Nonlinear association between betel quid chewing and oral cancer

Implications for prevention

Sreenath Arekunnath Madathil, Marie Claude Rousseau, Willy Wynant, Nicolas F. Schlecht, Gopalakrishnan Netuveli, Eduardo L. Franco, Belinda Nicolau

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose Betel quid chewing is a major oral cancer risk factor and the human papillomaviruses (HPV) may play an aetiological role in these cancers. However, little is known about the shape of the dose-response relationship between the betel quid chewing habit and oral cancer risk in populations without HPV. We estimate the shape of this dose-response relationship, and discuss implications for prevention. Methods Cases with oral squamous cell carcinoma (350) and non-cancer controls (371) were recruited from two major teaching hospitals in South India. Information on socio-demographic and behavioral factors was collected using a questionnaire and the life grid technique. The effect of daily amount of use and duration of the habit were estimated jointly as risk associated with cumulative exposure (chew-years). The shape of the dose-response curve was estimated using restricted cubic spline transformation of chew-years in a conditional logistic regression model. Risk estimates for low dose combinations of daily amount and duration of the habit were computed from flexible regression. Results Most (72%) oral cancer cases were betel quid chewers in contrast to only 18% of controls. A nonlinear dose-response relationship was observed; the risk increased steeply at low doses and plateaued at high exposures to betel quid (>425 chew-years). A threefold increase in risk (OR = 3.92, 95%CI: 1.87–8.21) was observed for the lowest dose; equivalent to the use of one quid per day for one year. Conclusion Our findings may be used to counsel people to refrain from even low betel quid chewing.

Original languageEnglish (US)
Pages (from-to)25-31
Number of pages7
JournalOral Oncology
Volume60
DOIs
StatePublished - Sep 1 2016

Fingerprint

Mouth Neoplasms
Mastication
Habits
Logistic Models
Squamous Cell Neoplasms
Teaching Hospitals
India
Squamous Cell Carcinoma
Demography
Population
Neoplasms

Keywords

  • Betel quid chewing
  • Dose-response
  • Nonlinearity
  • Oral cancer
  • Restricted cubic spline

ASJC Scopus subject areas

  • Oncology
  • Oral Surgery
  • Cancer Research

Cite this

Madathil, S. A., Rousseau, M. C., Wynant, W., Schlecht, N. F., Netuveli, G., Franco, E. L., & Nicolau, B. (2016). Nonlinear association between betel quid chewing and oral cancer: Implications for prevention. Oral Oncology, 60, 25-31. https://doi.org/10.1016/j.oraloncology.2016.06.011

Nonlinear association between betel quid chewing and oral cancer : Implications for prevention. / Madathil, Sreenath Arekunnath; Rousseau, Marie Claude; Wynant, Willy; Schlecht, Nicolas F.; Netuveli, Gopalakrishnan; Franco, Eduardo L.; Nicolau, Belinda.

In: Oral Oncology, Vol. 60, 01.09.2016, p. 25-31.

Research output: Contribution to journalArticle

Madathil, SA, Rousseau, MC, Wynant, W, Schlecht, NF, Netuveli, G, Franco, EL & Nicolau, B 2016, 'Nonlinear association between betel quid chewing and oral cancer: Implications for prevention', Oral Oncology, vol. 60, pp. 25-31. https://doi.org/10.1016/j.oraloncology.2016.06.011
Madathil, Sreenath Arekunnath ; Rousseau, Marie Claude ; Wynant, Willy ; Schlecht, Nicolas F. ; Netuveli, Gopalakrishnan ; Franco, Eduardo L. ; Nicolau, Belinda. / Nonlinear association between betel quid chewing and oral cancer : Implications for prevention. In: Oral Oncology. 2016 ; Vol. 60. pp. 25-31.
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