Safrole in betel quid may be a risk factor for hepatocellular carcinoma: case report

Chewing betel quid or the combination of chewing, betel quid and smoking ci garettes is associated with an increased risk of oral squamous cell carcino ma.(1) The composition of betel quid varies with geographic location. In Ta iwan betel quid is composed of areca nut (Areca catechu, an, Asian tropical palm), slaked lime, and the inflorescence or leaf of Piper betle (an Asian climbing plant). The inflorescence of Piper betle contains high concentrat ions (15 mg/g fresh weight) of safrole, an essential oil used in cosmetics and as a food flavouring. Safrole is classified as a rodent hepatocarcinoge n,(2) and chewing betel quid may contribute to human exposure to this compo und. The saliva of a person chewing betel quid contains on average 420 mu m ol/L of safrole.(3) We describe a case of hepatocellular carcinoma in a Taiwanese man who had c hewed betel quid for over 32 years; safrole-DNA adducts, a likely cause of liver carcinogenesis, were found in liver biopsy specimens.