Betel leaves are arranged aesthetically on a decorated plate called pandani and it is offered to the elderly people, particularly women, when they engage in leisure time gossip with their friends and relatives. A Lancet Oncology publication claims that paan masala may cause tumours in different parts of the body and not just the oral cavity as previously thought. Oral submucous fibrosis and lichen planus, which are generally accepted to be precancerous conditions, appear to be related to the habit of chewing paan. Although not as ubiquitous as in the Terai, most residents of Kathmandu occasionally enjoy paan. Paan Supari is perhaps the first such brand, which offers a wide range of khili paan. The average yield per acre is 2. In Bangladesh pan is traditionally chewed not only as a habit but also as an item of rituals, etiquette and manners. Paan is also used in Hindu puja and wedding festivals and to visit relatives. They also offer a khili paan for diabetic patients called the "paan afsana".
The paan business is famously handled and run by muhajir traders, who migrated from western India to Pakistan after the independence in also cite pg 60, of Pakistan, By Samuel Willard Crompton, Charles F. Betel leaves are arranged aesthetically on a decorated plate called pandani and it is offered to the elderly people, particularly women, when they engage in leisure time gossip with their friends and relatives. Paan stalls and kiosks used to be run mainly by people of Indian origin in towns and cities. Some follow-up studies have shown malignant transformation of a proportion of leukoplakias. The sweet paan of the Khasi tribe is famous for its special quality. Although 'paan' has been a staple Bengali custom for ages, a number of high-end stores with premium quality paan has become available in recent times. A sweet version of paan called meetha paan is popular amongst many who do not like the strong taste of plain sada paan. Old Dhakaites have a rich heritage of creating the best khili paan with many complex, colourful, aromatic and mouth-watering ingredients. In hamsters, forestomach carcinomas occurred after painting the cheek-pouch mucosa with aqueous extracts or implantation of a wax pellet containing powdered paan with tobacco into the cheek pouch; carcinomas occurred in the cheek pouch following implantation of the wax pellets. Chewing betel leaf quid and smoking, the scientists claimed, shortened the life span by nearly six years. It has become a ritual, tradition and culture of Bangladeshi society. After screening for various causes, the scientists reported paan chewing to be the major risk factor, with or without tobacco. In festivals and dinners, in pujas and punyas pan is an indispensable item. In the past, the best quality of elegant camphor-scented betel leaf named Kafuri paan was produced in the sonargaon area of Narayangonj district. The next best is the Sanchi paan grown in Chittagong hill tracts. Tamakh paan, a betel leaf bended with tobacco and spices. Burmese history also mentions an ancient custom of a condemned enemy asking for "a paan and a drink of water" before being executed. Hindus make use of paans as offerings in worship. Spittoons, therefore, are still ubiquitous, and signs saying "No paan-spitting" are commonplace, as it makes a messy red splodge on floors and walls; many people display betel-stained teeth from the habit. Pakistan grows a large variety of betel leaf, specifically in the coastal areas of Sindh ,  although paan is imported in large quantities from India , Bangladesh , Sri Lanka and, recently, Thailand. Chewing and smoking, as combined by most betel chewers, interacted synergistically and was responsible for half of all cancer deaths in this group. Throughout Terai, paan is as common as anywhere in northern India. Paan Supari is perhaps the first such brand, which offers a wide range of khili paan. In the famous Anarkali Bazar in Lahore a street called paan gali is dedicated for paan and its ingredients together with other Pakistani products. The effects were similar to those reported for women who consume alcohol or tobacco during pregnancy. Adult women gather with pandani  along with friends and relatives in leisure time.
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