Background: Worldwide smoking practices are in vogue, but chewing tobacco with pan or pan masala is typical to the Indian sub-continent. There is sufficient evidence to implicate tobacco to oral cancers, but it is unknown if non tobacco areca nut chewing substances (AS) are harmful. Clandestine sale of AS in the form of plain pan masala in the society may have a direct causal relationship to oral precancer and cancer.
Aim: To study the direct risk imposition (odds ratio) from the use of AS.
Methods: In order to achieve a sample size of 0.4 million, all households in old city of Lucknow were visited by trained social workers and dentists, ensuring similarity in style of asking questions during the interview. All permanent residents, residing for more than 6 months, age 15 years and above were included, while the mentally challenged were excluded. A two page survey tool was designed and validated. General oral health examination revealed oral mucosal lesions. Regular supervisory visits were made. The survey was carried out mainly during early morning or evening to ensure maximum compliance.
Results: 3% population consumed AS whereas 24% consumed tobacco. Usage of AS declined with advancement of age. Prevalence of Oral Precancer, when Leukoplakia, Erythroplakia, Oral Sub Mucous Fibrosis, Verrucous hyperplasia, Smokers Palate and Lichen Planus were considered, was 3.2% amongst AS users; only 0.16% amongst non-users, and 12.2% amongst tobacco users. Odds ratio (95 % CI) for oral precancer in AS Users was 20.71 (18.79 - 22.82) against non-users, while in tobacco users was 88.07 (84.02 – 92.31)
Conclusions: AS consumption was very commonly seen in the population. The odds of developing oral precancer was 20 times more in AS users than non users. Hence, we conclude that non tobacco areca nut products carry a huge risk to develop oral precancer.