Expert Consensus on the Detection and Screening of Oral Cancer and Precancer.

The Chinese Journal of Dental Research smoking and alcohol drinking are major risk factors in Western countries, betel quid use and smoking are major aetiologic factors of oral cancer in South Asia, Southeast Asia and Taiwan1-3. Unfortunately, a higher rate of incidence of oral cancer and a higher mortality rate have been shown to correlate with the increasing prevalence rate of betel chewing in this area. For hundreds of years, betel chewing in Asia has been generally accepted as a social custom or behaviour. Previous epidemiological studies reported that the incidence of oral squamous cell carcinoma (OSCC) in BQ users and smokers was more than 100 times higher than the general population3,4. There is abundant literature clarifying the roles of ingredients of BQ-related carcinogenesis. It is generally agreed that BQ can potentially damage the oral mucosa to induce genotoxic or non-genotoxic effects, which may further contribute to initiation, promotion and progression of oral cancer. Various ingredients in BQ, including areca nuts, nitroso-derivatives, arecoline, safrole, lime and so on, have been extensively studied and linked to carcinogenic effects, co-carcinogenic effects and tumour promotion3,5-10. In addition to oral cancer, other betel quid-associated diseases in the oral cavity such as mucositis, submucous fibrosis, severe tooth attrition and periodontitis have been difficult to manage, which has presented a great challenge for the general healthcare system. Currently, 1 Professor and Chair, Department of Stomatology, Taipei-Veterans General Hospital, School of Dentistry, Yang-Ming University, Taipei. 2 Professor and Chair, Department of Oncology and Diagnostic Science, School of Dentistry, University of Maryland, Maryland, USA. 3 Professor, Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China. 4 Clinical Professor, Rajan Dental Hospital, Adjunct professor, Tamil Nadu Dr. MGR Medical University, Chennai, India. 5 Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China.