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R K, Chandra A, Jain T, Singh N, Agrawal R. An enigmatic pathogenetic mechanism of hypoxia inducible factor - 1/2 alpha in the progression of fibrosis of oral submucous fibrosis and its malignant transformation: A systematic review and meta-analysis. Arch Oral Biol 2024; 162:105944. [PMID: 38492547 DOI: 10.1016/j.archoralbio.2024.105944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/12/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Oral submucous fibrosis is a frequently reported potentially malignant disorder characterized by fibrosis and a malignant transformation rate of 7-30%. The role of hypoxia-inducible factor-1/2α in malignant transformation mechanisms of oral submucous fibrosis remains uncharted territory owing to a scarcity of studies. Thus the present systematic review and meta-analysis aimed to determine the role of hypoxia-inducible factor-1/2α in the progression of fibrosis of oral submucous fibrosis and its malignant transformation. MATERIAL AND METHODS Using PubMed, Google Scholar, and Cochrane Library databases, full-text articles that investigated hypoxia-inducible factor-1/2α in oral submucous fibrosis were entailed for review. A modified Newcastle-Ottawa scale was employed to evaluate risk of bias in all articles and Review Manager was utilized for meta-analysis. RESULTS Eighteen and eight qualified articles respectively were included for qualitative and quantitative data synthesis. Progressive upregulation of hypoxia-inducible factor-1/2α in oral submucous fibrosis is associated with fibrosis-induced carcinogenesis. A Random-effects model uncloaked that oral submucous fibrosis cases with significantly increased expression of hypoxia-inducible factor-1α had an increased associated risk of malignant transformation compared with controls (combined odds ratio 523.83, 95% confidence interval 125.74- 2182.28, p < 0.00001). CONCLUSION The existing evidence substantiates the notion that hypoxia-inducible factor-1/2α, a fundamental pathogenetic mechanism of progression and malignant transformation of oral submucous fibrosis in the background of fibrosis.
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Affiliation(s)
- Keerthika R
- MDS, Senior Resident, Unit of Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | - Akhilesh Chandra
- MDS, Assistant Professor, Unit of Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Trupti Jain
- MDS, Junior Resident, Unit of Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Neha Singh
- MDS, Junior Resident, Unit of Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rahul Agrawal
- MDS, Professor, Unit of Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
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Kafle Dahal U, Dhimal M, Budukh A, Khadka K, Poudel S, Baral G, Gyanwali P, Jha AK, Chapagain S. Burden of tobacco-related cancers in urban, semi-urban and rural setting of Nepal: Findings from population-based cancer registries 2019. PLoS One 2024; 19:e0300271. [PMID: 38805435 PMCID: PMC11132438 DOI: 10.1371/journal.pone.0300271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/25/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Nepal is one of the high prevalent countries for tobacco use in Southeast Asia regions. Tobacco related cancer share the major burden since a decade, however, population-based estimates is still lacking. This study provides results from population-based cancer registries on tobacco-related cancer (TRCs) burden in Nepal. METHODS The data were collected by population-based cancer registry conducted in nine districts by Nepal Health Research Council. The districts were categorized in urban, semi-urban and rural regions on the basis of geographical locations and facilities available in the regions. Analysis was done to identify tobacco-associated cancer incidence, mortality and patterns along with cumulative risk of having cancer before the age of 75 years. RESULTS Tobacco-related cancer was 35.3% in men and 17.3% in women. We found that every one in 36 men and one in 65 women developed tobacco-related cancer before age 75 in Nepal. Cancer of lung, mouth, esophagus and larynx were among the five most common tobacco-related cancers in both men and women. The incidence of tobacco-associated cancers was higher in urban region with age adjusted rate 33.6 and 17.0 per 100,000 population for men and women respectively compared to semi-urban and rural regions. Tobacco-associated cancer mortality was significantly higher compared to incidence. CONCLUSION The prevalence of tobacco-related cancer found high in Nepal despite of enforcement of tobacco control policy and strategies including WHO framework convention on tobacco control. Concerned authorities should focus towards monitoring of implemented tobacco control policy and strategies.
