Htay Zin Wai, Bhandari Aliza K C, Parvin Rokshana, Abe Sarah Krull
Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Environmental Epidemiology Section, Health and Environmental Risk Research Division, National Institute for Environmental Studies, Tsukuba, Japan.
Cancer Causes Control. 2025 Apr;36(4):321-352. doi: 10.1007/s10552-024-01933-w. Epub 2024 Dec 24.
The prevalence of smokeless tobacco consumption remains high despite policies on reduction interventions. This study aims to quantify the associations between smokeless tobacco use with cancer incidence and mortality globally.
We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and PROSPERO protocol (ID: CRD42023390468). A comprehensive literature search was performed using PubMed, Web of Science, and Scopus databases, covering the period from January 1, 2000, to February 28, 2023. We included peer-reviewed observational studies, specifically case-control and cohort studies, where smokeless tobacco use was the primary exposure and cancer incidence, or mortality were the main outcomes. Three independent reviewers screened titles, abstracts, and full texts, and extracted data from the included studies. Risk of bias was assessed by the same three reviewers. Any disagreements were resolved through discussion with a fourth reviewer. We performed random-effects meta-analyses and assessed heterogeneity and publication bias to ensure the robustness of our findings.
Of the 3,611 articles identified, 80 were included in the final analysis. Increased risks were observed for cancer mortality [Risk Ratio (RR) 1.38, 95% Confidence Interval (CI) 1.22-1.56] and incidence [RR 1.17, 95% CI 1.08-1.27]. The specific cancer sites with increased mortality risk included head and neck cancers, as well as stomach cancer. For cancer incidence, associations were observed with head and neck, oral, esophageal, stomach, and pancreatic cancers. Significant heterogeneity (I statistic 65% to 90%) was observed among most cancer outcomes.
Our study found significant associations between smokeless tobacco use and cancer incidence and mortality. Targeted policy interventions, such as stricter regulations on smokeless tobacco use, are recommended to reduce its consumption and mitigate the associated cancer risks.
尽管有减少干预措施的政策，但无烟烟草消费的流行率仍然很高。本研究旨在量化全球无烟烟草使用与癌症发病率和死亡率之间的关联。
我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南和PROSPERO方案（ID：CRD42023390468）进行了系统评价和Meta分析。使用PubMed、科学网和Scopus数据库进行了全面的文献检索，涵盖2000年1月1日至2023年2月28日期间。我们纳入了同行评审的观察性研究，特别是病例对照研究和队列研究，其中无烟烟草使用是主要暴露因素，癌症发病率或死亡率是主要结局。三名独立评审员筛选了标题、摘要和全文，并从纳入的研究中提取数据。由相同的三名评审员评估偏倚风险。任何分歧都通过与第四名评审员讨论来解决。我们进行了随机效应Meta分析，并评估了异质性和发表偏倚，以确保我们研究结果的稳健性。
在确定的3611篇文章中，80篇纳入了最终分析。观察到癌症死亡率[风险比（RR）1.38，95%置信区间（CI）1.22 - 1.56]和发病率[RR 1.17，95% CI 1.08 - 1.27]增加。死亡率风险增加的特定癌症部位包括头颈癌以及胃癌。对于癌症发病率，观察到与头颈癌、口腔癌、食管癌、胃癌和胰腺癌有关联。在大多数癌症结局中观察到显著的异质性（I统计量为65%至90%）。
我们的研究发现无烟烟草使用与癌症发病率和死亡率之间存在显著关联。建议采取有针对性的政策干预措施，如对无烟烟草使用实施更严格的监管，以减少其消费并降低相关的癌症风险。
