Nonlinear association between betel quid chewing and oral cancer: Implications for prevention

More than 300,000 individuals were diagnosed with oral cancer worldwide in 2012 [1], with India having one of the highest rates of the disease in the world. The 2010 age-standardized mortality rates from this cancer were 22.1 and 9.4 deaths per 100,000 men and women, respectively [2]. The high prevalence of betel quid chewing is the major cause of this elevated incidence and mortality; more than one fourth of the Indian population are betel quid chewers [3]. Betel quid is a mixture of areca nut (nut of a palm tree – Areca catechu), slaked lime (calcium hydroxide), and betel leaf (leaf of the piper betel vine), with or without tobacco [4].

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