Sankaranarayanan R, Duffy S W, Padmakumary G, Day N E, Krishan Nair M
Regional Cancer Centre, Trivandrum-India.
J Epidemiol Community Health. 1990 Dec;44(4):286-92. doi: 10.1136/jech.44.4.286.
The aim was to investigate risk factors for cancer of the buccal and labial mucosa in Kerala, southern India.
The investigation was a case-control study.
Regional Cancer Centre, Trivandrum, Kerala, and local teaching hospitals.
Cases were all those registered with oral cancers at the Regional Cancer Centre during 1983 and 1984 (n = 414). Controls (n = 895) were selected from admissions to the cancer centre who were found to have non-malignant conditions, or from patients attending outpatients in teaching hospitals of Trivandrum medical college with non-malignant conditions.
The risk in males of the following habits was investigated: pan (betel)-tobacco chewing, bidi and cigarette smoking, drinking alcohol, and taking snuff. Only pan-tobacco chewing was investigated in females as very few indulged in other habits. Among males predisposing effects were found for pan-tobacco chewing (p less than 0.001), bidi smoking (p less than 0.001), drinking alcohol (p less than 0.001), and taking snuff (p less than 0.01). As in males, pan-tobacco chewing also had a predisposing effect in females (p less than 0.001). Duration of use was a better predictor of risk than either daily frequency of use or total lifetime exposure, both for pan-tobacco chewing (especially if the habit started before age 21 years) and bidi smoking. However, there were also very high risks associated with the current occasional use of both factors. Pan-tobacco chewing was the most important risk factor, with relative risk of 13.24 with 31-40 years' use, and 37.75 with greater than 40 years' use among males. Corresponding relative risks in females were 21.30 and 54.93. No effect of cigarette smoking was observed (relative risk 0.64, p greater than 0.1).
A substantial majority of cases of buccal and labial cancers are attributable to chewing pan-tobacco. This has obvious implications for instituting preventive measures.
旨在调查印度南部喀拉拉邦颊黏膜和唇黏膜癌的危险因素。
该调查为病例对照研究。
喀拉拉邦特里凡得琅的地区癌症中心及当地教学医院。
病例为1983年和1984年期间在地区癌症中心登记的所有口腔癌患者（n = 414）。对照（n = 895）选自癌症中心的非恶性疾病入院患者，或特里凡得琅医学院教学医院门诊的非恶性疾病患者。
调查了男性以下习惯的风险：嚼槟榔（萎叶）-烟草、抽比迪烟和香烟、饮酒以及吸鼻烟。女性仅调查了嚼槟榔-烟草，因为很少有人有其他习惯。在男性中，发现嚼槟榔-烟草（p < 0.001）、抽比迪烟（p < 0.001）、饮酒（p < 0.001）和吸鼻烟（p < 0.01）有诱发作用。与男性一样，嚼槟榔-烟草在女性中也有诱发作用（p < 0.001）。对于嚼槟榔-烟草（尤其是如果该习惯在21岁之前开始）和抽比迪烟，使用持续时间比每日使用频率或终生总暴露量更能预测风险。然而，当前偶尔使用这两种因素也存在非常高的风险。嚼槟榔-烟草是最重要的危险因素，男性使用31 - 40年的相对风险为13.24，使用超过40年的相对风险为37.75。女性相应的相对风险为21.30和54.9。未观察到吸烟的影响（相对风险0.64，p > 0.1）。
绝大多数颊癌和唇癌病例归因于嚼槟榔-烟草。这对制定预防措施具有明显意义。
