Use Of Chewing Tobacco Research Articles

Incidence and Mortality of Salivary Gland Cancer Worldwide and Its Correlation with Tobacco Use (Smoking and Chewing) and With the Human Development Index

Objective: The aim of this study was to quantify the association between the incidence and mortality of salivary gland cancer (SGC) with the consumption of tobacco and with the Human Development Index (HDI). Material and Methods: An ecological study was designed using SGC incidence and mortality data in 172 countries in 2020, reported per 100,000 population with an age range of 10–85 years. Such dependent variables were obtained from the Global Cancer Observatory (GLOBOCAN). The prevalences of smoked and chewed tobacco were obtained from reports made in 2019, sourced from Global Burden of Diseases Study, while the HDI was obtained from the Human Development Report (2019) presented by the United Nations Development Program, and were considered independent variables. Statistical analysis was performed in Stata using Spearman’s correlation test. Results: In 2020, there were 53,583 new cases of SGC worldwide, and countries with very high HDI exhibited a higher incidence. In terms of mortality, there were 22,778 cases worldwide, and countries with a moderate HDI showed a higher number of deaths. SGC mortality was associated with chewing tobacco use overall and in women. Surprising negative associations were found with the incidence of SGC and tobacco smoking in men, as well as with mortality of SGC and smoking overall and in women. CGS mortality was negatively associated with the HDI and all its components. Conclusion: In this international overview, SGC mortality is associated with chewing tobacco in women, as well as with the HDI and its components.

Health effects associated with chewing tobacco: a Burden of Proof study.

Chewing tobacco use poses serious health risks; yet it has not received as much attention as other tobacco-related products. This study synthesizes existing evidence regarding the health impacts of chewing tobacco while accounting for various sources of uncertainty. We conducteda systematic review and meta-analysis of chewing tobacco and seven health outcomes, drawing on 103 studies published from 1970 to 2023. We use a Burden of Proof meta-analysis to generate conservative risk estimates and find weak-to-moderate evidence that tobacco chewers have an increased risk of stroke, lip and oral cavity cancer, esophageal cancer, nasopharynx cancer, other pharynx cancer, and laryngeal cancer. We additionally find insufficient evidence of an association between chewing tobacco and ischemic heart disease. Our findings highlight a need for policy makers, researchers, and communities at risk to devote greater attention to chewing tobacco by both advancing tobacco control efforts and investing in strengthening the existing evidence base.

Screening of the Combined Risk of Genetics and Epidemiology on Infertility Among Indian Men: Synergistic Effect of AZFc Partial Deletions and Habits of Smokeless Chewing Tobacco.

The AZFc partial deletions of Y chromosome and lifestyle/epidemiological factors such as the use of smokeless chewing tobacco (SCT) exhibit intriguing variations in their association with male infertility across the population, ethnicity, and genetic background. Here, a pioneering attempt has been made to elucidate the interactions of such deletions with the habits of SCT consumption among the participating individuals, using their large epidemiological data. This screening program was conducted among Bengali-speaking men in West Bengal, India. We screened the prevalence and association of distinct partial deletions (gr/gr, b1/b3, and b2/b3) of the AZFc region using locus-specific sequence-tagged site (STS) markers among 728 case subjects and compared them with 264 ethnicity- and age-matched proven-fertile control men. The recorded epidemiological data of the study group and the outcome of partial deletion analysis were compiled to frame the plausible Gene × Epidemiological factor (G × E) interactions. The gr/gr deletion was reported to be significantly associated with azoospermic (p = .0015, odds ratio [OR] = 3.413) and oligozoospermic (p = .0382, OR = 3.012) case subgroups, and b1/b3 deletions were also detected among the infertile persons only. The G × E model revealed that men who carried microdeletions as well as were SCT users had an elevated risk of infertility (p = .002, OR = 6.38). The study highlights the fact that AZFc partial deletions and SCT, when co-occurred, synergistically increase the risk of infertility among men. This work helps to get more insight into the etiology of male infertility in the light of gene-environmental interaction.

Inhibition of Oral Fibrinogenesis Through Transforming Growth Factor-Beta/SMAD2/3 Signalling Inhibition Using Mangosteen Pericarp Extract.

Background Chewing areca nuts can result in an oral disorder known as oral submucous fibrosis (OSF), which has the potential to be cancerous. Although it is only beginning to spread to European and the North American continents, it is highly prevalent in Southeast Asia. The probability of malignant transformation from OSF is raised by chewing tobacco use. In the current research, our objective was to assess the potential anti-fibrosis effects and the ability to prevent malignant transformation through the application of mangosteen pericarp extract. Methodology The Ethical Approval-IHEC/SDC/OMED-2101/23/085 from the institution was obtained to conduct this ex vivo study. The cytotoxicity effect of mangosteen pericarp extract on both normal and fibrotic buccal mucosal fibroblasts originating from OSF tissues was tested. Cell proliferationand cell migration by scratch wound healing assay was examined. Dual staining was done to determine the mode of cell death. Additionally, real-time PCR was utilized to measure the expression of TGF-β/Smad2/3 signalling, α-SMA, and type I collagen gene expression. Results Mangosteen extract exerted higher cytotoxicity of fibrotic buccal mucosal fibroblasts compared to normal cells. Furthermore, mangosteen-receiving cells exhibited downregulation in the expression of the TGF-β/Smad2 pathway, as well as reduced expression of α-SMA and type I collagen. Conclusion Findings from this study suggest that mangosteen could serve as a promising agent for averting the progression of oral fibrogenesis and halting the malignancy of the oral epithelium in patients with OSF.

