Division of Health Policy Research and Development, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
Cancer Causes Control. 2010 Sep;21(9):1427-35. doi: 10.1007/s10552-010-9570-1. Epub 2010 May 11.
This cohort study is to assess the extent of cancer risks of betel quid chewing (without tobacco added) beyond oral cancer, as such information was limited from case-control studies.
The cohort, selected from participants in a medical screening program since 1994, consisted of 177,271 adult men with 19.2% chewers of betel quid. As of 2006, out of 4,840 deaths, 1,901 cancer deaths were identified. Mortality hazard ratios (HR) were estimated by Cox proportional hazard model. Life expectancy was calculated by life table method.
One-third of smokers chewed (33%) but most of chewers smoked (90%). Risk for all cancer doubled among chewers (HR = 2.00). Risks of at least six cancer sites were increased among chewers: oral cavity (HR = 12.52), esophagus (HR = 5.64), liver (HR = 2.27), pancreas (HR = 2.67), larynx (HR = 6.24), and lung (HR = 2.43) with risks increased with increasing betel quid amount consumed. All-cancer age-adjusted mortality rates in Taiwan increased 25%, including 223% increase in oral cancer, during the last 20 years when chewing rate increased five- to tenfolds. Chewing on top of smoking increased the risks synergistically, and these two were responsible for at least half (50%) of all cancer deaths among 2 million chewers in Taiwan. Life expectancy of chewers was shorter than non-chewers by 5.93 years at age 20 and 5.55 years at age 40.
In addition to oral cancer, significant increases were seen among chewers for cancer of the esophagus, liver, pancreas, larynx, lung, and all cancer. Chewing and smoking, as combined by most chewers, interacted synergistically and was responsible for half of all cancer deaths in this group. They were responsible for the recent increases in oral, esophageal, pancreatic, and liver cancer in Taiwan. Chewing and smoking shortened their life span by nearly 6 years.
本队列研究旨在评估咀嚼不含烟草的槟榔（简称食檳）除口腔癌以外的癌症风险程度，因为此类信息在病例对照研究中有限。
该队列是从 1994 年以来参加医学筛查计划的参与者中选择的，包括 177271 名成年男性，其中 19.2%为食檳者。截至 2006 年，在 4840 例死亡中，有 1901 例癌症死亡。使用 Cox 比例风险模型估计死亡率风险比（HR）。使用寿命表法计算预期寿命。
三分之一的吸烟者（33%）也咀嚼食檳，但大多数食檳者（90%）都吸烟。食檳者的所有癌症风险增加了一倍（HR=2.00）。食檳者至少有六个癌症部位的风险增加：口腔（HR=12.52）、食道（HR=5.64）、肝脏（HR=2.27）、胰腺（HR=2.67）、喉（HR=6.24）和肺（HR=2.43），且随着食檳量的增加，风险也随之增加。在过去的 20 年里，当咀嚼率增加五到十倍时，台湾所有癌症的年龄调整死亡率增加了 25%，其中口腔癌增加了 223%。在台湾 200 万食檳者中，咀嚼和吸烟的协同作用导致了至少一半（50%）的癌症死亡。食檳者的预期寿命比非食檳者短 5.93 岁（20 岁时）和 5.55 岁（40 岁时）。
除了口腔癌，食檳者还显著增加了食道癌、肝癌、胰腺癌、喉癌、肺癌和所有癌症的风险。作为大多数食檳者的组合，咀嚼和吸烟协同作用，并导致该人群中一半的癌症死亡。它们导致了台湾近期口腔癌、食道癌、胰腺癌和肝癌的增加。咀嚼和吸烟使他们的寿命缩短了近 6 年。
