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head and neck cancer (hnc) refers to tumors of the oral cavity, pharynx including nasopharynx, oropharynx, hypopharynx; and larynx, paranasal sinuses and the salivary glands (cosa 2011, ncsm 2010). there were 940 cases of nasopharyngeal cancer diagnosed in 2007 and registered at national cancer registry, comprising of 685 males and 255 females. nasopharyngeal cancer is the fourth most common cancer (5.2%) among malaysian and the third most common cancer among males in malaysia. statistics showed that smoking and drinking rates are higher in men than in women (cosa 2011; ncr 2007). this is probably a reason why hnc incidence was more than 2 folds higher among males when compared to females (ncsm 2010). among the ethnics, chinese were found to have higher incidence rate of hnc compared to malay and indian. recent genome-wide association study focused on esophageal squamous cell carcinoma has identified genetic variants in chinese population might be associated with the high incidence of hnc (yuan et al. 2013). however, future studies with larger samples and functional evaluation are needed to validate the findings. in addition, hnc is most common in people aged 50 or older. however, the peak of age-specific incidence rate of hnc was at aged of 70 to 75 based on ncr (2007) statistics. moreover, higher incidence rate found in developing countries, particularly in south asia (india, pakistan, kabul) as compared to european or western countries (boyle et al. 2008). by far, tobacco smoking or chewing, alcohol drinking and betel nut chewing are the most common risk factors associated with hnc (akhtar et al. 2012; chang et al. 2005; znaor et al. 2003). betel nut is a mixture of areca nut, slaked lime with aqueous calcium hydroxide paste and tobacco, condiments and with or without sweeteners wrapped in a betel leaf (jeng et al. 2001). thus, chewing betel nuts is highly addictive and carcinogenic (nitrosamines) which play a significant role in the aetiology of oral cancer (akhtar et al. 2012). studies showed that the incidence of hnc for individuals who smoke, drink alcohol and chew betel nut has been reported to be 123-fold higher than drink alcohol alone (jeng et al. 2001; ko et al. 1995). other observed risk factors are poor oral hygiene, epstein-barr virus, human papillomavirus (hpv) and occupational exposure to asbestos, formadehyde and nick (attar et al. 2010; kreimer et al. 2005). nevertheless, recent studies found there is an association between diet and hnc (jia et al. 2010). studies showed that consumption of salted vegetables such as soybeans, canned pickle vegetable and salted fish and meat is associated with hnc particularly nasopharynx cancer. this is because cooking of such foods releases carcinogens, nitrosamines into the fumes that we breathe (scs 2013; jia et al. 2010).
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