Innovations and Limitations in Areca Nut Research: A Narrative Review

Areca nut (AN) and betel quid (BQ) products have been highly scrutinized by the scientific community in the last decade due to their classification by the International Agency for Research on Cancer as a group 1 carcinogen. However, neither the size of the user demographic nor the production levels of the product have varied greatly since the announcement, demonstrating that large demographics remain susceptible to oral cancer. Researching the demographic groups and their preferred AN or BQ products has helped provide an overview of the problem globally, from the diversity of products used to the users' demographic variation, including ethnicity, age group, wealth levels, and other factors. However, there is still a considerable lack of available sources related to AN or BQ usage in China, which is the region with the second-highest number of AN or BQ users. Recent studies of the chemical composition of AN or BQ products from different regions or with different preparation methods have reported varied chemical compositions. This is a novel view of the product because chemical components found to be carcinogenic, such as alkaloid arecoline, decreased under certain processes. Thus, different innovative approaches could be considered for AN or BQ research as use of these products has great historical, cultural, and social significance and there is a potential to be less harmful to humans.