Impact of chewing betel-nut (Areca catechu) on liver cirrhosis and hepatocellular carcinoma: a population-based study from an area with a high prevalence of hepatitis B and C infections.
BACKGROUND
Chewing betel-nuts (Areca catechu) is carcinogenic but the risk for hepatocellular carcinoma (HCC) and liver cirrhosis (LC) is little considered. Worldwide 600 million people chew betel, including emigrants from palm-growing countries.


OBJECTIVE
We aimed to assess the relationships and dose-response effects of betel chewing on LC and HCC risks, since habit cessation could reduce the increased risks of HCC and LC found in such communities.


METHODS
Screening 60 326 subjects aged 30-79 years in a population-based study in Taiwan identified LC in 588 and HCC in 131 subjects. Demographic features, hepatitis B/C infections, other risk factors and betel chewing were noted. Multiple Cox regression models were used to assess independent relationships, interactions and synergisms between age, betel chewing and hepatitis B/C.


RESULTS
Betel chewing increased LC and HCC risk 4.25-fold (95 % CI 2.9, 6.2) in current chewers and 1.89-fold (95 % CI 1.13, 3.16) in ex-chewers v. never-chewers, with dose effects for quantity, duration and cumulative exposure in chewers. Subjects without hepatitis B/C infections had 5.0-fold (95 % CI 2.87, 9.03) increased risk of LC/HCC v. never-chewers, and betel chewing had an additive synergistic effect on hepatitis B/C-related risks. Risk reduction with betel habit cessation could exceed that expected from immunization programmes for hepatitis B and C.


CONCLUSIONS
Increased risks of cirrhosis and hepatocellular cancer were found in betel chewers free of hepatitis B/C infection, and these risks were synergistically additive to those of hepatitis B/C infections. Estimated risk reduction from effective anti-betel chewing programmes would be sizeable.
Wu
Grace Hui-Min
GH
Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Room 521, No. 17 Hsuchow Road, Taipei, Taiwan.
Boucher
Barbara J
BJ
Chiu
Yueh-Hsia
YH
Liao
Chao-Sheng
CS
Chen
Tony Hsiu-Hsi
TH
D000328:Adult; D000368:Aged; D001114:Areca / Q000009:adverse effects*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology*; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008409:Mastication; D008875:Middle Aged; D015995:Prevalence
D006514:Hepatitis B Surface Antigens