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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 betel quid plus tobacco and the risk of oral cancer.
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fig3: Forest plot of betel quid plus tobacco and the risk of oral cancer.

Mentions: A total of nine publications included in this review reported OR or contained data from which OR could be calculated for the risk of chewing paan/betel quid and oral cancer (Table 3). Six publications [29–31, 38, 41, 44] reported overall OR which were adjusted for confounding factors such as smoking and/or alcohol. The adjusted OR varied from 3.1 [41] to 14.1 [7.4–26.5] [31]. Overall, the OR (both adjusted and unadjusted) varied from 3.1 [41] to 15.7 [11.0–22.1] [39]. The pooled OR for chewing paan/betel quid and risk of oral cancer was 7.1 [4.5–11.1] (Figure 3). The studies where adjustment for alcohol and/or smoking had been done, when combined, provided a pooled OR of 6.3 [3.9–10.2]. Case-control studies having hospitals as a source of controls when combined gave a pooled estimate of 7.4 [4.4–12.4]. For studies carried out in India the pooled estimate was 7.0 [4.4–11.1]. For studies carried out in South India the pooled OR was 7.4 [4.1–13.0]. Only one study was carried out in the state of Maharashtra where the OR was 9.3 [5.1–17.2]. When the one “weak” study, for which the OR was 3.9 [2.4–6.4], was excluded, the pooled estimate came out to be 7.6 [4.7–12.3]. Similarly the pooled risk estimates from studies carried out in South India were comparatively higher than the overall pooled estimate.


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 betel quid plus tobacco and the risk of oral cancer.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: Forest plot of betel quid plus tobacco and the risk of oral cancer.
Mentions: A total of nine publications included in this review reported OR or contained data from which OR could be calculated for the risk of chewing paan/betel quid and oral cancer (Table 3). Six publications [29–31, 38, 41, 44] reported overall OR which were adjusted for confounding factors such as smoking and/or alcohol. The adjusted OR varied from 3.1 [41] to 14.1 [7.4–26.5] [31]. Overall, the OR (both adjusted and unadjusted) varied from 3.1 [41] to 15.7 [11.0–22.1] [39]. The pooled OR for chewing paan/betel quid and risk of oral cancer was 7.1 [4.5–11.1] (Figure 3). The studies where adjustment for alcohol and/or smoking had been done, when combined, provided a pooled OR of 6.3 [3.9–10.2]. Case-control studies having hospitals as a source of controls when combined gave a pooled estimate of 7.4 [4.4–12.4]. For studies carried out in India the pooled estimate was 7.0 [4.4–11.1]. For studies carried out in South India the pooled OR was 7.4 [4.1–13.0]. Only one study was carried out in the state of Maharashtra where the OR was 9.3 [5.1–17.2]. When the one “weak” study, for which the OR was 3.9 [2.4–6.4], was excluded, the pooled estimate came out to be 7.6 [4.7–12.3]. Similarly the pooled risk estimates from studies carried out in South India were comparatively higher than the overall pooled estimate.

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