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Both betel-quid and gutka chewing increase the risk of cancer of the oral cavity and oropharynx.[4,12] The carcinogenic component of chewed betel quid arises from the areca nut.[4] Relative risks are typically stronger for betel quid with tobacco than for betel quid alone.[12] A meta-analysis of oral cavity cancer studies conducted on the Indian subcontinent calculated a statistically significant eightfold increase in risk for betel quid with tobacco and a statistically significant twofold increase in risk for betel quid alone.[12] A statistically significant tenfold increase in oral cavity cancer risk for betel-quid chewing was demonstrated by studies conducted in China or Taiwan

Mnatzaganian G, Ryan P, Reid CM, Davidson DC, Hiller JE