ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, IN.
UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), CESPU, Gandra, Portugal and Medicine and Oral Surgery Department, Instituto Universitário de Ciências da Saúde (IUCS), Gandra, PT.
Ann Glob Health. 2022 Jan 11;88(1):5. doi: 10.5334/aogh.3643. eCollection 2022.
Areca nut (AN), the principal ingredient of betel quid (BQ) has been categorized as a human carcinogen associated with various cancers of upper aerodigestive tract. However, there has been no attempt at summarizing the risk reversal of oral and other cancers after cessation of BQ with or without tobacco (BQ+T/BQ-T).
To analyze the effect of cessation of betel quid without tobacco (BQ-T) and with tobacco (BQ+T) on reversal of the risk of oral, pharyngeal and oesophageal cancers.
A systematic literature search was conducted for publications evaluating risk of these three cancers among current and former users of BQ-T or BQ+T. The overall as well as subgroup meta-relative risks (meta-RR) were estimated using random-effect models.
A total of 14 studies, seven each providing estimates for BQ-T and BQ+T, were identified. For BQ-T and oral cancer, a 28.9% risk reversal was observed among former users (meta-RR 5.61, 95% CI 2.24-14.04) compared to current users (meta-RR 7.89, 95% CI 3.90-15.98). A risk reversal of 48% was noted for pharyngeal cancer - former users (meta-RR 2.50, 95% CI 1.43-4.38), current users (meta-RR 4.81, 95% CI 2.05-11.30). For oesophageal cancer, no appreciable difference in risk was observed between current and former users.For BQ+T and oral cancer the overall meta-RR indicated a higher risk in former than in current users. However, sensitivity analysis including only better-quality studies showed a modestly lower cancer risk in former than in current users. Compared to current users, the risk in former users who quit less than 10 years ago (meta-RR 1.21, 95% CI 0.90-1.63) was increased, but decreased in former users who quit more than 10 years ago (meta-RR 0.72, 95% CI 0.48-1.07).
Our analysis highlights for the first time the potential of risk reversal for oral and pharyngeal cancers following cessation of BQ-T and for oral cancer in long-term quitters (greater than 10 years) of BQ+T. The suggestive evidence from this systematic review further supports the imperative need of a strong policy to reduce the initiation of BQ use and inclusion of interventions for BQ cessation in cancer control efforts especially in geographic regions where BQ chewing is prevalent.
槟榔（AN）是槟榔果的主要成分，已被归类为人类致癌物，与上呼吸道道各种癌症有关。然而，目前还没有尝试总结停止使用含或不含烟草的槟榔果（BQ+T/BQ-T）后口腔和其他癌症风险逆转的情况。
分析停止使用含烟草的槟榔果（BQ+T）和不含烟草的槟榔果（BQ-T）对逆转口腔、咽和食管癌症风险的影响。
对评估当前和以前使用 BQ-T 或 BQ+T 的人群中这三种癌症风险的出版物进行系统文献检索。使用随机效应模型估计总体和亚组的meta-相对风险（meta-RR）。
共确定了 14 项研究，其中 7 项分别提供了 BQ-T 和 BQ+T 的估计值。对于 BQ-T 和口腔癌，与当前使用者（meta-RR 7.89，95%CI 3.90-15.98）相比，前使用者（meta-RR 5.61，95%CI 2.24-14.04）的风险逆转了 28.9%。咽癌的风险逆转了 48% - 前使用者（meta-RR 2.50，95%CI 1.43-4.38），当前使用者（meta-RR 4.81，95%CI 2.05-11.30）。对于食管癌，当前使用者和前使用者之间的风险无明显差异。对于 BQ+T 和口腔癌，总体 meta-RR 表明前使用者的风险高于当前使用者。然而，包括仅高质量研究的敏感性分析表明，前使用者的癌症风险略低于当前使用者。与当前使用者相比，10 年前戒烟的前使用者的风险增加（meta-RR 1.21，95%CI 0.90-1.63），但 10 年前戒烟的前使用者的风险降低（meta-RR 0.72，95%CI 0.48-1.07）。
我们的分析首次强调了停止使用 BQ-T 后口腔和咽癌以及 BQ+T 中长时间戒烟者（大于 10 年）的口腔癌风险逆转的潜力。本系统评价的提示性证据进一步支持了在槟榔咀嚼流行的地理区域，需要制定强有力的政策来减少槟榔使用的开始，并将槟榔戒除干预措施纳入癌症控制工作的迫切需要。
