Accortt Neil A, Waterbor John W, Beall Colleen, Howard George
Medical Statistics Section, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Cancer Causes Control. 2005 Nov;16(9):1107-15. doi: 10.1007/s10552-005-0247-0.
Smokeless tobacco (ST) use remains a prevalent form of tobacco use among certain US populations. The purpose of this paper is to clarify its role in cancer development.
Using data from a prospective cohort of the US population, we categorized 6,779 subjects 45-75 years of age as ST users or non-ST users. Subjects were further stratified by cigarette smoking status in order to differentiate 'exclusive' ST users (n=414) from never tobacco users (n=2,979).
In this cohort, exclusive ST use was not associated with increased incidence of all cancer in males (hazard ratio=0.8, 95% CI: 0.4, 1.6) or females (HR=1.2, 95% CI: 0.7-2.1) or oral cancer (standardized incidence ratio=30, 95% CI: 3, 95). No synergistic effect was observed between ST and cigarette smoking among male combined users (females were not analyzed for combined use) for the major cancers.
In contrast to the well-known deleterious effects of cigarette smoking, ST use did not substantially increase the risk for cancer incidence above that of non-tobacco users, particularly among males. Although the use of tobacco in any form is to be discouraged, our data suggests that cancer risks are much lower from ST use than from cigarette smoking.
无烟烟草（ST）的使用在美国某些人群中仍然是一种普遍的烟草使用形式。本文旨在阐明其在癌症发展中的作用。
利用来自美国人群前瞻性队列的数据，我们将6779名45 - 75岁的受试者分为ST使用者或非ST使用者。受试者进一步按吸烟状况分层，以区分“单纯”ST使用者（n = 414）和从不使用烟草者（n = 2979）。
在这个队列中，单纯使用ST与男性（风险比 = 0.8，95%置信区间：0.4，1.6）或女性（风险比 = 1.2，95%置信区间：0.7 - 2.1）的所有癌症发病率增加无关，也与口腔癌（标准化发病率比 = 30，95%置信区间：3，95）无关。对于主要癌症，在男性联合使用者中未观察到ST与吸烟之间的协同效应（未对女性联合使用情况进行分析）。
与吸烟众所周知的有害影响相反，使用ST并未使癌症发病率风险比非烟草使用者大幅增加，尤其是在男性中。尽管不鼓励以任何形式使用烟草，但我们的数据表明，使用ST导致癌症的风险远低于吸烟。
