page_title: Paan
section_title: Effects on health
hierarchical_section_title: Paan / Effects on health
caption_attribution_description: Oversharpened smile of a Ikat seller in Kupang. The front staining is a wadge of Pann (Betelnut) under his front lip. Pann also stains the teeth badly, makes the lips go red, and causes oral cancer. Processed in Photomechanic. neilsrtw.blogspot.com/
context_page_description: Paan is a preparation combining betel leaf with areca nut widely consumed throughout Southeast Asia, East Asia and South Asia. It is chewed for its stimulant and psychoactive effects. After chewing, it is either spat out or swallowed. Paan has many variations. Slaked lime paste is commonly added to bind the leaves. Some preparations in the Indian subcontinent include katha paste or mukhwas to freshen the breath.
  Magahi paan is an expensive variety of betel which is grown in Aurangabad, Gaya and Nalanda districts of central Bihar. It is non-fibrous, sweeter, tastier and the softest of the lot.
  The origin and diffusion of betel chewing originates from and is closely tied to the Neolithic expansion of the Austronesian peoples. It was spread to the Indo-Pacific during prehistoric times, reaching Near Oceania at 3,400 to 3,000 BP; South India and Sri Lanka by 3,500 BP; Mainland Southeast Asia by 3,000 to 2,500 BP; Northern India by 1500 BP; and Madagascar by 600 BP. From India, it was also spread westwards to Persia and the Mediterranean.
  Paan is also consumed in many other Asian countries and elsewhere in the world by some Asian emigrants, with or without tobacco.
context_section_description: The International Agency for Research on Cancer (IARC) and the World Health Organization (WHO) accept the scientific evidence that chewing betel quids and areca nut is carcinogenic to humans. The main carcinogenic factor is believed to be areca nut. A recent study found that areca-nut paan with and without tobacco increased oral cancer risk by 9.9 and 8.4 times, respectively.
  In one study (c. 1985), scientists linked malignant tumours to the site of skin or subcutaneous administration of aqueous extracts of paan in mice. In hamsters, forestomach carcinomas occurred after painting the cheek-pouch mucosa with aqueous extracts or implantation of a wax pellet containing powdered paan with tobacco into the cheek pouch; carcinomas occurred in the cheek pouch following implantation of the wax pellets. In human populations, they reported observing elevated frequencies of micronucleated cells in buccal mucosa of people who chew betel quid in the Philippines and India. The scientists also found that the proportion of micronucleated exfoliated cells is related to the site within the oral cavity where the paan is kept habitually and to the number of betel quids chewed per day. In related studies, the scientists reported that oral leukoplakia shows a strong association with habits of paan chewing in India. Some follow-up studies have shown malignant transformation of a proportion of leukoplakias. Oral submucous fibrosis and lichen planus, which are generally accepted to be precancerous conditions, appear to be related to the habit of chewing paan.
  In a study conducted in Taiwan, scientists reported the extent of cancer risks of betel quid (paan) chewing beyond oral cancer, even when tobacco was absent. In addition to oral cancer, significant increases were seen among chewers for cancer of the oesophagus, liver, pancreas, larynx, lung, and all cancer. Chewing and smoking, as combined by most betel chewers, interacted synergistically and was responsible for half of all cancer deaths in this group. Chewing betel leaf quid and smoking, the scientists claimed, shortened the life span by nearly six years.
  A Lancet Oncology publication claims that paan masala may cause tumours in different parts of the body and not just the oral cavity as previously thought.
  In a study conducted in Sri Lanka, scientists found high prevalence of oral potentially malignant disorders in rural Sri Lankan populations. After screening for various causes, the scientists reported paan chewing to be the major risk factor, with or without tobacco.
  In October 2009, 30 scientists from 10 countries met at the International Agency for Research on Cancer (IARC), a World Health Organization sponsored group, to reassess the carcinogenicity of various agents including areca nut, a common additive in paan. They reported there is sufficient evidence that paan chewing, even without tobacco, leads to tumours in the oral cavity and oesophagus, and that paan with added tobacco is a carcinogen to the oral cavity, pharynx and oesophagus.
caption: Health effects of chewing paan: gum damage, tooth decay and oral cancer
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