A working group of sixteen experts from seven countries re-evaluated the evidence of the carcinogenicity of betel-quid and areca-nut chewing and some areca-nut related nitrosamines. Betel-quid and areca-nut chewing are widely practised in many parts of Asia and in Asian-migrant communities elsewhere in the world. There are hundreds of millions of users worldwide. They evaluated betel quid with tobacco as carcinogenic to humans (Group 1) on the basis of sufficient evidence of an increased risk of cancer of the oral cavity, pharynx and oesophagus. The working group reviewed epidemiological studies of human cancer, mainly studies from India, Pakistan and Taiwan (China). Studies on betel quid with tobacco and areca nut with tobacco in experimental animals now also provide sufficient evidence of carcinogenicity. The working group also evaluated betel quid without tobacco as carcinogenic to humans (Group 1), on the basis of sufficient evidence of an increased risk of oral cancer. Studies on betel quid without tobacco and areca nut without tobacco in experimental animals now also provide sufficient evidence of carcinogenicity. Areca nut, a common ingredient of betel quid and many different chewing preparations, including those available commercially, has been observed to cause oral submucous fibrosis

This eighty-ninth volume of the IARC Monographs is the third and last of a series on tobacco-related agents. Volume 83 reported on the carcinogenicity of tobacco smoke and involuntary smoking (second-hand smoke or environmental tobacco smoke) (IARC 2004a). Volume 85 summarized the evidence on the carcinogenic risk of chewing betel quid with and without tobacco (IARC 2004b). That volume explored the variety of products chewed in South Asia and other parts of the word that contain areca nut in combination with other ingredients, often including tobacco. In this eighty-ninth volume, the carcinogenic risks associated with the use of smokeless tobacco, including chewing tobacco and snuff, are considered in a first monograph. The second monograph reviews some tobacco-specific nitrosamines. These agents were evaluated earlier in Volume 37 of the Monographs (IARC 1985) and information gathered since that time has been summarized and evaluated.

A working group of sixteen experts from seven countries re-evaluated the evidence of the carcinogenicity of betel-quid and areca-nut chewing and some areca-nut related nitrosamines. Betel-quid and areca-nut chewing are widely practised in many parts of Asia and in Asian-migrant communities elsewhere in the world. There are hundreds of millions of users worldwide. They evaluated betel quid with tobacco as carcinogenic to humans (Group 1) on the basis of sufficient evidence of an increased risk of cancer of the oral cavity, pharynx and oesophagus. The working group reviewed epidemiological studies of human cancer, mainly studies from India, Pakistan and Taiwan (China). Studies on betel quid with tobacco and areca nut with tobacco in experimental animals now also provide sufficient evidence of carcinogenicity. The working group also evaluated betel quid without tobacco as carcinogenic to humans (Group 1), on the basis of sufficient evidence of an increased risk of oral cancer. Studies on betel quid without tobacco and areca nut without tobacco in experimental animals now also provide sufficient evidence of carcinogenicity. Areca nut, a common ingredient of betel quid and many different chewing preparations, including those available commercially, has been observed to cause oral submucous fibrosis

Smokeless tobacco use is increasing throughout the U.S., especially among the most vulnerable of our citizens -- the children. With more than 30,000 new cases of oral cancer reported last year in the U.S. alone, it is time that use of smokeless tobacco take its rightful place next to cigarette smoking as a serious health risk that must be stopped. This report includes the following chapters: Clinical and Pathological Effects; Carcinogenesis; Nicotine Effects and Addiction; Prevention; Cessation: Recommendations for the Control of Smokeless Tobacco. Tables, photos and graphs.

The IARC Monographs series publishes authoritative independent assessments by international experts of the carcinogenic risks posed to humans by a variety of agents, mixtures and exposures. They are a resource of information for both researchers and national and international authorities. This volume is particularly significant because tobacco smoke not only causes more deaths from cancer than any other known agent; it also causes more deaths from vascular and respiratory diseases. This volume contains all the relevant information on both direct and passive smoking. It is organised by first looking at the nature of agent before collecting the evidence of cancer in humans. This is followed by carcinogenicity studies on animals and then any other data relevant to an evaluation.