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Smokeless tobacco and oral cancer in South Asia: a systematic review with meta-analysis.

Khan Z, Tönnies J, Müller S - J Cancer Epidemiol (2014)

Bottom Line: Effect estimates (odds ratios (OR)) were abstracted or calculated from the given data.Results and Conclusion.Public health policies in affected countries should consider SLT specific cessation programs in addition to campaigns and activities incorporated into smoking cessation programs.

View Article: PubMed Central - PubMed

Affiliation: Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359 Bremen, Germany ; Khyber Medical University, Peshawar 25000, Pakistan.

ABSTRACT
Introduction. Smokeless tobacco is considered one of the major risk factors for oral cancer. It is estimated that over 90% of the global smokeless tobacco use burden is in South Asia. This paper aims to systematically review publications reporting epidemiological observational studies published in South Asia from 1984 till 2013. Methods. An electronic search in "Medline" and "ISI Web of Knowledge" yielded 734 publications out of which 21 were included in this review. All publications were assessed for quality using a standard quality assessment tool. Effect estimates (odds ratios (OR)) were abstracted or calculated from the given data. A random effects meta-analysis was performed to assess the risk of oral cancer with the use of different forms of smokeless tobacco. Results and Conclusion. The pooled OR for chewing tobacco and risk of oral cancer was 4.7 [3.1-7.1] and for paan with tobacco and risk of oral cancer was 7.1 [4.5-11.1]. The findings of this study suggest a strong causal link between oral cancer and various forms of smokeless tobacco. Public health policies in affected countries should consider SLT specific cessation programs in addition to campaigns and activities incorporated into smoking cessation programs.

No MeSH data available.


Related in: MedlinePlus

Forest plot of chewing tobacco and risk of oral cancer.
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Related In: Results  -  Collection


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fig2: Forest plot of chewing tobacco and risk of oral cancer.

Mentions: Overall 14 publications reported different forms of chewing tobacco, predominantly Gutkha and chewing tobacco leafs (Table 2). Five publications reported OR that had been adjusted for smoking among other confounders. The adjusted OR ranged from 3.6 [2.5–5.6] [34] to 8.3 [5.4–13] [48]. The OR ranged from 1.2 [1.0–1.4] [47] to 12.9 [7.5–22.3] [33] among the publications in which either crude odds ratios were mentioned or a MH-OR was calculated from the given data. The pooled OR for chewing tobacco and risk of oral cancer was 4.7 [3.1–7.1] (Figure 2). The studies where adjustment for alcohol and/or smoking had been done, when combined, provided a pooled OR of 4.3 [3.1–5.8]. The pooled OR from combining only case-control studies was 5.4 [4.1–7.1]. Case-control studies having hospitals as a source of controls when combined gave a pooled estimate of 4.2 [2.5–6.9]. Cohort studies when combined provided a pooled OR of 2.9 [1.1–8.3]. For studies carried out in India the pooled estimate was 4.8 [3.2–7.4]. For studies carried out in South India, which comprises of the states of Andhra Pradesh, Kerala, Karnataka, and Tamil Nadu, the pooled OR was 5.1 [3.3–8.1]. The pooled OR for studies carried out in the state of Maharashtra was 4.8 [1.7–13.5]. When studies of moderate quality were combined, the pooled estimate came out to be 4.5 [2.8−7.3]. The pooled estimate for studies ranked as “weak” was 5.2 [2.6–10.3].


Smokeless tobacco and oral cancer in South Asia: a systematic review with meta-analysis.

Khan Z, Tönnies J, Müller S - J Cancer Epidemiol (2014)

Forest plot of chewing tobacco and risk of oral cancer.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4109110&req=5

fig2: Forest plot of chewing tobacco and risk of oral cancer.
Mentions: Overall 14 publications reported different forms of chewing tobacco, predominantly Gutkha and chewing tobacco leafs (Table 2). Five publications reported OR that had been adjusted for smoking among other confounders. The adjusted OR ranged from 3.6 [2.5–5.6] [34] to 8.3 [5.4–13] [48]. The OR ranged from 1.2 [1.0–1.4] [47] to 12.9 [7.5–22.3] [33] among the publications in which either crude odds ratios were mentioned or a MH-OR was calculated from the given data. The pooled OR for chewing tobacco and risk of oral cancer was 4.7 [3.1–7.1] (Figure 2). The studies where adjustment for alcohol and/or smoking had been done, when combined, provided a pooled OR of 4.3 [3.1–5.8]. The pooled OR from combining only case-control studies was 5.4 [4.1–7.1]. Case-control studies having hospitals as a source of controls when combined gave a pooled estimate of 4.2 [2.5–6.9]. Cohort studies when combined provided a pooled OR of 2.9 [1.1–8.3]. For studies carried out in India the pooled estimate was 4.8 [3.2–7.4]. For studies carried out in South India, which comprises of the states of Andhra Pradesh, Kerala, Karnataka, and Tamil Nadu, the pooled OR was 5.1 [3.3–8.1]. The pooled OR for studies carried out in the state of Maharashtra was 4.8 [1.7–13.5]. When studies of moderate quality were combined, the pooled estimate came out to be 4.5 [2.8−7.3]. The pooled estimate for studies ranked as “weak” was 5.2 [2.6–10.3].

Bottom Line: Effect estimates (odds ratios (OR)) were abstracted or calculated from the given data.Results and Conclusion.Public health policies in affected countries should consider SLT specific cessation programs in addition to campaigns and activities incorporated into smoking cessation programs.

View Article: PubMed Central - PubMed

Affiliation: Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359 Bremen, Germany ; Khyber Medical University, Peshawar 25000, Pakistan.

ABSTRACT
Introduction. Smokeless tobacco is considered one of the major risk factors for oral cancer. It is estimated that over 90% of the global smokeless tobacco use burden is in South Asia. This paper aims to systematically review publications reporting epidemiological observational studies published in South Asia from 1984 till 2013. Methods. An electronic search in "Medline" and "ISI Web of Knowledge" yielded 734 publications out of which 21 were included in this review. All publications were assessed for quality using a standard quality assessment tool. Effect estimates (odds ratios (OR)) were abstracted or calculated from the given data. A random effects meta-analysis was performed to assess the risk of oral cancer with the use of different forms of smokeless tobacco. Results and Conclusion. The pooled OR for chewing tobacco and risk of oral cancer was 4.7 [3.1-7.1] and for paan with tobacco and risk of oral cancer was 7.1 [4.5-11.1]. The findings of this study suggest a strong causal link between oral cancer and various forms of smokeless tobacco. Public health policies in affected countries should consider SLT specific cessation programs in addition to campaigns and activities incorporated into smoking cessation programs.

No MeSH data available.


Related in: MedlinePlus