Relationship Between Smokeless Tobacco and Cervical Premalignant and Malignant Lesions Among the Patients Screened for Cervical Cancer in the Health Promotion Clinic, Noida

Abstract

Background: Global Adult Tobacco Survey (GATS-2) India (2016-17), reported that 5.1 crore rural women and 1.4 crore urban women use tobacco in any form. Cervical cancer is the second most common cancer in India among women accounting for 22.86% of all cancer cases in women and 12% of all cancer cases in both men and women. One woman dies of cervical cancer every 8 minutes in India. The risk of cervical intraepithelial neoplasia (CIN) was found to be increased with the women who smoke but the association between smokeless tobacco (SLT) and areca nut have not been adequately reported in the literature; hence this study was contemplated to bridge the literature gap. Aim: To find the association between SLT use and cervical premalignant and malignant lesions among those women screened for cervical cancer at Health Promotion Clinic. Methods: Retrospective analysis was performed on the electronically maintained records of the individuals screened for cervical cancer from February 2014 - February 2018 at the Health Promotion Clinic at National Institute of Cancer Prevention and Research (NICPR), Noida. All married women above 30 years of age were eligible to be screened for cervical cancer using visual inspection with acetic acid (VIA) and Papanicolaou (PAP) test, if any abnormality was found colposcopy was done, if required biopsy was performed for confirmation. The premalignant lesions were treated with thermocoagulation or loop electrosurgical excision procedure (LEEP) and those diagnosed of malignancy were referred to a tertiary care center for further treatment. The participant's data on sociodemographic status, tobacco use and results cervical cancer screening are maintained in an online electronic data capture system. Results: Out of 6538 individuals attended the Health Promotion Clinic, for their oral, breast and cervical cancer screening from February 2014 - February 2018, 5431 (83.1%) were females and 1107 (16.9%) were males. All the females with eligible criteria were screened for cervical cancer 5431. Among which 126 (2.3%) reported with the habit of smoking, 595 (11%) reported of SLT use and 52 (1%) reported of both smoking and SLT use. The SLT users were at a higher risk [odds ratio (OR)] of developing cervical lesions compared with the non-SLT users diagnosed by the PAP test 1.02 (1.020-1.028). Conclusion: Women consuming SLT are at high risk of developing cervical premalignant and malignant lesions compared with the non-SLT users.