Valen Håkon, Becher Rune, Vist Gunn Elisabeth, Holme Jørn Andreas, Mdala Ibrahimu, Elvsaas Ida-Kristin Ørjasaeter, Alexander Jan, Underland Vigdis, Brinchmann Bendik Christian, Grimsrud Tom Kristian
Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
Nordic Institute of Dental Materials, Oslo, Norway.
Int J Cancer. 2023 Dec 15;153(12):1942-1953. doi: 10.1002/ijc.34643. Epub 2023 Jul 21.
The main objective of this systematic review was to assess cancer risk, and mortality after cancer diagnosis, for exclusive users of Swedish snus, compared with non-users of tobacco. We followed international standards for systematic reviews and graded our confidence in the risk estimates using the GRADE approach. Our search gave 2450 articles, of which 67 were assessed in full text against our inclusion criteria. Of these, 14 cohort-studies and one case-control study were included in the review. The studies investigated risk of cancer in the oral cavity or oropharynx (3 studies), esophagus (1 study), stomach (1 study), pancreas (2 studies), colorectum (2 studies), anus (1 study) and lung (1 study), as well as malignant lymphoma (1 study), leukemia and multiple myeloma (1 study), melanoma (1 study), any cancer (1 study) and mortality after cancer diagnosis (4 studies). Cancer risk could only be evaluated in men as there was a general lack of data for women. All included studies were evaluated to have a moderate risk of bias, mostly related to validity of exposure information. An increased risk of cancer of the esophagus, pancreas, stomach and rectum as well as an association between use of snus and increased mortality after a cancer diagnosis was reported. Our confidence in the various risk estimates varied from moderate through low to very low.
本系统评价的主要目的是评估与非烟草使用者相比，瑞典口含烟唯一使用者的癌症风险以及癌症诊断后的死亡率。我们遵循系统评价的国际标准，并使用GRADE方法对风险估计的可信度进行分级。我们的检索得到2450篇文章，其中67篇根据纳入标准进行了全文评估。其中，14项队列研究和1项病例对照研究纳入了本评价。这些研究调查了口腔或口咽癌（3项研究）、食管癌（1项研究）、胃癌（1项研究）、胰腺癌（2项研究）、结直肠癌（2项研究）、肛门癌（1项研究）和肺癌（1项研究）的风险，以及恶性淋巴瘤（1项研究）、白血病和多发性骨髓瘤（1项研究）、黑色素瘤（1项研究）、任何癌症（1项研究）和癌症诊断后的死亡率（4项研究）。由于普遍缺乏女性数据，仅对男性的癌症风险进行了评估。所有纳入研究的偏倚风险均为中度，主要与暴露信息的有效性有关。报告显示，食管癌、胰腺癌、胃癌和直肠癌的风险增加，以及口含烟使用与癌症诊断后死亡率增加之间存在关联。我们对各种风险估计的可信度从中度到低度再到极低不等。
