Tobacco smoking, alcohol drinking, betel quid chewing, and the risk of head and neck cancer in an East Asian population

Head Neck. 2019 Jan;41(1):92-102. doi: 10.1002/hed.25383. Epub 2018 Dec 15.


Background: The smoking prevalence among men in China is high, but the head and neck cancer incidence rates are low. This study's purpose was to investigate the impact of tobacco, betel quid, and alcohol on head and neck cancer risk in East Asia.

Methods: A multicenter case-control study (921 patients with head and neck cancer and 806 controls) in East Asia was conducted. The odds ratio (OR) and 95% confidence interval (CI) were estimated using logistic regression.

Results: Head and neck cancer risks were elevated for tobacco (OR = 1.58), betel quid (OR = 8.23), and alcohol (OR = 2.29). The total attributable risk of tobacco and/or alcohol was 47.2%. Tobacco/alcohol appeared to account for a small proportion of head and neck cancer among women (attributable risk of 2.2%). Betel quid chewing alone accounted for 28.7% of head and neck cancer.

Conclusions: Betel quid chewing is the strongest risk factor for oral cavity cancer in this Chinese population. Alcohol may play a larger role for head and neck cancer in this population than in European or U.S.

Keywords: alcohol drinking; attributable fraction, head and neck cancer risk; betel quid chewing; tobacco smoking.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alcohol Drinking / adverse effects*
  • Alcohol Drinking / epidemiology
  • Areca / adverse effects*
  • Asian Continental Ancestry Group
  • Case-Control Studies
  • Far East / epidemiology
  • Female
  • Head and Neck Neoplasms / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Tobacco Smoking / adverse effects*
  • Tobacco Smoking / epidemiology