Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis

Background: Areca nut (AN), the principal ingredient of betel quid (BQ) has been categorized as a human carcinogen associated with various cancers of upper aerodigestive tract. However, there has been no attempt at summarizing the risk reversal of oral and other cancers after cessation of BQ with or...

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Main Authors: Ruchika Gupta, Lorena C. Mariano, Suzanne T. Nethan, Ashwini Kedar, Dhirendra N. Sinha, Saman Warnakulasuriya, Luis Monteiro, Shashi Sharma, Sanjay Gupta, Shalini Singh, Kurt Straif
Format: Article
Language:English
Published: Ubiquity Press 2022-01-01
Series:Annals of Global Health
Online Access:https://annalsofglobalhealth.org/articles/3643
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author Ruchika Gupta
Lorena C. Mariano
Suzanne T. Nethan
Ashwini Kedar
Dhirendra N. Sinha
Saman Warnakulasuriya
Luis Monteiro
Shashi Sharma
Sanjay Gupta
Shalini Singh
Kurt Straif
author_facet Ruchika Gupta
Lorena C. Mariano
Suzanne T. Nethan
Ashwini Kedar
Dhirendra N. Sinha
Saman Warnakulasuriya
Luis Monteiro
Shashi Sharma
Sanjay Gupta
Shalini Singh
Kurt Straif
author_sort Ruchika Gupta
collection DOAJ
description Background: Areca nut (AN), the principal ingredient of betel quid (BQ) has been categorized as a human carcinogen associated with various cancers of upper aerodigestive tract. However, there has been no attempt at summarizing the risk reversal of oral and other cancers after cessation of BQ with or without tobacco (BQ+T/BQ-T). Objective: To analyze the effect of cessation of betel quid without tobacco (BQ-T) and with tobacco (BQ+T) on reversal of the risk of oral, pharyngeal and oesophageal cancers. Methods: A systematic literature search was conducted for publications evaluating risk of these three cancers among current and former users of BQ-T or BQ+T. The overall as well as subgroup meta-relative risks (meta-RR) were estimated using random-effect models. Results: A total of 14 studies, seven each providing estimates for BQ-T and BQ+T, were identified. For BQ-T and oral cancer, a 28.9% risk reversal was observed among former users (meta-RR 5.61, 95% CI 2.24–14.04) compared to current users (meta-RR 7.89, 95% CI 3.90–15.98). A risk reversal of 48% was noted for pharyngeal cancer – former users (meta-RR 2.50, 95% CI 1.43–4.38), current users (meta-RR 4.81, 95% CI 2.05–11.30). For oesophageal cancer, no appreciable difference in risk was observed between current and former users. For BQ+T and oral cancer the overall meta-RR indicated a higher risk in former than in current users. However, sensitivity analysis including only better-quality studies showed a modestly lower cancer risk in former than in current users. Compared to current users, the risk in former users who quit less than 10 years ago (meta-RR 1.21, 95% CI 0.90–1.63) was increased, but decreased in former users who quit more than 10 years ago (meta-RR 0.72, 95% CI 0.48–1.07). Conclusion: Our analysis highlights for the first time the potential of risk reversal for oral and pharyngeal cancers following cessation of BQ-T and for oral cancer in long-term quitters (greater than 10 years) of BQ+T. The suggestive evidence from this systematic review further supports the imperative need of a strong policy to reduce the initiation of BQ use and inclusion of interventions for BQ cessation in cancer control efforts especially in geographic regions where BQ chewing is prevalent.
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spelling doaj.art-d78f195d4c1448419ad5ba0a2f5423be2022-12-21T17:24:39ZengUbiquity PressAnnals of Global Health2214-99962022-01-0188110.5334/aogh.36432713Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-AnalysisRuchika Gupta0Lorena C. Mariano1Suzanne T. Nethan2Ashwini Kedar3Dhirendra N. Sinha4Saman Warnakulasuriya5Luis Monteiro6Shashi Sharma7Sanjay Gupta8Shalini Singh9Kurt Straif10ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, NoidaUNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), CESPU, Gandra; Medicine and Oral Surgery Department, Instituto Universitário de Ciências da Saúde (IUCS), GandraSchool of Preventive Oncology, PatnaProgram Officer QC Process, STOP C clinical trial, YRGCARE, DelhiSchool of Preventive Oncology, PatnaFaculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, WHO Collaborating Centre for Oral Cancer, LondonUNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), CESPU, Gandra; Medicine and Oral Surgery Department, Instituto Universitário de Ciências da Saúde (IUCS), GandraIndependent researcherICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, NoidaICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida; WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, NoidaISGlobal, Barcelona, Spain, and Boston College, Chestnut Hill, MABackground: Areca nut (AN), the principal ingredient of betel quid (BQ) has been categorized as a human carcinogen associated with various cancers of upper aerodigestive tract. However, there has been no attempt at summarizing the risk reversal of oral and other cancers after cessation of BQ with or without tobacco (BQ+T/BQ-T). Objective: To analyze the effect of cessation of betel quid without tobacco (BQ-T) and with tobacco (BQ+T) on reversal of the risk of oral, pharyngeal and oesophageal cancers. Methods: A systematic literature search was conducted for publications evaluating risk of these three cancers among current and former users of BQ-T or BQ+T. The overall as well as subgroup meta-relative risks (meta-RR) were estimated using random-effect models. Results: A total of 14 studies, seven each providing estimates for BQ-T and BQ+T, were identified. For BQ-T and oral cancer, a 28.9% risk reversal was observed among former users (meta-RR 5.61, 95% CI 2.24–14.04) compared to current users (meta-RR 7.89, 95% CI 3.90–15.98). A risk reversal of 48% was noted for pharyngeal cancer – former users (meta-RR 2.50, 95% CI 1.43–4.38), current users (meta-RR 4.81, 95% CI 2.05–11.30). For oesophageal cancer, no appreciable difference in risk was observed between current and former users. For BQ+T and oral cancer the overall meta-RR indicated a higher risk in former than in current users. However, sensitivity analysis including only better-quality studies showed a modestly lower cancer risk in former than in current users. Compared to current users, the risk in former users who quit less than 10 years ago (meta-RR 1.21, 95% CI 0.90–1.63) was increased, but decreased in former users who quit more than 10 years ago (meta-RR 0.72, 95% CI 0.48–1.07). Conclusion: Our analysis highlights for the first time the potential of risk reversal for oral and pharyngeal cancers following cessation of BQ-T and for oral cancer in long-term quitters (greater than 10 years) of BQ+T. The suggestive evidence from this systematic review further supports the imperative need of a strong policy to reduce the initiation of BQ use and inclusion of interventions for BQ cessation in cancer control efforts especially in geographic regions where BQ chewing is prevalent.https://annalsofglobalhealth.org/articles/3643
spellingShingle Ruchika Gupta
Lorena C. Mariano
Suzanne T. Nethan
Ashwini Kedar
Dhirendra N. Sinha
Saman Warnakulasuriya
Luis Monteiro
Shashi Sharma
Sanjay Gupta
Shalini Singh
Kurt Straif
Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis
Annals of Global Health
title Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis
title_full Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis
title_fullStr Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis
title_full_unstemmed Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis
title_short Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis
title_sort risk reversal of oral pharyngeal and oesophageal cancers after cessation of betel quid users a systematic review and meta analysis
url https://annalsofglobalhealth.org/articles/3643
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