title: Screening for oral potentially malignant disorders among areca (betel) nut chewers in Guam and Saipan.
abstract: BACKGROUND
  The Mariana Islands, including Guam and Saipan, are home to many ethnic subpopulations of Micronesia. Oral cancer incidence rates vary among subpopulations, and areca (betel) nut chewing, a habit with carcinogenic risks, is common. Our objectives were to conduct a screening program to detect oral potentially malignant disorders (OPMD) in betel nut chewers, measure their betel nut chewing practices, and assess the prevalence of the oral human papillomavirus (HPV) infection in a subset of betel nut chewers in these islands.
  
  
  METHODS
  A cross-section of 300 betel nut chewers ≥18 years old [in Guam (n = 137) and in Saipan (n = 163)] were recruited between January 2011-June 2012. We collected demographic, socioeconomic, and oral behavioural characteristics. Latent class analysis was used to identify chewing patterns from selected chewing behaviours. Following calibration of OPMD against an expert, a registered oral hygienist conducted oral examinations by house to house visits and referred positive cases to the study dentist for a second oral examination. Buccal smears were collected from a subset (n = 123) for HPV testing.
  
  
  RESULTS
  Two classes of betel nut chewers were identified on 7 betel nut behaviours, smoking, and alcohol use; a key difference between the two Classes was the addition of ingredients to the betel quid among those in Class 2. When compared on other characteristics, Class 1 chewers were older, had been chewing for more years, and chewed fewer nuts per day although chewing episodes lasted longer than Class 2 chewers. More Class 1 chewers visited the dentist regularly than Class 2 chewers. Of the 300 participants, 46 (15.3%; 3.8% for Class 1 and 19.4% for Class 2) had OPMD and one (0.3%) was confirmed to have squamous cell carcinoma. The prevalence of oral HPV was 5.7% (7/123), although none were high-risk types.
  
  
  CONCLUSIONS
  We found two patterns of betel nut chewing behaviour; Class 2 had a higher frequency of OPMD. Additional epidemiologic research is needed to examine the relationship between pattern of chewing behaviours and oral cancer incidence. Based on risk stratification, oral screening in Guam and Saipan can be targeted to Class 2 chewers.
authors.affiliation: Cancer Research Center of Guam, University of Guam, UOG Station, Mangilao, GU, USA. yvettecpaulino@uguam.uog.edu.
authors.forename: Yvette C
authors.initials: YC
authors.lastname: Paulino
authors.forename: Eric L
authors.initials: EL
authors.lastname: Hurwitz
authors.forename: Saman
authors.initials: S
authors.lastname: Warnakulasuriya
authors.forename: Robert R
authors.initials: RR
authors.lastname: Gatewood
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Pierson
authors.forename: Lynnette F
authors.initials: LF
authors.lastname: Tenorio
authors.forename: Rachel
authors.initials: R
authors.lastname: Novotny
authors.forename: Neal A
authors.initials: NA
authors.lastname: Palafox
authors.forename: Lynne R
authors.initials: LR
authors.lastname: Wilkens
authors.forename: Grazyna
authors.initials: G
authors.lastname: Badowski
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology; D052685:Alphapapillomavirus / Q000502:physiology; D001114:Areca / Q000145:classification; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D003430:Cross-Sectional Studies; D003581:Cytodiagnosis; D003729:Dental Care / Q000706:statistics & numerical data; D005260:Female; D006141:Guam / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D008297:Male; D008403:Mass Screening; D008849:Micronesia / Q000453:epidemiology; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D009909:Oral Health; D030361:Papillomavirus Infections / Q000453:epidemiology; D010865:Pilot Projects; D011230:Precancerous Conditions / Q000453:epidemiology*; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D013997:Time Factors