Tobacco, alcohol, pan:
Cigarette smoking and excessive alcohol consumption represent the most
important factors for the development of HNSCC and they have a
synergistic effect. Reverse smoking is a technique in which the lighted
end of the cigarette is kept inside the mouth while smoking is a habit
practiced in some areas of India and South America, leads to HNSCC of
the hard palate. Chewing of the “betel quid’, which is popularly known
as ‘pan’ is also considered an important risk factor for the development
of HNSCC of the buccal mucosa and the mandibular buccal sulcus. The
habit of betel quid chewing is highly practiced in countries such as
India, Pakistan, Bangladesh and Sri Lanka. Although alcohol is not
considered to be a carcinogenic agent, heavy alcohol intake along with
tobacco use acts synergistically to cause HNSCC.