UPPER ALIMENTARY TRACT CANCER IN NATAL INDIANS WITH SPECIAL REFERENCE TO BETEL-CHEWING HABIT

The general features of the South African Indian community are outlined. A recent survey of cancer morbidity incidence in Durban Indians indicates that cancers of the mouth, throat, oesophagus and stomach are commoner in Indian females than males, and that the combined incidence of these neoplasms is high. Realisation that the habit of betel-chewing in Durban Indians was also predominantly a female habit promoted an intensive study of the habit among Durban Indians. Analysis of this study shows that 8·3% of Indian males and 54·2% of Indian females aged 20 years or more are addicted to betel-chewing, and this difference is significant. Schooling attainments and ability to speak English, when regarded as indices of westernisation, showed that younger people of both sexes were more westernised, and that males at all ages were more westernised than females. Differences between Moslems and Hindus (age-adjusted) were not significant. The tendency towards greater westernisation in Indian males may be the main reason for less betel-chewing in the male group, and it is likely that the habit in both sexes may be dying out. Among chewers, comparisons between males and females (age-matched groups) showed that the betel-quid is chewed significantly more frequently by females, and that the lifetime consumption of the female group was significantly higher than that of the males. Duration of the habit, and age of adoption of the habit did not differ between the sexes. Moslem and Hindu differences were not significant, but there was a tendency for Moslems to adopt the habit at an earlier age. The commonest ingredients used in the betel-quid are the leaf, the areca nut and the slaked lime. Tobacco is used very rarely. Reasons for adoption of the habit are most commonly given as being for social or health reasons. Unpleasant effects include a diaphoretic effect. Pleasant effects seem to be predominantly tranquillising. This study differs from previous studies made by workers in India and the East in that tobacco is seldom added as an ingredient in Natal, and in that sexdifferences in cancer of the upper alimentary tract and in the prevalence of the betel-chewing habit are marked, both being commoner in females. This observation must direct our attention to a possible association between betel-chewing and upper alimentary tract cancer, and to elements other than tobacco in the betelquid which may be cancer promoting. The leaf, nut, and the lime component should in the first instance be investigated. This study was financed by the National Cancer Association of South Africa, and we are indebted to the Institute of Social Research, Natal University, for assistance and advice. © 1969, The British Empire Cancer Campaign for Research. All rights reserved.