Spangler J G, Michielutte R, Bell R A, Dignan M B
Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Ethn Dis. 2001 Winter;11(1):36-43.
Cigarette smoking and smokeless tobacco use have been associated with the development of a variety of cancers. While cigarette smoking may be associated with breast cancer, smokeless tobacco use has never been evaluated as a breast cancer risk factor. This study explores such an association.
A complete census was carried out among Eastern Band Cherokee women aged 18 years and older, residing on tribal lands in western North Carolina. Self-reported alcohol, cigarette and smokeless tobacco use, demographic information, and personal history of breast cancer (stratified by age of onset < 55 years or > or = 55 years) were obtained by questionnaire.
1,070 out of 1,408 (76%) eligible women were interviewed. Current and former smokeless tobacco use was common (6% and 21%, respectively). Five cases of breast cancer were identified in women under the age of 55 years and 3 cases were found in women at > or = 55 years. Only the odds ratio (OR) for younger-onset breast cancer among ever-users of smokeless tobacco was significantly elevated (OR = 7.79, 95% CI = 1.05-66.0). While the ORs for younger onset breast cancer were elevated among ever-smokers or women reporting at least monthly alcohol use, these were not significant (OR 8.49, 95% CI = 0.09-200; and OR = 1.72, 95% CI = 0.19-15.2, respectively). No ORs were significantly elevated for breast cancer among older women.
These preliminary data are the first to document an apparent relationship between smokeless tobacco use and breast cancer risk, but should be confirmed in other studies due to the small number of cases. The nearly 8-fold increase in risk suggests that smokeless tobacco is not a safe alternative to cigarette smoking.
吸烟和使用无烟烟草与多种癌症的发生有关。虽然吸烟可能与乳腺癌有关，但无烟烟草的使用从未被评估为乳腺癌的风险因素。本研究探讨了这种关联。
对居住在北卡罗来纳州西部部落土地上的18岁及以上的东部邦联切罗基族女性进行了全面普查。通过问卷调查获取自我报告的酒精、香烟和无烟烟草使用情况、人口统计学信息以及乳腺癌个人史（按发病年龄<55岁或≥55岁分层）。
1408名符合条件的女性中有1070名（76%）接受了访谈。当前和以前使用无烟烟草的情况很常见（分别为6%和21%）。在55岁以下的女性中发现了5例乳腺癌，在55岁及以上的女性中发现了3例。只有曾经使用无烟烟草的女性中，发病年龄较轻的乳腺癌的优势比（OR）显著升高（OR = 7.79，95%可信区间 = 1.05 - 66.0）。虽然曾经吸烟者或报告至少每月饮酒一次的女性中，发病年龄较轻的乳腺癌的OR有所升高，但这些都不显著（OR分别为8.49，95%可信区间 = 0.09 - 200；以及OR = 1.72，95%可信区间 = 0.19 - 15.2）。老年女性中乳腺癌的OR没有显著升高。
这些初步数据首次记录了无烟烟草使用与乳腺癌风险之间的明显关系，但由于病例数量较少，应在其他研究中得到证实。风险增加近8倍表明无烟烟草并非吸烟的安全替代品。
