Betel quid–associated cancer: Prevention strategies and targeted treatment

• Published in: Cancer letters Vol. 477; pp. 60 - 69
• Main Authors: Ko, Albert Min-Shan, Lee, Chien-Hung, Ko, Ying-Chin
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2020; Elsevier Limited
• Subjects: Acetylcysteine; Acetylcysteine - metabolism; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antioxidants; Areca - adverse effects; Areca - toxicity; Areca catechu; Arecoline - analogs & derivatives; Arecoline - toxicity; Arecoline N-Oxide; Carcinogenesis; Carcinogens; Carcinogens - toxicity; Chemoprevention; Chemopreventive agents; Cyclic N-Oxides - toxicity; Detoxification; Drug dosages; Hazardous materials; Humans; Hyperplasia; Inactivation, Metabolic; Inflammation; Mass Screening; Medical prognosis; Metabolites; Mouth Neoplasms - etiology; Mouth Neoplasms - mortality; Mouth Neoplasms - prevention & control; Mouth Neoplasms - therapy; Mutation; Nuts; Oral cancer; Oxidation; Patients; Prevention; Reactive oxygen species; Risk groups; Surgery; Tobacco; Taiwan; India; Reactive oxygen species; Carcinogenesis; Chemoprevention; Arecoline N-Oxide; Detoxification
• ISSN: 0304-3835; 1872-7980; 1872-7980
• DOI: 10.1016/j.canlet.2020.02.030

Betel quid (BQ) and areca nut use are at risk of cancer. This review includes the latest evidence of carcinogenesis caused by BQ exposure, suggests possible prevention strategies. We conducted a systematic literature search in the PubMed and Web of Science databases to identify relevant articles published in the past 10 years according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Arecoline N-oxide, a metabolite of areca nut, is likely an initiator in carcinogenesis and is detoxified by N-acetylcysteine. Oral potentially malignant disorder and reactive oxygen species involved in carcinogenesis pathways may be treatable using antioxidants. Screening programs conducted by trained physicians are useful for identifying patients with early stages of oral cancer in high-risk groups. Anti-inflammatory medications may be used as chemopreventive agents in the disease-free stage after surgery. The association between survival and tumor somatic mutations in patients who chew BQ should be addressed in cancer studies. Current evidence on the natural course from BQ exposure to cancer occurrence and development provides information for developing primary, secondary, and tertiary prevention strategies against BQ-associated cancer at clinical or translational levels. •Arecoline N-oxide may be a carcinogenic initiator and is detoxified by N-acetylcysteine.•ROS and OPMD play a role in carcinogenesis and may be treatable using antioxidants.•Screening programs are useful for identifying patients with early stages of oral cancer in high-risk groups.•Anti-inflammatory medication may be used as chemopreventive agent in the disease-free stage after surgery for oral cancer.•The relationship between AN metabolites, tumor somatic mutation and patient survival should be addressed in future studies.