Paan without tobacco: An independent risk factor for oral cancer

Oral cancer is the second most common cancer in women and the third most co mmon in men in Pakistan. Tobacco is smoked and chewed extensively in Pakist an. Paan is a quid of piper betel leaf that contains areca nut, lime, condi ment, sweeteners, and sometimes tobacco, which is also used extensively. We did this study to clarify the independent association of paan and oval can cer. Between July 1996 and March 1998, we recruited biopsy-proven, primary cases of oral squamous-cell carcinoma, from 3 tertiary teaching centers in Karachi, Pakistan, and controls pair-matched for age, gender, hospital and time of occurrence, excluding persons with a past or present history of any malignancy. There were 79 cases and 149 controls. Approximately 68% of the cases were men, 49 years old on average, the youngest being 22 years old a nd the eldest 80. People with oral submucous fibrosis were 19.1 times more likely to develop oral cancer than those without it, after adjusting for ot her risk factors. People using paan without tobacco were 9.9 times, those u sing paan with tobacco 8.4 times, more likely to develop oral cancer as com pared with non-users, after adjustment for other covariates. This study ide ntifies an independent effect of paan without tobacco in the causation of o ral cancer. Its findings may be of significance in South Asian communities where paan is used, and among health-care providers who treat persons from South Asia. Int. J. Cancer 86:128-131, 2000. (C) 2000 Wiley-Liss. Inc.