Araghi Marzieh, Galanti Maria Rosaria, Lundberg Michael, Liu Zhiwei, Ye Weimin, Lager Anton, Engström Gunnar, Manjer Jonas, Alfredsson Lars, Knutsson Anders, Norberg Margareta, Palmqvist Richard, Gylling Björn, Wennberg Patrik, Lagerros Ylva Trolle, Bellocco Rino, Pedersen Nancy L, Östergren Per-Olof, Magnusson Cecilia
1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
2 Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, Sweden.
Scand J Public Health. 2017 Dec;45(8):741-748. doi: 10.1177/1403494817714191. Epub 2017 Oct 10.
Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association.
A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis.
Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention.
尽管吸烟被认为是结直肠癌的既定危险因素，但目前关于无烟烟草与结直肠癌之间关联的证据很少且尚无定论。我们使用来自瑞典鼻烟使用健康影响合作项目的汇总个体数据来评估这种关联。
对瑞典9项队列研究中的417872名男性参与者进行随访，观察结直肠癌的发病率和死亡率。通过与健康登记册的关联来确定结果。我们使用在研究水平上具有随机效应的共享脆弱模型来估计风险比（HR）和95%置信区间（CI）。
在7135504人年的观察期内，4170名男性患了结直肠癌。总体而言，鼻烟使用与结直肠癌之间没有明显关联。然而，当前仅使用鼻烟的使用者患直肠癌的风险增加（HR 1.40：95% CI 1.09，1.79）。在结直肠癌诊断后，鼻烟使用与全因死亡率或结直肠癌特异性死亡率之间没有统计学上的显著关联。
我们从大量样本中得出的研究结果不支持鼻烟使用与男性结直肠癌风险及生存率之间存在任何强关联。然而，观察到的直肠癌风险增加值得注意，值得进一步关注。
