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IARC Monographs on the Evaluation of Carcinogenic Risks to Humans WORLD HEALTH ORGANIZATION INTERNATIONAL AGENCY FOR RESEARCH ON CANCER IARC Monographs on the Evaluation of Carcinogenic Risks to Humans VOLUME 85 Betel-quid and Areca-nut Chewing and Some Areca-nut-derived Nitrosamines LYON, FRANCE 2004 ppi-iv-first pages.qxd 21/09/2004 13:09 Page i WORLD HEALTH ORGANIZATION INTERNATIONAL AGENCY FOR RESEARCH ON CANCER IARC Monographs on the Evaluation of Carcinogenic Risks to Humans VOLUME 85 Betel-quid and Areca-nut Chewing and Some Areca-nut-derived Nitrosamines This publication represents the views and expert opinions of an IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, which met in Lyon, 11–18 June 2003 2004 ppi-iv-first pages.qxd 21/09/2004 13:09 Page ii IARC MONOGRAPHS In 1969, the International Agency for Research on Cancer (IARC) initiated a programme on the evaluation of the carcinogenic risk of chemicals to humans involving the production of critically evaluated monographs on individual chemicals. The programme was subsequently expanded to include evaluations of carcinogenic risks associated with exposures to complex mixtures, life-style factors and biological and physical agents, as well as those in specific occupations. The objective of the programme is to elaborate and publish in the form of monographs critical reviews of data on carcinogenicity for agents to which humans are known to be exposed and on specific exposure situations; to evaluate these data in terms of human risk with the help of international working groups of experts in chemical carcinogenesis and related fields; and to indicate where additional research efforts are needed. The lists of IARC evaluations are regularly updated and are available on Internet: http://monographs.iarc.fr/ This project was supported by Cooperative Agreement 5 UO1 CA33193 awarded by the United States National Cancer Institute, Department of Health and Human Services. Addi- tional support has been provided since 1993 by the United States National Institute of Environmental Health Sciences. International Agency for Research on Cancer, 2004 Distributed by IARCPress (Fax: +33 4 72 73 83 02; E-mail: [email protected]) and by the World Health Organization Marketing and Dissemination, 1211 Geneva 27 (Fax: +41 22 791 4857; E-mail: [email protected]) Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. Application for rights of reproduction or translation, in part or in toto, should be made to the International Agency for Research on Cancer. IARC Library Cataloguing in Publication Data Betel-quid and areca-nut chewing and some areca-nut-derived nitrosamines / IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2003 : Lyon, France) (IARC monographs on the evaluation of carcinogenic risks to humans ; v. 85) 1. Areca – adverse effects 2. Carcinogens 3. Esophageal neoplasms 4. Mouth neoplasms 5. Neoplasms 6. Nitrosamines – toxicity 7. Pharyngeal neoplasms 8. Tobacco, smokeless I. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans II. Series ISBN 92 832 1285 1 (NLM Classification: W1) ISSN 1017-1606 PRINTED IN FRANCE ppi-iv-first pages.qxd 21/09/2004 13:09 Page iii 2 3 4 5 1 6 7 1 Betel quid stand at a Phnom Penh local market (provided by Peter Reichart) 2 Betel quid, unfolded 3 Betel quid, folded 4 Gutka, as commercially manufactured and sold in Southeast Asia 5 Pan masala, as commercially manufactured and sold in Southeast Asia 6 Lao-hwa areca nuts, as sold in Taiwan, China (provided by Peter Reichart) 7 Pan masala, as served in restaurants after the meal Cover design by Georges Mollon, IARC ppi-iv-first pages.qxd 21/09/2004 13:09 Page iv ppv-x-cont.qxd 21/09/2004 13:20 Page v CONTENTS NOTE TO THE READER............................................................................................1 LIST OF PARTICIPANTS............................................................................................3 PREAMBLE ................................................................................................................7 1. Background........................................................................................................9 2. Objective and Scope ..........................................................................................9 3. Selection of Topics for Monographs ..............................................................10 4. Data for Monographs ......................................................................................11 5. The Working Group ........................................................................................11 6. Working Procedures ........................................................................................11 7. Exposure Data..................................................................................................12 8. Studies of Cancer in Humans ..........................................................................14 9. Studies of Cancer in Experimental Animals....................................................17 10. Other Data Relevant to an Evaluation of Carcinogenicity and its Mechanisms ........................................................................................20 11. Summary of Data Reported ............................................................................22 12. Evaluation ........................................................................................................23 13. References........................................................................................................28 GENERAL REMARKS..............................................................................................33 THE MONOGRAPHS................................................................................................37 Betel-quid and Areca-nut Chewing ........................................................................39 1. Exposure Data..................................................................................................41 1.1 Composition of betel quid........................................................................41 1.1.1 Betel quid ....................................................................................41 1.1.2 Areca nut......................................................................................42 1.1.3 Betel leaf......................................................................................50 1.1.4 Betel inflorescence ......................................................................50 1.1.5 Slaked lime ..................................................................................50 1.1.6 Catechu ........................................................................................51 1.1.7 Tobacco........................................................................................51 1.1.8 Miscellaneous additives and contaminants..................................51 1.2 Areca nut-based industrial packaged products ........................................52 1.3 Consumption by geographical region ......................................................52 –v– ppv-x-cont.qxd 21/09/2004 13:20 Page vi vi IARC MONOGRAPHS VOLUME 85 1.3.1 India ............................................................................................52 (a) Adults....................................................................................53 (b) Children and adolescents ......................................................59 1.3.2 Pakistan ......................................................................................61 1.3.3 Bangladesh ..................................................................................62 1.3.4 Sri Lanka......................................................................................62 1.3.5 Maldives ......................................................................................63 1.3.6 People’s Republic of China ........................................................63 1.3.7 Taiwan, China ..............................................................................64 1.3.8 Myanmar......................................................................................68 1.3.9 Thailand ......................................................................................68 1.3.10 Lao People’s Democratic Republic ............................................69 1.3.11 Cambodia ....................................................................................69 1.3.12 Malaysia ......................................................................................69 1.3.13 Singapore ....................................................................................70 1.3.14 Indonesia......................................................................................70 1.3.15 The Philippines ............................................................................71 1.3.16 Papua New Guinea ......................................................................71 1.3.17 Palau ............................................................................................72 1.3.18 Guam............................................................................................73 1.3.19 Others ..........................................................................................73 1.3.20 Migrant populations ....................................................................74 (a) South Africa ..........................................................................74
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