Chewing tobacco use among pregnant women in India: Analysis of national family health surveys

BackgroundIndia accounts for over 67% of chewing tobacco users globally and more than 50 million women in India chew tobacco. Chewing tobacco is documented to have negative effects on health of mother and foetus. This research was conducted to study the trends in chewing tobacco use among pregnant women in India, and identify factors associated with chewing tobacco use among pregnant women. MethodsWe analyzed micro-data from two representative national surveys i.e., National Family Health Survey (NFHS)-4 (2015–16) & NFHS-5 (2019–21). A sample of 32,428 & 28,408 pregnant women were extracted from NFHS-4 & NFHS-5 respectively. Weighted prevalence and 95% confidence levels of chewing tobacco use were computed. State wide comparisons in chewing tobacco use were made. Employing binary logistic regression, adjusted odds ratios (AOR) were computed to identify factors associated with chewing tobacco use. ResultsFrom NFHS-4 to 5 the prevalence of chewing tobacco use among pregnant women decreased from 4.0%(95% CI = 3.9–4.0) to 2.3%(95% CI = 2.2–2.4) respectively indicating a relative reduction of 42.5%. The highest prevalence remains to be in north-eastern India at 13.0%. Belonging to north-eastern region AOR = 7.0(95 %CI = 6.2–7.9), no-education AOR = 13.2(95 %CI = 10.5–16.5), poorest wealth index AOR = 6.7(95 %CI = 5.6–8.0) and belonging to scheduled tribe AOR = 2.6(95 %CI = 2.4–2.9) was significantly associated with chewing tobacco use among pregnant women. ConclusionFrom NFHS-4 to 5, chewing tobacco use during pregnancy has shifted more towards socio-economically vulnerable population. Targeted approaches with accessible and affordable tobacco cessation advice integrated to primary healthcare system are needed.

Put Down the Tin: Chewing Tobacco Use Is Associated With Worse Outcomes After Primary Lumbar Fusion.

Retrospective study. This study evaluated the impact of chewing tobacco on both medical and spine-related complication rates after spinal lumbar fusions in comparison to both a control cohort and a smoking cohort. Smoking is a prevalent modifiable risk factor that has been demonstrated to be associated with increased complications after lumbar fusion. Although smoking rates have decreased in the United States, chewing tobacco use has not similarly reduced. Despite chewing tobacco delivering up to 4 times the dose of smoking, the impact of chewing tobacco is incompletely understood. A retrospective cohort study was conducted using the PearlDiver database. Patients who underwent lumbar spine fusion and used chewing tobacco were matched with a control cohort and a smoking cohort. Medical complications within 90 days after primary lumbar fusion were evaluated, including deep venous thrombosis, acute kidney injury, pulmonary embolism, transfusion, acute myocardial infarction, and inpatient readmission. Spine-related complications were evaluated at 2 years postoperatively, including pseudoarthrosis, incision and drainage (I&D), instrument failure, revision, and infection. After primary lumbar fusion, the chewing tobacco cohort demonstrated significantly higher rates of pseudoarthrosis [odds ratio (OR): 1.41], revision (OR: 1.57), and any spine-related complication (OR: 1.32) compared with controls. The smoking cohort demonstrated significantly higher rates of pseudoarthrosis (OR: 1.88), I&D (OR: 1.27), instrument failure (OR: 1.39), revision (OR: 1.54), infection (OR: 1.34), and any spine-related complication (OR: 1.77) compared with controls. The chewing tobacco cohort demonstrated significantly lower rates of pseudoarthrosis (OR: 0.84), I&D (OR: 0.49), infection (OR: 0.70), and any spine-related complication (OR: 0.81) compared with the smoking cohort. This study demonstrated that chewing tobacco is associated with higher rates of both spine-related and medical complications after primary lumbar fusion. However, chewing tobacco use is associated with less risk of complications compared with smoking. Level III.

Lip and Oral Cavity Cancer Incidence and Mortality Rates Associated with Smoking and Chewing Tobacco Use and the Human Development Index in 172 Countries Worldwide: An Ecological Study 2019-2020.

