Nair Urmila, Bartsch Helmut, Nair Jagadeesan
Division of Toxicology and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Mutagenesis. 2004 Jul;19(4):251-62. doi: 10.1093/mutage/geh036.
In south-east Asia, Taiwan and Papua New Guinea, smoking, alcohol consumption and chewing of betel quid with or without tobacco or areca nut with or without tobacco are the predominant causes of oral cancer. In most areas, betel quid consists of a mixture of areca nut, slaked lime, catechu and several condiments according to taste, wrapped in a betel leaf. Almost all habitual chewers use tobacco with or without the betel quid. In the last few decades, small, attractive and inexpensive sachets of betel quid substitutes have become widely available. Aggressively advertised and marketed, often claimed to be safer products, they are consumed by the very young and old alike, particularly in India, but also among migrant populations from these areas world wide. The product is basically a flavoured and sweetened dry mixture of areca nut, catechu and slaked lime with tobacco (gutkha) or without tobacco (pan masala). These products have been strongly implicated in the recent increase in the incidence of oral submucous fibrosis, especially in the very young, even after a short period of use. This precancerous lesion, which has a high rate of malignant transformation, is extremely debilitating and has no known cure. The use of tobacco with lime, betel quid with tobacco, betel quid without tobacco and areca nut have been classified as carcinogenic to humans. As gutkha and pan masala are mixtures of several of these ingredients, their carcinogenic affect can be surmised. We review evidence that strongly supports causative mechanisms for genotoxicity and carcinogenicity of these substitute products. Although some recent curbs have been put on the manufacture and sale of these products, urgent action is needed to permanently ban gutkha and pan masala, together with the other established oral cancer-causing tobacco products. Further, education to reduce or eliminate home-made preparations needs to be accelerated.
在东南亚、台湾和巴布亚新几内亚，吸烟、饮酒以及咀嚼含有或不含有烟草的槟榔或含有或不含有烟草的槟榔果是口腔癌的主要病因。在大多数地区，槟榔是由槟榔果、熟石灰、儿茶和几种根据口味添加的调味品混合而成，用槟榔叶包裹。几乎所有经常咀嚼槟榔的人都会使用烟草，无论是否与槟榔一起使用。在过去几十年里，小巧、诱人且价格低廉的槟榔替代产品小包装已广泛可得。这些产品经过大力宣传和营销，常宣称是更安全的产品，受到年轻人和老年人的喜爱，尤其在印度，世界各地来自这些地区的移民群体中也有消费。该产品基本上是一种加了香料和甜味剂的干混合物，包含槟榔果、儿茶、熟石灰，有烟草（古特卡）或没有烟草（潘马萨拉）。这些产品与近期口腔黏膜下纤维化发病率的上升密切相关，尤其是对年轻人，即使短时间使用后也是如此。这种癌前病变恶性转化率很高，极其使人衰弱，且尚无已知的治愈方法。使用含石灰的烟草、含烟草的槟榔、不含烟草的槟榔和槟榔果已被归类为对人类致癌。由于古特卡和潘马萨拉是这些成分中的几种的混合物，可以推测它们的致癌作用。我们综述了有力支持这些替代产品遗传毒性和致癌性致病机制的证据。尽管最近对这些产品的生产和销售采取了一些限制措施，但仍需要采取紧急行动，永久禁止古特卡和潘马萨拉以及其他已确定的导致口腔癌的烟草产品。此外，需要加快开展教育，以减少或消除自制制剂。
