Betel Quid Chewing Without Tobacco

@article{Song2015BetelQC,
  title={Betel Quid Chewing Without Tobacco},
  author={Han Song and Yi Wan and Yong-yong Xu},
  journal={Asia-Pacific Journal of Public Health},
  year={2015},
  volume={27},
  pages={NP47 - NP57}
}
Betel quid without tobacco is an important factor influencing the incidences of oral cancer and precancer. This study systematically evaluated the associations between betel quid containing no tobacco and oral cancer and precancer, with implications for the prevention of oral cancer. We searched MEDLINE, ISI Web of Science, and EMBASE (to April 2011) and retrieved studies that investigated the relationship between chewing betel quid and oral cancer (or precancer). We performed a meta-analysis… 
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References

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TLDR
It was found by univariate analysis that alcohol consumption, smoking, betel quid chewing, educational level and occupation were associated with oral cancer, and there was a statistically significant association between oral cancer and betelQuid chewing alone.
Betel quid not containing tobacco and oral cancer: A report on a case–control study in Papua New Guinea and a meta‐analysis of current evidence
TLDR
Preventive efforts should discourage betel quid chewing as well as smoking, according to a case–control study in Papua New Guinea and a systematic review of previous studies.
The precancer risk of betel quid chewing, tobacco use and alcohol consumption in oral leukoplakia and oral submucous fibrosis in southern Taiwan
TLDR
It is suggested that, although betel quid chewing was a major cause for both OL and OSF, its effect might be difference between the two diseases, and cigarette smoking has a modifying effect in the development of oral leukoplakia.
The association of smoking, alcoholic consumption, betel quid chewing and oral cavity cancer: a cohort study
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Results of multivariate logistic regression showed that habitual cigarette smokers, alcohol consumers, and betel quid chewers have a higher risk of contracting oral cavity cancer and should receive oral mucosal screening regularly so potential Oral cavity cancer can be detected as early as possible, which may result in better and improved survival of oral cancer patients.
Impact of betel quid, tobacco and alcohol on three-stage disease natural history of oral leukoplakia and cancer: implication for prevention of oral cancer
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TLDR
It was concluded that smoking and betel quid were two significant risk factors for the occurrence of leukoplakia, whereas alcohol was significantly responsible for malignant transformation.
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TLDR
There is a well-established association between betel quid use and severe oral disorders, including oral submucous fibrosis, oral leukoplakia, oral squamous cell carcinoma, and periodontal disease.
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