Betel (Piper betle) is the leaf of a vine belonging to the Piperaceae family which includes Pepper and Kawa. The Betel leaf is popularly used as a mild stimulant, for medicinal purposes and as a food supplement in Asia. In October 2009, 30 scientists from 10 countries met under the auspices of the WHO’s International Agency for Research on Cancer (IARC) to access the carcinogenicity of betel quid and their conclusion was that betel quid without tobacco can definitely lead to cancer of the oral cavity and esophagus, while betel quid with tobacco is a carcinogen of the oral cavity, pharynx and esophagus.

Betel quid as a food is an Asian edible condiment that has its main ingredient as betel leaf. Betel quid is made up of betel leaf, areca nut (another carcinogen), slaked lime, and may (or may not) contain tobacco. Betel quid is food to an astonishing over 600 million people worldwide, mostly from Asia, hence the concern about its role as a toxic material and carcinogen. Betel quid as a food supplement or additive is important as an aphrodisiac, antiseptic and breath freshener. According to another report, this toxic material and carcinogen is the fourth most popular psychoactive substance in the world after tobacco, alcohol and caffeine.

The WHO research group on cancer observed a higher percentage of diagnosis of oral cancer in Asian hospitals when compared to that of the western countries where betel quid is virtually unknown. This discovery, coupled with other research findings led to the conclusion that chewing this toxic material called betel quid goes beyond oral cancer. They noticed a significant increase also in cancer of the esophagus, liver, pancreas, larynx, lung and other cancer. A study in Papua New Guinea showed that oral squamous cell cancer is the most common malignant tumor in Papua New Guinea. This oral cancer concentrates at the corner of the mouth and the cheeks and has been attributed to betel quid consumption. The study also showed that eating betel quid and smoking is responsible for half of all cancer deaths and reduces life span by 6 years.

One research study explains how this toxic material/carcinogen can cause cancer. The presence of areca nut in betel quid is carcinogenic. Components of betel quid can alkylate the genetic material of the DNA to increase the risk of cancer. These carcinogens in betel quid are present at levels sufficient enough to cause DNA damage and could potentially have adverse implications to human health, especially as it concerns oral cancer development.


  1. Hi, Is it possible to use the labelled Betel ingredients image in health education resources?

  2. Actually the betel leaf itself is beneficial, has vitamin C and anti-oxidants. In the WHO report the betel leaf was shown to have beneficial anti-cancer properties and is being experimented with in other studies for this reason.
    It is only the areca nut (containing nitrosamines) that is proven to cause cancer in mice when given as an oral extract or concentration. The reason the betel quid also caused cancer in some of the experiments, they concluded, was because it had areca nut in it. As you mention the addition of tobacco is another carcinogen in the package.


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