Areca Nut Production, Imports, and Their Impact on Oral Cancer Incidence

Approximately one-third of global lip and oral cavity cancer (LOC) cases are linked to smokeless tobacco or areca nut (AN) consumption. Over the past 32 y, AN production has significantly increased, accompanied by rising international trade. This study explores the relationship between changes in AN production/import quantities and LOC incidence in regions where consumption is prevalent. LOC incidence rates were obtained from the Global Burden of Disease and GLOBOCAN databases, while AN production and import data were sourced from the Food and Agriculture Organization Corporate Statistical Database and Hainan province's statistical yearbook. Spearman's correlation analysis was used to evaluated the relationship between AN production or AN imports and LOC incidence rate in AN-producing/importing regions. Descriptive statistics were used to describe the trends of AN production, AN imports, and LOC incidence in AN-producing/importing regions. In 2021, the total AN production of 12 regions (Bangladesh, Bhutan, China mainland, Taiwan, India, Indonesia, Malaysia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand) was 5.4 times that of 1990, with an average annual production of 1,177,926 tons. A strong positive correlation (R ≥ 0.8, P < 0.001) was observed between increased production and LOC incidence in Bangladesh, Bhutan, China mainland, India, Myanmar, Nepal, Sri Lanka, Thailand, and the combined data for all 12 regions. Additionally, among the top 10 countries by average annual AN imports from 2012 to 2021, a positive correlation was observed between their average annual imports and the incidence of LOC in 2022. The findings highlight a positive correlation between large-scale AN production and a rising LOC incidence rate, and AN imports may be associated with a higher incidence of LOC. These results support the need for regulatory measures on AN similar to those used for tobacco to address this growing public health concern.