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Affiliation(s)
- Uma Kafle Dahal
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Meghnath Dhimal
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Atul Budukh
- Centre for Cancer Epidemiology (ACTREC), Tata Memorial Centre, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Kopila Khadka
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Sudha Poudel
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Gehanath Baral
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Pradip Gyanwali
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Anjani Kumar Jha
- Department of Radiation Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Nepal
| | - Sandhya Chapagain
- Department of Clinical Oncology, National Academy of Medical Sciences (NAMS), Bir Hospital, Kathmandu, Nepal
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Chatterjee N, Gupte HA, Mandal G. A Qualitative Study of Perceptions and Practices Related to Areca Nut Use Among Adolescents in Mumbai, India. Nicotine Tob Res 2021; 23:1793-1800. [PMID: 33831182 DOI: 10.1093/ntr/ntab067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/06/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Areca nut, commonly known as supari, is widely used in India. In addition to tobacco and alcohol, it has been identified as one of the contributory factors for high rates of oral cancer in the country. METHODS This qualitative study explored perceptions and practices around the use of areca nut by conducting in-depth interviews and focus group discussions with 61 school-going adolescents in the city of Mumbai, India. RESULTS Respondents used low-priced sachets of sweetened, flavored areca nut called supari. They perceived supari as harmless because it was sweet, it had a fresh after-taste as compared to bitter-tasting smokeless tobacco products. How can something sweet be harmful was a common argument offered by respondents. Respondents invariably compared and contrasted areca nut to more harmful and addictive tobacco products; perceiving supari to have milder or inconsequential health effects. Supari use was initiated with friends, a sibling, or a cousin. It was almost always used with friends. Respondents also reported difficulty in refusal to use when offered supari by friends. Parental response to finding out about the child's supari use was often muted in comparison to extreme reactions associated with the child's tobacco use. CONCLUSIONS Perceptions of low risk or relative harmlessness of the product, social influence, and the features of the product itself influence adolescents' use of areca nut. Although more research on perceptions of risk, with larger samples, is required, these findings are useful for school-based tobacco prevention and cessation programs and health policy-makers. IMPLICATIONS The study findings have implications for prevention and cessation programs, and policymakers. School-based health education programs should allocate special sessions on areca nut use. Focused mass media communication campaigns describing its harms and association with oral cancer are required for the larger community. As was done for tobacco, Indian policymakers will have to evaluate the marketing, commerce, and distribution of areca nut and create appropriate laws. More research, with larger nationwide samples, is required to examine perceptions of areca nut.
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M. Mounika S, Manne R, Kannan N, Beeraka S, Sarath P, Saikiran K. Colchicine as a therapeutic drug in the management of oral submucous fibrosis - A randomized clinical study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2021. [DOI: 10.4103/jiaomr.jiaomr_108_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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de la Monte SM, Moriel N, Lin A, Abdullah Tanoukhy N, Homans C, Gallucci G, Tong M, Saito A. Betel Quid Health Risks of Insulin Resistance Diseases in Poor Young South Asian Native and Immigrant Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186690. [PMID: 32937888 PMCID: PMC7558723 DOI: 10.3390/ijerph17186690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 01/30/2023]
Abstract
Betel quid, traditionally prepared with areca nut, betel leaf, and slaked lime, has been consumed for thousands of years, mainly in the form of chewing. Originally used for cultural, medicinal, and ceremonial purposes mainly in South Asian countries, its use has recently spread across the globe due to its psychoactive, euphoric, and aphrodisiac properties. Now it is widely used as a social lubricant and source of financial profit. Unfortunately, the profit motive has led to high rates of habitual consumption with eventual conversion to addiction among young girls and boys. Moreover, the worrisome practice of including tobacco in quid preparations has grown, particularly among pregnant women. Major health concerns include increased rates of malignancy, oral pathology, and cardiovascular, hepatic, fertility, metabolic, and neuropsychiatric disorders. Metabolic disorders and insulin resistance disease states such as type 2 diabetes, obesity, and metabolic syndrome contribute to cognitive decline and neurodegeneration. Mechanistically, the constituents of areca nut/betel quid are metabolized to N-nitroso compounds, i.e., nitrosamines, which are carcinogenic at high doses and cause insulin resistance following chronic low-level exposures. From an epidemiological perspective, the rising tide of insulin resistance diseases including obesity, diabetes, and dementias that now disproportionately burden poor countries has been propagated by rapid commercialization and enhanced access to betel quid. Public health measures are needed to impose socially and ethically responsible barriers to yet another cause of global health disparity.
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Affiliation(s)
- Suzanne M. de la Monte
- Department of Pathology and Laboratory Medicine, Providence VA Medical Center, Providence, RI 02808, USA
- Women & Infants Hospital of Rhode Island, Providence, RI 02808, USA
- Alpert Medical School, Brown University, Providence, RI 02808, USA
- Departments of Medicine, Rhode Island Hospital, Providence, RI 02808, USA; (G.G.); (M.T.)
- Neurology, Neurosurgery and Neuropathology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Correspondence:
| | - Natalia Moriel
- Department of Molecular Pharmacology and Physiology at Brown University, Providence, RI 02912, USA; (N.M.); (A.L.); (N.A.T.)
| | - Amy Lin
- Department of Molecular Pharmacology and Physiology at Brown University, Providence, RI 02912, USA; (N.M.); (A.L.); (N.A.T.)
| | - Nada Abdullah Tanoukhy
- Department of Molecular Pharmacology and Physiology at Brown University, Providence, RI 02912, USA; (N.M.); (A.L.); (N.A.T.)
| | - Camille Homans
- Department of Neuroscience, Brown University, Providence, RI 02912, USA;
| | - Gina Gallucci
- Departments of Medicine, Rhode Island Hospital, Providence, RI 02808, USA; (G.G.); (M.T.)
| | - Ming Tong
- Departments of Medicine, Rhode Island Hospital, Providence, RI 02808, USA; (G.G.); (M.T.)
