Intended for healthcare professionals


Areca nut use: an independent risk factor for oral cancer

BMJ 2002; 324 doi: (Published 06 April 2002) Cite this as: BMJ 2002;324:799

The health problem is under-recognised

  1. Saman Warnakulasuriya, professor (,
  2. Chetan Trivedy, research associate,
  3. Timothy J Peters, professor
  1. Department of Oral Medicine and Pathology, Dental Institute, London SE5 9RW

Areca nut is the seed of the fruit of the oriental palm, Areca catechu. It is the basic ingredient of a variety of widely used chewed products. Thin slices of the nut, either natural or processed, may be mixed with a variety of substances including slaked lime (calcium hydroxide) and spices such as cardamom, coconut, and saffron. Most significantly, they may be mixed with tobacco products or wrapped in the leaf of the piper betel plant. Hence the more common name betel nut. Areca nut is used by an estimated 200-400 million people, mainly IndoAsians and Chinese.1 It is used by men and women—in some societies the latter predominate. All age groups and social classes use the product. Areca nut has a long history of use and is deeply ingrained in many sociocultural and religious activities.2

Of particular interest in the United Kingdom, and perhaps other developed countries, is that use of areca nut continues and is often enhanced following migration. Thus British Asians have brought the use of areca from India (some via East Africa), Pakistan, Bangladesh, and other countries in the region …

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