Motlhale Melitah, Sitas Freddy, de Villiers Chantal Babb, Simba Hannah, Feliu Ariadna, Chen Wenlong Carl, Schüz Joachim, Muchengeti Mazvita, McCormack Valerie
Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
Int J Cancer. 2025 May 15;156(10):1916-1925. doi: 10.1002/ijc.35293. Epub 2024 Dec 16.
Smokeless tobacco (SLT) use is an established carcinogen to the nasal cavity, lip, and oropharynx, however, few studies have examined cancer risks in older African women among whom SLT use is common. We investigated snuff use and the risk of site-specific cancers among 15,336 newly diagnosed female cancer patients in the Johannesburg Cancer Study, South Africa. We designed case-control comparisons across multiple cancer outcomes: (a) known SLT-associated cancers; (b) other tobacco-related cancers and (c) genital cancers owing to intravaginal snuff use. Controls (n = 2961) comprised all other cancer patients. We also investigated (d) each control cancer type versus the remaining controls to explore possible associations with other cancers. Logistic models were fitted to estimate odds ratios adjusted for age, education, tobacco smoking, alcohol, HIV, and language. Overall, ever use of snuff was 22% among control cancers. Ever snuff use was associated with cervical (OR 1.14 [95%CI 1.00-1.30]) and eye and adnexa cancer (OR 1.95 [95%CI 1.03-3.70]). Associations with vulva cancer were less clear, 95% CI's for the main effects included 1 but a subgroup analysis restricted to never-smokers of current-versus-never users was positive (OR 2.10 [95%CI 1.25-3.50]). Surprisingly SLT users have lower risks of stomach cancer (OR 0.60 [95%CI 0.37-0.99]) and Hodgkin Lymphoma (OR 0.48 [95%CI 0.23-0.97]). Snuff use may increase the risk for cervical and vulva cancer in women, which is plausible via intravaginal use. Further research on the impact of SLT on female genital cancers with more detailed exposure data, including timing, intensity, and routes of use are required.
无烟烟草（SLT）的使用已被确认为鼻腔、嘴唇和口咽的致癌物，然而，很少有研究调查在经常使用SLT的老年非洲女性中的癌症风险。我们在南非约翰内斯堡癌症研究中，对15336名新诊断的女性癌症患者进行了鼻烟使用情况及特定部位癌症风险的调查。我们针对多种癌症结局设计了病例对照比较：（a）已知与SLT相关的癌症；（b）其他与烟草相关的癌症；（c）因阴道内使用鼻烟导致的生殖器癌症。对照组（n = 2961）包括所有其他癌症患者。我们还调查了（d）每种对照癌症类型与其余对照组，以探索与其他癌症的可能关联。采用逻辑模型来估计经年龄、教育程度、吸烟、饮酒、艾滋病毒和语言因素调整后的比值比。总体而言，在对照癌症患者中，曾经使用鼻烟的比例为22%。曾经使用鼻烟与宫颈癌（比值比1.14 [95%置信区间1.00 - 1.30]）以及眼和附属器癌症（比值比1.95 [95%置信区间1.03 - 3.70]）相关。与外阴癌的关联不太明确，主要效应的95%置信区间包含1，但仅限于从不吸烟者的当前使用者与从未使用者的亚组分析呈阳性（比值比2.10 [95%置信区间1.25 - 3.50]）。令人惊讶的是，SLT使用者患胃癌（比值比0.60 [95%置信区间0.37 - 0.99]）和霍奇金淋巴瘤（比值比0.48 [95%置信区间0.23 - 0.97]）的风险较低。女性使用鼻烟可能会增加患宫颈癌和外阴癌的风险，这通过阴道内使用是合理的。需要进一步研究SLT对女性生殖器癌症的影响，并获取更详细的暴露数据，包括使用时间、强度和途径。
