Global Outreach

We are actively involved in Global Outreach research, with a particular focus on betel nut-induced oral cancer.

Betel nut is the seed of Areca catechu, a fruit-bearing tropical palm tree commonly cultivated in Asian countries.

It is chewed alone or can form the basic ingredient to a variety of chewed products, including betel quid which is prepared with areca nut, betel leaf, slaked lime and spices, with or without tobacco (Gupta et al., 1980).

It is chewed by approximately 10% of the world’s population which makes betel nut the fourth most common psychoactive substance after tobacco, alcohol and caffeine (Gupta & Warnakulasuriya, 2002).

A branch of palm tree fruits / nuts, dripping water

Beat Betel

Betel nut is an addictive substance chewed by one-tenth of the global population and is a known cause of mouth cancer.

In a study conducted in Pune, India, we found that 40% of individuals chew betel nut and those who chew were significantly less likely to be aware of its cancer risk, compared to non-chewers.

In the UK, we have found that over half of respondents chew betel more than once per year and are also significantly less aware of its cancer risk. Additionally, more than one quarter of GPs were unaware of betel nut being a risk factor for throat cancer. It is evident that this is an issue on both the national and global scale.

One of the main limiting factors to poor survival in mouth cancer is late detection of disease. No validated biomarkers are in clinical use and targeted therapies are lacking.

We have sought to advance this field by conducting targeted genomic sequencing of tumour specimens, which we collected in Pune, India, in partnership with Deenanath Mangeshkar Hospital and Foundation Medicine (Cambridge, US). This was based on a previous partnership with Foundation Medicine on the analysis of HPV-associated oropharyngeal cancer (published in Genome Medicine).

This analysis enabled us to determine a panel of genes which are frequently mutated in the tumour cohort and may serve as a potential diagnostic or prognostic biomarker.

Selected publications

  1. Rehman U, Polglase N, Kahn D ... Lechner M. Bridging the Gap in Rhinoplasty Training: The Effectiveness of 3D-Printed Models in Surgical Education. Aesthet Surg J. 2025 Mar 25:sjaf045.
  2. Rehman U, Liu J, Oakley R ... Lechner M. Rapidly rising rates of oropharyngeal cancer and economic burden in the UK. Lancet Infect Dis. 2025 May;25(5):e255. Erratum in: Lancet Infect Dis. 2025 Mar 31: S1473-3099(25)00228-2.
  3. Liu J, Bewicke-Copley H, Patel S ... Lechner M. Exploring targets in oropharyngeal cancer - association with immune markers and AI-scoring of B7-H3 expression. Clin Transl Med. 2025 Mar;15(3):e70265.
  4. Lechner M, Liu J, Counsell N, et al. The burden of olfactory dysfunction during the COVID-19 pandemic in the United Kingdom. Rhinology. 2023 Feb 1;61(1): 93-96.
  5. Lechner M, Breeze CE, Vaz F, Lund VJ, Kotecha B. Betel nut chewing in high-income countries - lack of awareness and regulation. Lancet Oncol. 2019 Feb;20(2): 181-183.
  6. Lechner M, Liu J, Masterson L, Fenton TR. HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nat Rev Clin Oncol. 2022 May;19(5): 306-327.
  7. Emanuel O, Liu J, Schartinger VH ... Lechner M. SSTR2 in Nasopharyngeal Carcinoma: Relationship with Latent EBV Infection and Potential as a Therapeutic Target. Cancers (Basel). 2021 Sep 30;13(19): 4944.
  8. Kaur RP, Izumchenko E, Blakaj DM, Mladkova N, Lechner M, et al. The genomics and epigenetics of olfactory neuroblastoma: A systematic review. Laryngoscope Investig Otolaryngol. 2021 Jun 7;6(4): 721-728.

Research Team

  • Mr Sanket Kachole, Bioinformatician

Funders / Supporters

AGA ENT