Taiwan Collaboration

Oral squamous cell carcinoma (OSCC), a type of head and neck cancer, accounts for the fourth highest incidence of malignancy in males and the seventh highest in females in Taiwan. OSCC in Taiwan is largely attributed to the use of betel nut, which is used by over 2.5 million of Taiwan's population.

Although OSCC is highly curable if detected early, the expected 5-year relative survival rate (approx. 50%) has improved only marginally over the past few decades due to its frequent advanced stage presentations. The medical community in Taiwan is actively seeking methods which could help in the prevention and early detection of OSCC to reduce the occurrence and recurrence of oral cancer. At present, there are no clinically available diagnostic biomarkers for OSCC. 

Betel Nut

Harvested from the Areca palm and chewed for its warming glow and stimulating properties, betel nut, alongside nicotine, alcohol, and caffeine, is believed to be one of the most popular mind-altering substances in the world. Although used by women and children as well, the nuts are especially popular among working age men, who chew to stay awake through long hours of driving, fishing, or working on construction sites. The custom of chewing betel nut has contributed to Tawian having one of the highest incidences and mortality rates from OSCC. 

The International Agency for Research on Cancer (IARC) now regards the betel nut itself to be a known human carcinogen. 

Betel Nut-Associated OSCC in Taiwan

Betel nut chewing has contributed to Taiwan having one of the highest incidences and mortality rates from squamous cell carcinoma (OSCC). At present, there are no clinically available diagnostic biomarkers for OSCC. Therefore, there is a clear clinical need for the development of a cost-effective, reliable, and non-invasive test for a biomarker that can help with its early diagnosis. We have discovered that a protein, human beta defensin-3 (hBD-3), shows differential expression in oral primary epithelial cells in OSCC development. 

CWRU SODM researchers are collaborating with clinicians at Taipei Medical University to conduct a pilot study to test the feasibility of using hBD-3 expression as a predictive biomarker for head and neck cancer. The study consists of biospecimen and subject medical data collection, including saliva, oral rinse collection, a blood draw, cytobrush samples, and lesion biopsy samples, or primary tumor, lymph node, and paraffin block biopsy samples. This is in addition to internal pilot studies for the development of easy to use, cost-effective, and non-invasive approaches for head and neck cancer screening. Preliminary studies showed differential expression of hBD-3 in oral primary epithelial cells in response to low versus high risk HPV types and that HIV+ patients are at a higher risk for HPV-associated oral lesions.

Taiwan Team 

Name Institution
Wei Jen Chang, DDS, MS, PhD Taipei Medical University
Keng-Liang Ou Taipei Medical University
Che-Shun Wang Taipei Medical University
Ming-Heng Wu Taipei Medical University
Ching-Yu Yen Chi Mei Medical Center