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Betel-quid chewing is prevalent in many countries in south and southeast Asia, including China and India, and is an important risk factor for both oral cavity and oropharyngeal cancers.[4] Alcohol Use Alcohol use is a major independent risk factor for the development of head and neck squamous cell cancer.[5] Most epidemiological studies demonstrate an increase in risk with increasing drinks per day, with a more than twofold to sixfold increase in risk for individuals who consume two or more drinks a day relative to nonconsumers.[6] Associations are observed in studies that adjust for confounding by smoking, as well as in studies of nonsmokers.[7] There is a suggestion that consumption of beer and hard liquor confers a greater risk than does wine consumption.[6] Tobacco and Alcohol Use Head and neck squamous cell cancer risk is highest in people who consume large amounts of both alcohol and tobacco.[8-10] When both risk factors are present, the risk of oral cavity and oropharyngeal cancer is typically about two to three times greater than a simple multiplicative or additive effect.[11] In a study that pooled data from 17 case-control studies, individuals who consumed more than a pack of cigarettes and three or more alcoholic drinks per day had a 15-fold increased risk of oral cavity cancer, 14-fold increased risk of oropharyngeal cancer, and 36-fold increased risk of laryngeal cancer relative to individuals who neither smoked nor drank.[8,11] Betel-Quid Chewing Betel quid is composed of betel leaf, areca nut, and lime