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JABSOM Students Research Oral Cancer Connection with Betel Nut in USAPI

Date: September 29th, 2022 in JABSOM News, MINORITY, Research    Print or PDF


The Pacific is home to thousands of species of palm trees, but one in particular, the Areca palm, produces a highly-addictive fruit called betel nut, which causes oral cancer.

Kurtis Young, a 4th-year student at the John A. Burns School of Medicine, along with 2nd-year student Hannah Bulosan, helped to characterize the effects betel nut has on the people of the United States Affiliated Pacific Islands (USAPI.)


Kurtis Young

Young is aiming to specialize in otorhinolaryngology, commonly known as “ear, nose, and throat (ENT)”, which deals with diseases in those organs. Young first became aware of betel nut and the life-threatening problems the human carcinogen can pose while working with Dr. Eric Wirtz, MD, the program director of the ENT residency program at Tripler Army Medical Center.

“It’s just a big problem that’s often overlooked,” Young says. “We see a lot of patients in the USAPI who chew betel nuts, and of course, its usage is very heterogeneous across the different island jurisdictions. People from Yap, for example, chew a lot more than other people in maybe Kosrae.”

Young and Bulosan conducted a data analysis looking at the number of oral cancer cases in Pacific Islander populations compared to the United States. They were guided by Dr. Andrew Birkeland of UC Davis, and Dr. Lee Buenconsejo-Lum in her role as the Principal Investigator of the CDC-funded Pacific Regional Central Cancer Registry.


Hannah Bulosan

The cancer data comes from across the USAPI, and researchers found there may be a correlation between the prevalence of betel nut chewing and the incidence of oral cavity cancer.

“For example, in Yap, the prevalence of chewing betel nut was 94 percent, according to Dr. Yvette Paulino’s 2014 survey which was the highest across all the jurisdictions. From our study, incidence for oral cancer was above 95 per 100,000, which was the highest incidence of oral cancer across the world, according to Global Cancer Observatory estimates.”

Young also found significant disparities in cancer stage at the time of diagnosis. “This is perhaps more dramatically demonstrated by cancers of the lip,” Young says.

According to US national statistics, 93 percent of patients with lip cancer in the United States are caught within stage 1, which is more manageable.

JABSOM researchers found that only 34 percent of the Pacific Islanders were caught in stage 1.

“We see these people being diagnosed far later, which does lead to worse prognosis,” Young says. “Unfortunately, many of the patients seen from the USAPI present with very advanced disease, very large tumors that you wouldn’t normally see in the continent or in Hawai’i.”

Young would have liked to take the study an additional step by studying mortality data but Dr. Buenconsejo-Lum explained that detailed information regarding a person’s cause of death is not consistently available, due to a variety of infrastructure limitations in many jurisdictions.

Young presented this project in Philadelphia over the summer at the Academy of Otorhinolaryngology, which is the biggest ENT conference in the world.

The study is also in Laryngoscope, a premier otorhinolaryngology journal.

Read the comprehensive research here: http://doi.org/10.1002/lary.30419

Data provided by the PRCCR for this paper is supported by US Centers for Disease
Control and Prevention awards: CDC U58 DP006312, DP000976 and U58 DP003906.
The content is solely the responsibility of the presenter/author and does not necessarily
represent the official views of the Centers for Disease Control and Prevention or US Department of Health and Human Services.

Matthew Campbell, Director of Communications


The areca palm produces the betel nut, a highly addictive fruit that causes oral cancer. Courtesy photo.

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