Association of Smokeless Tobacco with Oral Cancer: A Review of Systematic Reviews

Overview

Journal Tob Prev Cessat

Date 2020 May 16

PMID 32411897

Citations 12

Authors

Smita Asthana

Parul Vohra

Satyanarayana Labani

Affiliations

Soon will be listed here.

Abstract

Introduction: Various primary studies and systematic reviews have been conducted to explain the association between smokeless tobacco and oral cancer. This study aims to consolidate and summarize the risk estimates from various systematic reviews with or without meta-analysis to provide the spectrum of estimates on the association between smokeless tobacco use and oral cancer.

Methods: A comprehensive literature search was done on various databases (PubMed, Google Scholar, IndMED, and TOXLINE) by two of the authors independently. Both qualitative and quantitative data extraction and analysis were performed for the included systematic reviews. Range of risk estimates was obtained and analyzed as quantitative findings due to the limitation of an overview of reviews for the pooled estimates. CASP (Critical Appraisals Skills Programme) and AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tools were used for the quality assessment of the studies included.

Results: In total, 12 systematic reviews with or without meta-analysis were included in the review. There was a positive and strong association of Smokeless Tobacco (SLT) use with oral cancer irrespective of gender, region, and type of smokeless tobacco. The risk estimate for the South-East Asia Region (SEAR) ranged 4.44-7.90, for Gutkha it was 8.67, while for Paan it ranged 6.3-7.90 and for overall SLT it ranged 1.36-7.90. Risk estimate for females ranged 5.83-14.56.

Conclusions: The study confirmed the association between SLT use and oral cancer. These findings are of high importance, especially to the South-East Asia Region.

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References

Khan Z, Tonnies J, Muller S . Smokeless tobacco and oral cancer in South Asia: a systematic review with meta-analysis. J Cancer Epidemiol. 2014; 2014:394696. PMC: 4109110. DOI: 10.1155/2014/394696. View

Niaz K, Maqbool F, Khan F, Bahadar H, Hassan F, Abdollahi M . Smokeless tobacco ( and ) consumption, prevalence, and contribution to oral cancer. Epidemiol Health. 2017; 39:e2017009. PMC: 5543298. DOI: 10.4178/epih.e2017009. View

Mallath M, Taylor D, Badwe R, Rath G, Shanta V, Pramesh C . The growing burden of cancer in India: epidemiology and social context. Lancet Oncol. 2014; 15(6):e205-12. DOI: 10.1016/S1470-2045(14)70115-9. View

Shea B, Reeves B, Wells G, Thuku M, Hamel C, Moran J . AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017; 358:j4008. PMC: 5833365. DOI: 10.1136/bmj.j4008. View

Boffetta P, Hecht S, Gray N, Gupta P, Straif K . Smokeless tobacco and cancer. Lancet Oncol. 2008; 9(7):667-75. DOI: 10.1016/S1470-2045(08)70173-6. View

Gates A, Gates M, Duarte G, Cary M, Becker M, Prediger B . Evaluation of the reliability, usability, and applicability of AMSTAR, AMSTAR 2, and ROBIS: protocol for a descriptive analytic study. Syst Rev. 2018; 7(1):85. PMC: 6000957. DOI: 10.1186/s13643-018-0746-1. View

Guha N, Warnakulasuriya S, Vlaanderen J, Straif K . Betel quid chewing and the risk of oral and oropharyngeal cancers: a meta-analysis with implications for cancer control. Int J Cancer. 2013; 135(6):1433-43. DOI: 10.1002/ijc.28643. View

Rodu B, Jansson C . Smokeless tobacco and oral cancer: a review of the risks and determinants. Crit Rev Oral Biol Med. 2004; 15(5):252-63. DOI: 10.1177/154411130401500502. View

Gupta B, Johnson N . Systematic review and meta-analysis of association of smokeless tobacco and of betel quid without tobacco with incidence of oral cancer in South Asia and the Pacific. PLoS One. 2014; 9(11):e113385. PMC: 4239077. DOI: 10.1371/journal.pone.0113385. View

10.

Asthana S, Labani S, Kailash U, Sinha D, Mehrotra R . Association of Smokeless Tobacco Use and Oral Cancer: A Systematic Global Review and Meta-Analysis. Nicotine Tob Res. 2018; 21(9):1162-1171. DOI: 10.1093/ntr/nty074. View

11.

Sinha D, Rizwan S, Aryal K, Karki K, Zaman M, Gupta P . Trends of Smokeless Tobacco use among Adults (Aged 15-49 Years) in Bangladesh, India and Nepal. Asian Pac J Cancer Prev. 2015; 16(15):6561-8. DOI: 10.7314/apjcp.2015.16.15.6561. View

12.

Critchley J, Unal B . Health effects associated with smokeless tobacco: a systematic review. Thorax. 2003; 58(5):435-43. PMC: 1746661. DOI: 10.1136/thorax.58.5.435. View

13.

Khan Z, Suliankatchi R, Heise T, Dreger S . Naswar (Smokeless Tobacco) Use and the Risk of Oral Cancer in Pakistan: A Systematic Review With Meta-Analysis. Nicotine Tob Res. 2018; 21(1):32-40. DOI: 10.1093/ntr/ntx281. View

14.

Petti S, Masood M, Scully C . The magnitude of tobacco smoking-betel quid chewing-alcohol drinking interaction effect on oral cancer in South-East Asia. A meta-analysis of observational studies. PLoS One. 2013; 8(11):e78999. PMC: 3832519. DOI: 10.1371/journal.pone.0078999. View

15.

Siddiqi K, Shah S, Abbas S, Vidyasagaran A, Jawad M, Dogar O . Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries. BMC Med. 2015; 13:194. PMC: 4538761. DOI: 10.1186/s12916-015-0424-2. View

16.

Lee P, Hamling J . Systematic review of the relation between smokeless tobacco and cancer in Europe and North America. BMC Med. 2009; 7:36. PMC: 2744672. DOI: 10.1186/1741-7015-7-36. View

17.

Weitkunat R, Sanders E, Lee P . Meta-analysis of the relation between European and American smokeless tobacco and oral cancer. BMC Public Health. 2007; 7:334. PMC: 2225413. DOI: 10.1186/1471-2458-7-334. View

18.

Sinha D, Suliankatchi Abdulkader R, Gupta P . Smokeless tobacco-associated cancers: A systematic review and meta-analysis of Indian studies. Int J Cancer. 2015; 138(6):1368-79. DOI: 10.1002/ijc.29884. View

19.

Wyss A, Hashibe M, Lee Y, Chuang S, Muscat J, Chen C . Smokeless Tobacco Use and the Risk of Head and Neck Cancer: Pooled Analysis of US Studies in the INHANCE Consortium. Am J Epidemiol. 2016; 184(10):703-716. PMC: 5141945. DOI: 10.1093/aje/kww075. View

20.

Edge S, Compton C . The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; 17(6):1471-4. DOI: 10.1245/s10434-010-0985-4. View