Abstract
In the wake of smokeless tobacco (SLT) being advocated as a mean of tobacco harm reduction, it is pertinent to establish individual health risks associated with each SLT product. This case-control study was aimed at assessing the risk of oral cancer associated with a smokeless tobacco product (Naswar). The study was conducted from September 2014 till May 2015 in Khyber Pakhtunkhwa, Pakistan. Exposure and covariate information was collected through a structured questionnaire. Conditional logistic regression was used to calculate odds ratios (OR) along with their 95% confidence intervals (CI). 84 oral cancer cases (62% males) and 174 age- and sex-matched controls were recruited. Ever users of Naswar had more than a 20-fold higher risk of oral cancer compared to never-users (OR 21.2, 95% CI 8.4–53.8). Females had a higher risk of oral cancer with the use of Naswar (OR 29.0, 95% CI 5.4–153.9) as compared to males (OR 21.0, 95% CI 6.1–72.1). Based on this result, 68% (men) and 38% (women) of the oral cancer burden in Pakistan is attributable to Naswar. The risk estimates observed in this study are comparable to risk estimates reported by previous studies on other forms of SLT use and the risk of oral cancer in Pakistan. The exposure-response relationship also supports a strong role of Naswar in the etiology of oral cancer in Pakistan. Although still requiring further validation through independent studies, these findings may be used for smokeless tobacco control in countries where Naswar use is common.
Highlights
The total number of attributable incident cases (AC) of oral cancer was obtained by the formula AC = population attributable fraction (PAF) Ã TC, TC is the total number of annual incident cases of oral cancer
The uncertain security situation led to a decrease in patient in-flow at most hospitals in Peshawar city as both inter and intra-city movement came to a halt
Naswar contributes to about 70% of oral cancers in the study region
Summary
A multi-center matched case-control study was carried out in two major cities of the Khyber Pakhtunkhwa province of Pakistan between September 2014 and May 2015. The catchment area of the study centers includes the whole province along with the Federally Administered Tribal Areas (FATA) of Pakistan. Controls were recruited from the same centers as well as from two additional health facilities in Peshawar (Pakistan Paraplegic Center, Peshawar and Institute for Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar). These facilities provide health services to the population of the whole province. To detect an OR of 3.0 with a two-sided 95% confidence level and a power of 90%, we had to recruit 78 cases and 156 controls
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
