Betel quid chewing as a risk factor for hepatocellular carcinoma: a case-control study

Br J Cancer. 2001 Mar 2;84(5):709-13. doi: 10.1054/bjoc.1999.1597.


The role of betel quid chewing in the aetiology of hepatocellular carcinoma (HCC) was evaluated in a case-control study including 263 pairs of age- and sex-matched HCC patients and healthy controls. Serum hepatitis B surface antigen (HBsAg), and antibodies to hepatitis C virus (anti-HCV) were determined, and standardized personal interview conducted using a structured questionnaire. Multivariate analysis indicated that betel quid chewing (odds ratio (OR), 3.49; 95% confidence interval (CI), 1.74-6.96), HBsAg (OR, 16.69; 95% CI, 9.92-28.07), anti-HCV (OR, 38.57; 95% CI, 18.15-81.96), and educational duration of less than 10 years (OR, 1.71; 95% CI, 1.05-2.78) are independent risk factors of HCC. In addition, there was an additive interaction between betel quid chewing and chronic infection with either hepatitis B virus (synergy index, 5.37) or hepatitis C virus (synergy index, 1.66). Moreover, risk on HCC increased as duration of betel quid chewing increased, or amount of betel quid consumed (each P for trend < 0.0001).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Areca / adverse effects*
  • Carcinoma, Hepatocellular / epidemiology
  • Carcinoma, Hepatocellular / etiology*
  • Case-Control Studies
  • Educational Status
  • Female
  • Hepatitis B / diagnosis
  • Hepatitis C / diagnosis
  • Humans
  • Liver Neoplasms / epidemiology
  • Liver Neoplasms / etiology*
  • Male
  • Mastication
  • Middle Aged
  • Plants, Medicinal*
  • Risk Factors