Association Between Betel Nut Chewing And Oral Squamous Cell Carcinoma: A Hospital-Based Retrospective Study

Abstract

Background: Oral squamous cell carcinoma (OSCC) is a major health problem in South and Southeast Asia linked to betel nut chewing, but detailed evidence on exposure patterns and independent risk is limited. This study assessed the association between betel nut chewing habits and OSCC, focusing on exposure and risk factors. Methods: A retrospective case–control study at Bangladesh Medical University in Dhaka (January 2024–January 2025) included 180 participants: 90 OSCC cases confirmed histopathologically and 90 controls. Data via questionnaire covered sociodemographics, betel nut chewing, betel quid use, smokeless tobacco, smoking, alcohol, and exposure duration and frequency. Chi-square tested associations, and multivariable logistic regression identified independent OSCC predictors. Results: Betel nut chewing was significantly higher in OSCC cases (80.0%) compared to controls (51.1%). Betel quid use (areca nut with tobacco) showed an even stronger association (66.7% vs 40.0%). Long-term chewing (>10 years) was more common among OSCC cases (64.4%). Multivariable analysis revealed that betel quid use (AOR = 4.15, p < 0.001), betel nut chewing (AOR = 3.42, p < 0.001), and duration >10 years (AOR = 2.96, p = 0.001) were significant independent predictors of OSCC. Smoking was also associated with increased risk (AOR = 1.88, p = 0.046), while alcohol consumption was not statistically significant. Increasing age and male gender were additionally identified as risk factors. Conclusion: Betel nut chewing, especially with tobacco, is a significant risk factor for OSCC. Urgent public health measures are needed to reduce areca nut use and lower oral cancer in high-risk groups.