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
David, Annette M; Haddock, Robert L; Bordallo, Renata et al. (2017) The use of tobacco tax revenues to fund the Guam Cancer Registry: A double win for cancer control. J Cancer Policy 12:34-35
Hernandez, Brenda Y; Zhu, Xuemei; Goodman, Marc T et al. (2017) Betel nut chewing, oral premalignant lesions, and the oral microbiome. PLoS One 12:e0172196
Leon Guerrero, Rachael T; Novotny, Rachel; Wilkens, Lynne R et al. (2017) Risk factors for breast cancer in the breast cancer risk model study of Guam and Saipan. Cancer Epidemiol 50:221-233
Huang, Junhao; Furuya, Hideki; Faouzi, Malika et al. (2017) Inhibition of TRPM7 suppresses cell proliferation of colon adenocarcinoma in vitro and induces hypomagnesemia in vivo without affecting azoxymethane-induced early colon cancer in mice. Cell Commun Signal 15:30
Paulino, Yvette C; Hurwitz, Eric L; Ogo, Joanne C et al. (2017) Epidemiology of areca (betel) nut use in the mariana islands: Findings from the University of Guam/University of Hawai`i cancer center partnership program. Cancer Epidemiol 50:241-246
Paulino, Yvette C; Ettienne, Reynolette; Novotny, Rachel et al. (2017) Areca (betel) nut chewing practices of adults and health behaviors of their children in the Freely Associated States, Micronesia: Findings from the Children's Healthy Living (CHL) Program. Cancer Epidemiol 50:234-240
Hernandez, Brenda Y; Bordallo, Renata A; Green, Michael D et al. (2017) Cancer in Guam and Hawaii: A comparison of two U.S. Island populations. Cancer Epidemiol 50:199-206
Somera, Lilnabeth P; Lee, Hye-Ryeon; Badowski, Grazyna et al. (2016) Health Information Seeking, Source Trust, and Culture: A Comparative Analysis of Health Information Trends and Needs Between Guam and the United States. J Health Commun 21:469-78
Chuang, Eleanore; Lim, Eunjung; Milne, Cris et al. (2016) Human Papillomavirus at Multiple Sites Associated with Anal Squamous Intraepithelial Lesions in HIV-Seropositive Individuals. Ann Clin Cytol Pathol 2:
Haddock, Robert L; Olson, David R; Backer, Lorraine et al. (2016) Urolithiasis, Urinary Cancer, and Home Drinking Water Source in the United States Territory of Guam, 2006-2010. Int J Environ Res Public Health 13:

Showing the most recent 10 out of 28 publications