Oral cancer is the sixth leading cancer in the world, and ranks in the top three cancers in countries where betel nut (also known as areca nut) chewing is common. In Micronesia, a group of Pacific Islands where betel nut is frequently chewed, the risk of oral cancer is elevated, but quite variable across populations. For the period 1985-1998 (age-adjusted to the 1988 U.S. population), the prevalence per 100,000 ranged from 4.2 in Chuuk to 31.8 in Yap. In Guam, the incidence of mouth cancer per 100,000 population for the period 1997-2003, age-adjusted to the 2000 U.S. population, varied between 8.1 for Chamorros to 17.9 among other Micronesians. The disparity in oral cancer rates among these populations may be due to differences in betel nut chewing patterns. To investigate the effect of chewing patterns, we must be able to conduct studies on multiple Micronesian islands with differing chewing patterns. Previously, we developed a comprehensive betel nut assessment protocol and a protocol for detecting oral lesions on Guam. The overall objectives of the pilot study are to further develop and test these methods, and to demonstrate that they can be applied in a research study of betel nut use on an island other than Guam. A convenience sample of 100 Micronesians (50 men and 50 women) who are long-term betel nut users (regular use for at least 10 years) will be recruited from the island of Saipan in the Commonwealth of the Northern Mariana Islands (CNMI). We will collect data on betel nut use, presence of oral precancerous lesions, diet, demographics, anthropometry, medical history, and physical activity.
The specific aims of this study are to: 1) collect information on betel nut use among study participants and other members of their families, 2) perform oral examinations, and biopsies, as needed, on study participants, 3) measure other health risks among this population, including obesity, high blood pressure, self-reported history of cardiovascular disease and diabetes, and unhealthy dietary practices and 4) examine associations of duration, frequency, and type of betel nut use with oral pre-cancers and with other health risks. This pilot project will help formulate the research methods for studying betel nut use and disease risk in Micronesia, and will provide the necessary preliminary data for a full multi-island study of betel nut use and the prevalence of oral lesions. Ultimately, a better understanding of these associations will provide important new directions for reduction of health risks through educational efforts and targeted intervention strategies.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center--Cooperative Agreements (U54)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-SRLB-D (O2))
Program Officer
Ogunbiyi, Peter
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Hawaii
Organized Research Units
United States
Zip Code
Zhang, Zheng; Faouzi, Malika; Huang, Junhao et al. (2014) N-Myc-induced up-regulation of TRPM6/TRPM7 channels promotes neuroblastoma cell proliferation. Oncotarget 5:7625-34
Herzog, Thaddeus A; Murphy, Kelle L; Little, Melissa A et al. (2014) The Betel Quid Dependence Scale: replication and extension in a Guamanian sample. Drug Alcohol Depend 138:154-60
Little, Melissa A; Pokhrel, Pallav; Murphy, Kelle L et al. (2014) The reasons for betel-quid chewing scale: assessment of factor structure, reliability, and validity. BMC Oral Health 14:62
Leon Guerrero, Rachael T; Badowski, Grazyna; Yamanaka, Alisha et al. (2014) University of Hawai'i Cancer Center connection: The vital role of cancer registries in the recruitment of an understudied minority population into a breast cancer study: Breast Cancer Risk Model for the Pacific. Hawaii J Med Public Health 73:335-40
Little, Melissa A; Pokhrel, Pallav; Murphy, Kelle L et al. (2014) Intention to quit betel quid: a comparison of betel quid chewers and cigarette smokers. Oral Health Dent Manag 13:512-8
Shiramizu, Bruce; Liang, Chin-Yuan; Agsalda-Garcia, Melissa et al. (2013) Presence of high-risk human papillomavirus genotype and human immunodeficiency virus DNA in anal high-grade and low-grade squamous intraepithelial lesions. AIDS Res Hum Retroviruses 29:178-81
Haddock, Robert L (2013) Shining light on cancer in the Pacific. Hawaii J Med Public Health 72:107-8
Robinett, Hali R; Ames, Todd; Peterson, John A et al. (2011) UH Cancer Center Hotline: the training and education program of the University of Guam/University of Hawai'i Cancer Center Partnership. Hawaii Med J 70:54-5
Payam, Ahoora; Shiramizu, Bruce; Shikuma, Cecilia et al. (2011) HIV-associated anal dysplasia: experience from a multiethnic-HIV clinic in Hawaii. J Health Care Poor Underserved 22:16-22