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A lesser known reason of epidemic proportion of oral cancer in India is the rampant use of Areca nut chewing. Just like tobacco, areca nut or betel nut is a psychostimulant, an addictive substance and a carcinogen. The cancer causing properties of areca nut have been well-reported in animal, human and epidemiologic studies. The World Health Organization and International Agency for Research on cancer classified areca nut as a Group 1 human carcinogens with sufficient evidence of increased risk of submucus fibrosis (precancerous oral lesion) and cancers of the oral cavity, pharynx, and esophagus. This was based upon several studies from India, Bangladesh, Pakistan and Taiwan. Cancers caused by betel nut chewing also shows a strong dose–response relationship for frequency and duration of chewing. It is postulated that areca nut-specific N-nitroso compounds converted from alkaloids are responsible for oral and pharyngeal cancer. There are several other reports that have linked areca nut chewing (with or without tobacco) with hepatocellular carcinoma, cholangiocarcinoma, cancers of the larynx, stomach, lung and cervix in humans.

Areca Nut or Betel Nut Control is Mandatory if India Wants to Reduce the Burden of Cancer Especially Cancer of the Oral Cavity