| | - Ayumi Saito
- Department of Epidemiology in the School of Public Health, Brown University, Providence, RI 02912, USA;
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More CB, Rao NR, More S, Johnson NW. Reasons for Initiation of Areca Nut and Related Products in Patients with Oral Submucous Fibrosis within an Endemic Area in Gujarat, India. Subst Use Misuse 2020; 55:1413-1421. [PMID: 32569538 DOI: 10.1080/10826084.2019.1660678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: While the patterns of consumption of areca nut and its by-products (ANBP) vary across South Asia and the rest of the world, all users share the probable severe outcome of oral submucous fibrosis (OSMF), and this is well reported. The role of psychosocial drivers of habit initiation and addiction is reported less. Objective: To reveal the burden of ANBP abuse, exploring the psychosocial relationship between sex, age at first exposure (AFE), the reason for initiation (RFI) with the type of habit (TOH). Methodology: Data came from the prospective hospital-based study conducted at K.M. Shah Dental College and Hospital covering years 2017 and 2018. Patients with oral lesions were assessed with complete history recording demographics, TOH, AFE, RFI, duration of habit, and clinical diagnosis of any oral and systemic diseases. Patients with a history of scleroderma, facial burns, and oral malignancy were excluded. Results: Of the 13,874 patients, 9.89% reported ANBP. We included 1000 OSMF patients. The mean age of the study cohort was 38.97 ± 14.29 years, with a range of 17-75 years. Males constituted the majority (80.1%). The most common TOH reported was regular use of gutkha (60.1%) followed by mawa (31.4%) with tension and stress (30.3%) being the most common RFI among the cohort. TOH was notably different in relation to AFE. Interestingly, mawa chewing (38.69%) was observed more in females. Importance: This study reveals the burden of ANBP abuse and reports the complex psychosocial relationships between sex, AFE, and RFI with TOH in OSMF patients in this high incidence population.
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Affiliation(s)
- Chandramani B More
- Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Piparia, Vadodara, Gujarat, India
| | - Naman Rajeshkumar Rao
- Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sucheta More
- Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Newell W Johnson
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.,Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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Gunjal S, Pateel DGS, Yang YH, Doss JG, Bilal S, Maling TH, Mehrotra R, Cheong SC, Zain RBM. An Overview on Betel Quid and Areca Nut Practice and Control in Selected Asian and South East Asian Countries. Subst Use Misuse 2020; 55:1533-1544. [PMID: 32569533 DOI: 10.1080/10826084.2019.1657149] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Areca nut (AN) and betel quid (BQ) chewing are ancient practices followed by an extensive proportion of the world's population. These practices are endemic in larger parts of South and Southeast Asia and selected Western Pacific countries. The prevalence of these habits varies across regions, age, gender, cultural practice, and socioeconomic status groups. Considerable variations exist between countries with respect to prevention/intervention programs, and policy guidelines of BQ usage. Objectives: (1) To provide an overview of the BQ chewing prevalence, practices, preventive interventions and policies in selected Asian and Western Pacific countries. (2) To explore the different terminologies associated with BQ use. Method: A narrative review of the current literature related to BQ, AN, and oral cancer was conducted by searching PUBMED, CINAHL, and GOOGLE databases. Results: The literature review revealed that the prevalence of BQ was found to be highest in Papua New Guinea, followed by Bangladesh, India, Pakistan, Myanmar and Sri Lanka. While, Cambodia, Malaysia, Indonesia and Taiwan had comparatively lower prevalence. Smokeless tobacco, BQ with tobacco, BQ without tobacco, AN were some of the terminologies used for BQ in various studies. Conclusions: The prevalence, and the interventional policies related to BQ and AN chewing habits varies widely among the selected countries. With the increasing awareness and association of BQ with oral cancer, there is a need to have better awareness, prevention and interventional strategies in place. We also found considerable variation in the use of terminologies associated with BQ.
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Affiliation(s)
- Shilpa Gunjal
- Department of Dental Public Health, Faculty of Dentistry, MAHSA University, Selangor, Malaysia
| | | | - Yi-Hsin Yang
- Division of Medical Statistics and Bioinformatics, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Jennifer Geraldine Doss
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Selangor, Malaysia
| | - Sobia Bilal
- Department of Children and Community Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | | | - Ravi Mehrotra
- ICMR-National Institute of Cancer Prevention and Research, WHO-FCTC Global Knowledge Hub on Smokeless Tobacco, Noida, National Capital Region, India
| | - Sok Ching Cheong
- Head and Neck Cancer Team, Cancer Research Malaysia, Subang Jaya, Malaysia
| | - Rosnah Binti Mohd Zain
- Department of Oral Pathology Oral Medicine, Faculty of Dentistry, MAHSA University, Selangor, Malaysia.,Faculty of Dentistry, University of Malaya, Wilayah Persekutuan, Kuala Lumpur, Malaysia.,Faculty of Dentistry, University of Airlangga, Suarabaya, East Java, Indonesia
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How Each Component of Betel Quid Is Involved in Oral Carcinogenesis: Mutual Interactions and Synergistic Effects with Other Carcinogens—a Review Article. Curr Oncol Rep 2019; 21:53. [DOI: 10.1007/s11912-019-0800-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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