–300.
    1. Macigo FG, Mwaniki DL, Guthua SW (1996) Influence of dose and cessation of kiraiku, cigarettes and alcohol use on the risk of developing oral leukoplakia. Eur J Oral Sci 104: 498–502.
    1. Maher R, Lee AJ, Warnakulasuriya KA, Lewis JA, Johnson NW (1994) Role of areca nut in the causation of oral submucous fibrosis: a case–control study in Pakistan. J Oral Pathol Med 23: 65–69.
    1. Mehta FS, Gupta PC, Pindborg JJ (1981) Chewing and smoking habits in relation to precancer and oral cancer. J Cancer Res Clin Oncol 99: 35–39.
    1. Merletti F, Boffetta P, Ciccone G, Mashberg A, Terracini B (1989) Role of tobacco and alcoholic beverages in the etiology of cancer of the oral cavity/oropharynx in Torino, Italy. Cancer Res 49: 4919–4924.
    1. Seedat HA, Van Wyk CW (1988) Betel chewing and dietary habits of chewers without and with oral submucous fibrosis and with concomitant oral cancer. S Afr Med J 74: 572–575.
    1. Shiu MN, Chen TH, Chang SH, Hahn LJ (2000) Risk factors for leukoplakia and malignant transformation to oral carcinoma: a leukoplakia cohort in Taiwan. Br J Cancer 82: 1871–1874.
    1. Tang JG, Jian XF, Gao ML, Ling TY, Zhang KH (1997) Epidemiological survey of oral submucous fibrosis in Xiangtan City, Hunan Province, China. Community Dent Oral Epidemiol 25: 177–180.
    1. Yang YH, Lee HY, Tung S, Shieh TY (2001) Epidemiological survey of oral submucous fibrosis and leukoplakia in aborigines of Taiwan. J Oral Pathol Med 30: 213–219.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel