a research agenda for betel quid and areca nut and oral cancer … · 2017. 12. 10. · 3...

A Research Agenda for Betel Quid and Areca Nut and Oral Cancer

Recommendations from the International Conference on Betel Quid and Areca Nut

Presented by: Mark Parascandola

Epidemiologist

National Cancer Institute

Interna'onalConferenceonBetelQuidandArecaNut

KualaLumpur,Malaysia,April27-28,2016

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International Conference on Betel Quid (BQ) and Areca Nut (AN) §  When and where: Kuala Lumpur, Malaysia, April 27-28 2016.

§  Goal: Convene regional experts in BQ/AN and gain a greater understanding of the impact of use of BQ/AN, both with and without tobacco.

§  Objectives of the conference: §  Identify research priorities §  Build research networks §  Identify evidence- based prevention and control strategies

§  Four Plenary Sessions and Concurrent Breakout Sessions: §  Biology, Disease and Epidemiology §  Prevention, Addiction and Dependence §  Screening and Early Diagnosis of Oral Cancers §  Policy Interventions and Economic Aspects of Betel-Leaf and Areca Nut Use

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Defining a global research and policy agenda for betel quid and areca nut H Mehrtash, K Duncan, M Parascandola, et. al. Forthcoming in Lancet Oncology §  More than 600 million users, ~10% of the global population, with prevalence especially

high in Asia-Pacific Region

§  Betel quid and areca nut are known risk factors for oral and oesophageal cancers, along with effects on the cardiovascular, nervous, gastrointestinal, metabolic, respiratory, and reproductive systems.

§  Unlike tobacco, for which the WHO Framework Convention on Tobacco Control provides evidence-based policies for reducing tobacco use, no global policy exists for the control of betel quid and areca nut use.

§  Research is needed to advance understanding of the basic biology, mechanisms, and epidemiology of betel quid and areca nut use, to advance prevention and cessation programs and policies for betel quid and areca nut users, and to design evidence-based screening and early diagnosis programs for oral cancer.

BetelQuidandCancer•  2004IARCreport

–  BQandANclassifiedascarcinogenictohumans(Group1)byIARC,withorwithouttobacco

–  SufficientevidencethatBQwithouttobaccocausesoralcancerandBQwithtobaccocausesoralcancerandcancerofthepharynxandesophagus

•  BQ/ANusemayaccountforupto50%oforalcancersinsomecountries

•  Oralcancersarethesixthmostcommoncancerintheworldwithacleargeographicalvaria'oninincidence,andtheprevalenceoforalcancersisespeciallyhighincountriesinSouthandSouthEastAsiawhereBQ/ANuseiscommon

OralCancerRiskFactors:Taiwan

CPWen2010

Cancer: Biological mechanisms and biomarkers associated with specific constituents

Variations in pH Level Determine Free Nicotine Levels

Total NNAL concentrations in urine of ST users varies across products

Relative Risks associated with ST use vary between countries

Annual Burden of Disease Attributable to Smokeless Tobacco Use in Two Countries: Sweden and India

Country/disease Sex Relative risk

Prevalence of smokeless

tobacco use

Attributable fraction

Attributable burden of disease

Sweden

Oral cancer men women

1.0 1.0

26% 7%

0% 0%

0 0

Esophageal cancer

men women

1.6 1.6

26% 7%

13.5% 4.0%

39 4

India

Oral cancer men women

5.1 5.1

33% 18%

57.5% 42.5%

26,131 10,359

Esophageal cancer

men women

3.7 3.7

33% 18%

47.1% 32.7%

13,569 6,308

Global Products Conclusion

•  ST products should not be viewed as a single homogenous product category for assessing composition or health effects

•  Because of these widely varying characteristics, along with different patterns of use, ST products are likely to differ across regions in their abuse liability, toxicity, carcinogenicity, and impact on health

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Monograph available online at

https://cancercontrol.cancer.gov/brp/tcrb/monographs/21/index.html

The Economics of Tobacco and Tobacco Control

Tobaccouseimposesanenormoushealthandeconomicburdenontheglobalworkforce Tobaccouseremainsoneoftheworld’sleadingcausesofpreventableprematuredeath,includingdeathfromcancer.Globally,thereare1.1billiontobaccosmokersage15orolder,andtobaccouseburdenseconomieswithmorethanUS$1trillioninhealthcarecostsandlostproduc'vityannually.

