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Head and Neck Surgery

(256) Implications of Betel (Areca) Nut Use on Buccal Mucosa Cancer

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Kelly A. Wentland, BBA

    Medical Student
    Loyola University Chicago Stritch School of Medicine
    Chicago, Illinois, United States

    • Co-Author(s)

  • Mohammad K. Shukairy, MD

    Resident Physician
    Loyola University Medical Center, Department of Otolaryngology
    Flushing, Michigan, United States

  • Eric J. Thorpe, MD

    Chairman
    Loyola University Medical Center, Department of Otolaryngology-Head and Neck Surgery
    Maywood, Illinois, United States

    • Senior Author(s)

  • Andrea Ziegler, MD

    Assistant Professor
    Loyola University Medical Center
    Maywood, Illinois, United States

Disclosure(s):
Kelly A. Wentland, BBA: No relevant relationships to disclose.
Mohammad K. Shukairy, MD: No relevant relationships to disclose.
Eric J. Thorpe, MD: No relevant relationships to disclose.
Andrea Ziegler, MD: No relevant relationships to disclose.


Introduction: There is growing evidence that betel nut use, a popular custom endemic to South and Southeast Asia, is strongly connected to several serious health conditions including oral cancer. Its clinical and prognostic significance pertaining to squamous cell carcinoma (SCC) of the buccal mucosa is an area of needed research.

Methods: This study is a retrospective chart review conducted from 1/1/2010 to 6/1/2022 evaluating the impact of betel nut use on patients with a history of surgically treated buccal mucosa SCC. Patients were screened to ensure the capture of SCC of the buccal mucosa, excluding other pathology or subsites. Data collected included patient demographics, social history, tumor stage, treatment type and complications, recurrence rates, and overall prognosis.

Results: During the study period, 769 operations were performed on a total of 684 patients. SCC of the buccal mucosa was identified in 53 (7.7%) patients. A history of betel nut use was seen in 13 (25%) of these patients. Betel nut use was associated with younger age of onset, stronger male predilection, and seen more commonly in patients from South Asia (p = < 0.05). Patients with a history of betel nut use were also more likely to undergo gastrostomy tube placement (p = < 0.05). No significant difference was found in tumor behavior between the 2 groups, specifically pertaining to histopathologic findings, recurrence rates, and 5-year overall survival.

Conclusions: The implications of betel nut use on SCC of the oral cavity, particularly of the buccal mucosa, are important to recognize as this practice may present new and unique challenges in the treatment of these patients. Our results are consistent with this conclusion, although more research with larger sample sizes is needed to expand our understanding of this process.