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. 2016 Oct 25;11(10):e0164937.
doi: 10.1371/journal.pone.0164937. eCollection 2016.

A Comprehensive Analysis on the Association between Tobacco-Free Betel Quid and Risk of Head and Neck Cancer in Taiwanese Men

Yuan-Hua Wu  1 , Chia-Jui Yen  2 , Jenn-Ren Hsiao  3 , Chun-Yen Ou  3 , Jehn-Shyun Huang  4 , Tung-Yiu Wong  4 , Sen-Tien Tsai  3 , Cheng-Chih Huang  3 , Wei-Ting Lee  3 , Ken-Chung Chen  4 , Sheen-Yie Fang  3 , Jiunn-Liang Wu  3 , Wei-Ting Hsueh  1 , Forn-Chia Lin  1 , Ming-Wei Yang  1 , Jang-Yang Chang  2   5 , Hsiao-Chen Liao  3 , Shang-Yin Wu  2 , Chen-Lin Lin  6 , Yi-Hui Wang  5 , Ya-Ling Weng  5 , Han-Chien Yang  5 , Yu-Shan Chen  3 , Jeffrey S Chang  5
Affiliations

A Comprehensive Analysis on the Association between Tobacco-Free Betel Quid and Risk of Head and Neck Cancer in Taiwanese Men

Yuan-Hua Wu et al. PLoS One. .

Abstract

Objectives: Although betel quid (BQ) is an established risk factor of head and neck cancer (HNC), insufficiencies exist in the literature regarding the dose-response, BQ types, HNC sites, and BQ cessation. The current study was conducted to fill these insufficiencies.

Materials and methods: A hospital-based case-control study was conducted to evaluate the association between BQ and HNC. In-person interview was conducted to collect data on BQ chewing. The current analysis included 487 men newly diagnosed with HNC and 617 male controls who were frequency-matched to the cases by age. The association between BQ and HNC was assessed using multivariable unconditional logistic regression.

Results: Ever BQ chewing was associated with an increased HNC risk regardless of the BQ types. A non-linear positive association between BQ and HNC was observed, with a steep rise in HNC risk for the first 5 pack-years or 200,000 minutes of BQ consumption. Every year of BQ cessation was associated with a 2.9% reduction in HNC risk; however, the risk did not reduce to the level of non-BQ chewers even after 20 years of BQ cessation. Eliminating BQ chewing may prevent 51.6% of HNCs, 62.6% of oral cancers, and 41.3% of pharyngeal cancers in Taiwan.

Conclusion: Our results supported the positive association between BQ and HNC. BQ cessation is effective in reducing HNC risk and should be encouraged. Because BQ cessation may not reduce the HNC risk to the level of non-BQ chewers, it is important to prevent the initiation of BQ chewing.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The association between pack-year of betel quid chewing and risk of head and neck cancer.
This figure shows the non-linear relationship between pack-year of betel quid chewing and risk of head and neck cancer. The middle solid line represents the odds ratios, the upper dashed line represents the 95% upper confidence intervals, and the lower dashed line represents the 95% lower confidence intervals.
Fig 2
Fig 2. The association between total minute of betel quid chewing and risk of head and neck cancer.
This figure shows the non-linear relationship between total minute of betel quid chewing and risk of head and neck cancer. The middle solid line represents the odds ratios, the upper dashed line represents the 95% upper confidence intervals, and the lower dashed line represents the 95% lower confidence intervals.
See this image and copyright information in PMC

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