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Raising Tobacco Taxes: A Critical Strategy

§  Though highly cost-effective in reducing tobacco use, increased tobacco taxation is the least implemented intervention

§  Only 10% of the world’s population is covered by taxation policies that are judged to be at the highest level of enforcement, compared to other tobacco control policies

§  There is big room for improvement – many LMICs, as well as China and Russia, have excise tax shares <50%.

Share of the World Population Covered by Selected Tobacco Control Policies, 2014

Source: NCI-WHO Monograph on the Economics of Tobacco and Tobacco Control (Figure)

Price per Pack in International Dollar Purchasing Power Parity (PPP) of Most Popular Brand and the Share of Excise and

Total Tax in Price, by Country Income Group, 2014

•  Ongoingintroduc'onofmanynewtobaccocontrolpoliciesdrivenbytheFrameworkConven'ononTobaccoControl(FCTC),butpoliciesand'melinesdifferwidelyacrosscountries.

•  Diverseandchangingcondi'onsinpacernsoftobaccouse,culturalandsocialadtudes,economicforces,andhealthcareenvironments.

•  Aseriesof“naturalexperiments”arecurrentlyunderway.–  Opportunityforstudyingtheimpactofdifferentpoliciesindifferent

environmentsandunderstandingwhatworks.

TheGlobalTobaccoControlLaboratory

Expanding tobacco control research and research-capacity in the developing world is crucial to reducing the disproportionate

burden of tobacco use and cancer.

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Definingaglobalresearchandpolicyagendaforbetelquidandarecanut

HMehrtash,KDuncan,MParascandola,et.al.ForthcominginLancetOncology

•  Morethan600millionusers,~10%oftheglobalpopula'on,withprevalenceespeciallyhigh

inAsia-PacificRegion•  Betelquidandarecanutareknownriskfactorsfororalandoesophagealcancers,alongwith

effectsonthecardiovascular,nervous,gastrointes'nal,metabolic,respiratory,andreproduc'vesystems.

•  Unliketobacco,forwhichtheWHOFrameworkConven'ononTobaccoControlprovidesevidence-basedpoliciesforreducingtobaccouse,noglobalpolicyexistsforthecontrolofbetelquidandarecanutuse.

•  Researchisneededtoadvanceunderstandingofthebasicbiology,mechanisms,andepidemiologyofbetelquidandarecanutuse,toadvancepreven'onandcessa'onprogramsandpoliciesforbetelquidandarecanutusers,andtodesignevidence-basedscreeningandearlydiagnosisprogramsfororalcancer.

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Recommenda?onsforfutureresearchdirec?ons(1)

§ Characterisa'onofthetypesofbetelquidandarecanutproductsandtheiruseacrosspopula'onsintheAsia–Pacificregion§ Strengthentheunderstandingofthebiologicalandbehavioralbasisofarecanutdependencetoaidinthedevelopmentofeffec'vepreven'onandcessa'oninterven'ons§ Developmentandevalua'onoftargetedbetelquidandarecanutusepreven'onandcessa'onmethodsthatincludetheevalua'onofexis'ngpreven'oncampaignsandmessages,anddefiningtheroleofhealth-careprovidersinpreven'onandcessa'oninterven'ons

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Recommenda?onsforfutureresearchdirec?ons(2)

§ Studyoftheculturalandsocialconven'onsthatmo'vatetheuseofbetelquidandarecanutproducts§ Quan'fica'onofthedose-responserela'onshipsbetweenvariousbetelquidandarecanutproducts,withandwithouttobacco,andtheriskoforalandoesophagealcancers§ Development,evalua'on,andimplementa'onofeffec'vescreeningandearlydiagnosisprogramsfororalcancers§ Comple'onandimplementa'onoftransla'onalresearchtobestapplyeffec'vepolicyinterven'onsintobaccocontroltothisdiversefieldtomi'gatethepoten'alriskofdisease

cancer.gov cancer.gov/espanol

a research agenda for betel quid and areca nut and oral cancer … · 2017. 12. 10. · 3...

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