Abstract
Background:Recreational use of the betel nut, which is common among the South Asian population, is a known risk factor for developing Head and Neck cancer. As South Asians comprise a significant proportion of the United States population, we seek to determine if those living within the country experience a higher rate of head and neck cancers compared to other races. Methods: Data of patients diagnosed with head & neck cancers from 2010-2016 was collected from the National Cancer Database® and compared to race-matched US census data for each corresponding year to calculate incidence. Pairwise comparisons were performed between the incidence for South Asians versus Whites and South Asians versus Blacks using one sided Chi-square tests. Results:South Asians experienced a significantly higher incidence of buccal mucosa/vestibule cancers when compared to Whites or Blacks for every year between 2010-2016, but a comparatively lower incidence of larynx or oropharynx cancers. Conclusions:South Asians residing within the United States have a higher incidence of buccal mucosa/vestibule cancers, but a lower incidence of more common cancers, such as larynx or oropharynx cancer. This may suggest that the etiology behind the high buccal mucosa/vestibule cancer incidence is due to a social habit, as opposed to an inherent racial susceptibility.
Highlights
Areca nut, commonly referred to as Betel nut, is the seed of the Areca catechu palm tree, which is indigenous to Southeast Asia, Pakistan, and India (Staples and Bevacqua, 2006)
Because we strongly suspected that any increased incidence would be due to social habits as opposed to any inherent racial susceptibility, we looked at the incidence rates by race for more common head & cancers, namely oral cavity, oropharynx and larynx cancer- if South Asian incidence rates were high for buccal mucosa cancer but not for more common cancers, that would be highly suggestive that a social habit was responsible
For every year between 2010 and 2016, there was a significantly higher incidence of buccal mucosa/vestibule cancer diagnosed in the South Asian population compared to the White and Black population (Table 2 and Figure 1)
Summary
Commonly referred to as Betel nut, is the seed of the Areca catechu palm tree, which is indigenous to Southeast Asia, Pakistan, and India (Staples and Bevacqua, 2006). Betel nut (with or without the concurrent use of tobacco) with oral cavity and buccal mucosa squamous cell carcinoma (SCC) (Niaz et al, 2017; Bedi and Scully, 2014; Warnakulasuriya et al, 2002; Stich et al, 1982; Dave et al, 1992). Its composition of significant levels of tannins and alkaloids can result in cytotoxicity and genotoxicity, leading to malignant transformation of surrounding tissue (Bedi and Scully, 2014) This is in line with the disproportionally higher recorded incidences and observed mortality of oral cavity and buccal mucosa SCC in South Asia (Pakistan and India) compared to the remainder of the world, with current age-standardized incidence rates estimated to be 12.2/100,000 and 9.1/100,000, respectfully (Warnakulasuriya et al, 2002; Bray et al, 2018). Because we strongly suspected that any increased incidence would be due to social habits as opposed to any inherent racial susceptibility, we looked at the incidence rates by race for more common head & cancers, namely oral cavity, oropharynx and larynx cancer- if South Asian incidence rates were high for buccal mucosa cancer but not for more common cancers, that would be highly suggestive that a social habit was responsible
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