Betel quid chewing, oral cancer and other oral mucosal diseases in Vietnam: a review

BACKGROUND: Betel quid chewing (BQC) in Vietnam is still prevalent, however, no detailed information about its association with oral cancer and pre-cancer are available in the English literature. Respective online searches (PubMed, Medline) were negative. METHODS: Relevant publications in Vietnamese were collected by the authors and translated. Visits to cancer centres and institutes of odontology (Ho Chi Minh City, Hanoi) were made and seminars with respective scientists were held. Field excursions to local markets and interviews with betel quid vendors and individual BQ chewers gave further insights. RESULTS: Generally, BQC is on the decline in Vietnam. 6.7% of the female population still seems to indulge in this habit. In an earlier study, a prevalence of 0.06% of oral cancer was reported. In a study of 1084 cases of oral cancer, the male:female ratio was 1.05:1 (1997). The age group between 60 and 75 years is most often affected by oral cancer. In BQ chewing women, the buccal mucosa (27.9%), tongue (23.1%) and lips (22.4%) are most often affected. Verrucous carcinoma is seen in the age group 70-79 years with women most often being affected (male:female ratio 1:3.4). The most important risk factor for oral cancer in women is BQC compared with men where smoking, alcohol drinking or combined smoking and drinking habits are the most common risk factors. Oral leukoplakia in BQ chewers is observed in 3.8%, oral submucous fibrosis in 13%. CONCLUSIONS: BQC in Vietnam is on the decline. Association between BQC and oral cancer in elderly women is still of importance. Eventually, the BQC habit will vanish and only play a role in socio-ritual contexts.