Areca nut-related oral cancer awareness in adults: A meta-analysis

Areca nut is classified as a Group I carcinogen for oral cavity malignancies by the International Agency for Research on Cancer. Cultivation of the substance and oral cancer incidences have risen considerably in recent years. The assessment of areca nut-related health risk awareness is an increasingly imperative global health topic.

A systematic review of the Medline, Web of Science, Embase and Cochrane databases was undertaken in search of prospective survey studies evaluating areca nut-related health literacy in adults. The primary outcome of interest was the percentage of respondents that were unaware that areca nut products cause oral cancer. A random effects meta-analysis was used to calculate pooled weighted averages. Subgroup analyses stratifying by healthcare education level, geography and publication year were performed using a Chi-square test.

Twenty-eight articles with a total of 13,440 respondents were included in the analysis. Collectively, 50 % (95 % CI: 40 %-60 %, I² 99·5 %) of respondents did not identify areca nut products in general as a risk factor for oral cancer. Only five studies specifically inquired about the carcinogenicity of areca nut without additives. Collectively, 80 % (95 % CI: 63 %-96 %, I² 99·3 %) of these respondents did not know that pure areca nut is a carcinogen. There were no significant discrepancies on subgroup analyses by healthcare education level, geography or date of publication.

An international collection of evidence substantiates drastic areca nut-related health literacy deficiencies internationally.

There is an urgent need for healthcare professionals in areca nut regions to launch formalized educational campaigns. Medically-accurate, culturally-sensitive warning labels are strongly indicated.