Different impact from betel quid, alcohol and cigarette: risk factors for pharyngeal and laryngeal cancer.
The risks of betel quid chewing with or without tobacco, alcohol drinking and cigarette smoking have been well explored in the oral cavity but not in the pharynx and larynx. We conducted a case-control study to investigate the association of these three risk factors to cancers of the pharynx and larynx in Taiwan. A total cases of 148 pharyngeal cancer, 128 laryngeal cancer and 255 hospital controls, all men, were recruited. Betel quid chewing was a significant independent risk factor (adjusted odds ratio [aOR] = 7.7; 95% confidence interval [CI] = 4.1-15.0) similar to that of alcohol drinking (aOR = 6.6; 95% CI = 3.5-13.0) for pharyngeal cancer, but not for laryngeal cancer (aOR = 1.3; 95% CI = 0.7-2.5) on which cigarette smoking (aOR = 7.1) exerts a stronger significant independent risk than alcohol drinking (aOR = 3.8). For pharyngeal cancers, chewers who consumed >20 quid/day, chewed with inflorescence in the quid or swallowed the betel quid juice were at higher risks; significant dose-response effects were found in daily quantity of drinking and chewing, and cumulative quantity of drinking. Synergistic effects from the 3 risk factors existed both on the pharynx (aOR = 96.9) and the larynx (aOR = 40.3), and attributed for 93.1% and 92.9% respectively. Our study is the first evidence to show that betel quid chewing without tobacco has different impact on the pharynx (digestive tract) and the larynx (airway), and supports the concept that exposure quantity and direct mucosal contact with the betel quid juice may contribute to carcinogenesis. Our results show an important insight into the impact of betel quid chewing on other sites of the digestive tract other than the oral cavity.
Lee
Ka-Wo
KW
Department of Otolaryngology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan, ROC.
Kuo
Wen-Rei
WR
Tsai
Shih-Meng
SM
Wu
Deng-Chyang
DC
Wang
Wen-Ming
WM
Fang
Fu-Min
FM
Chiang
Feng-Yu
FY
Ho
Kuen-Yao
KY
Wang
Ling-Feng
LF
Tai
Chih-Feng
CF
Kao
Eing-Long
EL
Chou
Shah-Hwa
SH
Lee
Chien-Hung
CH
Chai
Chee-Yin
CY
Ko
Ying-Chin
YC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects*; D001114:Areca / Q000009:adverse effects*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000209:etiology*; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D014026:Nicotiana