Abstract
BackgroundThe impact of smokeless tobacco (SLT) use on the risk of oral cavity cancer (OCC) has been confirmed; however, the sex-based difference in this association remains inconclusive. Therefore, this study aimed to estimate the association between SLT use and OCC risk in women and compared it to that in men.MethodsPubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies from their inception up to August 2020. Studies reporting the effect estimates of SLT use on OCC risk in men and women, were eligible for inclusion. The relative risk ratio (RRR) was applied to calculate the sex-based difference in the relationship between SLT use and OCC risk, and pooled analysis was conducted using a random-effects model with inverse variance weighting.ResultsNineteen studies reporting a total of 6593 OCC cases were included in the final meta-analysis. The pooled relative risk (RR) suggested that SLT use was associated with an increased risk of OCC in both men (RR, 2.94; 95% confidence interval [CI], 2.05–4.20; P < 0.001) and women (RR, 6.39; 95%CI, 3.16–12.93; P < 0.001). Moreover, the SLT-use-related risk of OCC was higher in women than that in men (RRR,1.79; 95%C, 1.21–2.64; P = 0.003). The risk of OCC related to SLT use in women was still significantly higher than that in men (RRR, 1.75; 95%CI, 1.15–2.66; P = 0.008) after excluding indirect comparison results. Finally, a subgroup analysis suggested significant sex-based differences only in individuals who received chewed smokeless products, regardless of the control definition. Pooled analysis of studies with high design quality confirmed the notably higher risk of OCC in women than in men.ConclusionsThis study found that SLT use was associated with a higher risk of OCC in women than in men. Further large-scale prospective cohort studies should be conducted to verify sex-based differences in the association between use of specific smokeless products and OCC risk.
Highlights
The impact of smokeless tobacco (SLT) use on the risk of oral cavity cancer (OCC) has been confirmed; the sex-based difference in this association remains inconclusive
Thereafter, 47 studies were excluded for the following reasons: effect estimates were only provided for men and women combined (n = 19), other exposures were investigated (n = 17), or insufficient data (n = 11)
We noted that SLT use was associated with an increased risk of OCC in both men (RR, 2.94; 95%confidence interval (CI), 2.05–4.20; P < 0.001) and women (RR, 6.39; 95%C, 3.16–12.93; P < 0.001) and women had a much higher risk than did men (Fig. 2)
Summary
The impact of smokeless tobacco (SLT) use on the risk of oral cavity cancer (OCC) has been confirmed; the sex-based difference in this association remains inconclusive. This study aimed to estimate the association between SLT use and OCC risk in women and compared it to that in men. Oral cavity cancer (OCC) is the subtype of head and neck cancer and defined as any cancerous tissue growth in the oral cavity. It is the sixth most common cancer and accounts for nearly 4–5% of all cancer cases [1]. The 5-year survival rate of OCC ranges from 39 to 84% depending on the disease stage and from 48 to 67% for individuals of various ethnicities [8]
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