Tobacco use is associated with diseases worldwide, including cancer. This is one of the major public health problems globally, causing more than 19 million new cases in 2020. Lip and oral cavity cancer (LOCC) is neoplastic growth in the tongue, gums, and lips. The objective of this ecological study was to quantify the strength of the association between incidence and mortality of LOCC, with tobacco use and with the Human Development Index (HDI). Incidence and mortality data on LOCC were obtained for 172 countries in 2020, from the Global Cancer Observatory (GLOBOCAN). The prevalence of tobacco smoking and chewing was obtained from reports conducted in 2019. The inequality in human development was estimated using the HDI from the United Nations Development Program, Human Development Report (2019). Statistically significant correlations were observed between the incidence of LOCC and tobacco smoking and chewing prevalence, except for negative correlations between the prevalence of tobacco smoking LOCC mortality in women, just as in the case of the HDI. No statistically significant differences were found between the prevalence of tobacco chewing only and the incidence of LOCC overall and by sex. A higher LOCC incidence overall and by sex was associated with higher HDI. In conclusion, the present study found positive correlations for various HDI socioeconomic indicators and tobacco use with the incidence and mortality of LOCC, but also a few inverse correlations.

Pattern of use, Contributing Factors and associated oral health problems among chewing Tobacco users in Urban Slum of Odisha

Background: The overall smokeless tobacco users in India is 29.6% as per Global Adult Tobacco Survey (GATS 2). Chewing tobacco causes dependence and various health risk among the users. The purpose of this study was to assess the pattern, contributing factors and associated oral health problems related to chewing tobacco use among adults. Methods: A cross-sectional study was conducted among 130 adults residing in a selected urban area of Odisha. A convenient sampling technique was adopted and the data was collected using structured questionnaire, Fagerstrom Nicotine Dependence Scale for smokeless tobacco (FTND-ST) and observational checklist. The data was analysed using descriptive and inferential statistics. Results: The mean age among chewing tobacco users was 41.01+10.75 with majority being males (82.3%) using chewing tobacco. The participants with no formal education (32.3%) and those who are self employed (59.2%) have a considerable percentage of using chewing tobacco. 56.2% of participants were mild to moderately dependent on chewing tobacco whereas 43.8% of the adults were severely dependent. About 36% of participants were influenced by peer group for using chewing tobacco. The associated oral health issues among users include bad breath (50%), tooth discoloration (90.8%), dental caries (53.1%), build-up of plaque and tartar over teeth (77.7%) and adverse effect on gum (37.7%) which includes pain on gums, swelling and redness. About 7% of users took their last dip of chewing tobacco within 5 minutes before going to bed. There is significant association among participants who consume chewing tobacco on daily basis with oral health problems like plaque and tartar on teeth, blackish gum discoloration and spontaneous gum bleeding. Conclusion: The present study signifies the need of lifestyle hygiene and the importance of self- motivation and medical attention for quitting chewing tobacco.

Associations between observed neighborhood physical disorder and health behaviors, New Jersey behavioral risk factor Surveillance System 2011–2016

This study tested associations between observed neighborhood physical disorder and tobacco use, alcohol binging, and sugar-sweetened beverage consumption among a large population-based sample from an urban area of the United States. Individual-level data of this cross-sectional study were from adult respondents of the New Jersey Behavioral Risk Factor Surveillance System, 2011–2016 (n = 62,476). Zip code tabulation area-level observed neighborhood physical disorder were from virtual audits of 23,276 locations. Tobacco use (current cigarette smoking or chewing tobacco, snuff, or snus use), monthly binge drinking occasions (5+/4+ drinks per occasion among males/females), and monthly sugar-sweetened beverages consumed were self-reported. Logistic and negative binomial regression models were used to generate odds ratios, prevalence rate ratios (PRR), 95 % confidence intervals (CI) by levels of physical disorder. Compared to the lowest quartile, residence in the second (PRR: 1.16; 95 % CI: 1.03, 1.13), third (PRR: 1.24; 95 % CI: 1.10, 1.40), and fourth (highest) quartile of physical disorder (PRR: 1.24; 95 % CI: 1.10, 1.40) was associated with higher monthly sugar-sweetened beverage consumption. Associations involving tobacco use and alcohol binging were mixed. Observed neighborhood disorder might be associated with unhealthy behaviors, especially sugar-sweetened beverage consumption.

Histological effects of the use of chewing tobacco during pregnancy on ovaries of the offspring of rats.

Introduction: Exposure to smokeless tobacco products (Nicotine) is associatedwith the generation of reactive oxygen species, modulation of inflammatory mediators, inhibition of collagen synthesis and impairment of DNA repair capacity whichin some way may cause harmful effects on the ovaries of the offspring.Objectives: To observe the effects of chewing tobacco on the gross morphologicaland histological alterations on the ovaries of offspring’s rats.Methodology: Twenty pregnant rats were divided in two groups: Group. A(Control) 10 pregnant rats received normal diet and water ad libitum. Group. B(Experimental) 10 pregnant rats received 5% tobacco mixed with normal feed andwater ad libitum. After 21 days, the female offspring of both control and experimental groups were sacrificed, ovaries removed and stained with H&E stains formicroscopic examination.Results: The results clearly showed that smokeless tobacco consumption duringgestation reduces the weight and size of ovary along with the congested blood vessels, compact stroma and degenerative primordial follicles. Hence the practice ofchewing tobacco in mothers is directly related to the adverse effects in offspringhealth and ovaries.
 Key words: Chewing Tobacco, Offspring, Ovaries, Rats.

Nicotine is an independent potential fibrogenic mediator in non-betel quid associated oral submucous fibrosis

Oral submucous fibrosis (OSF) is an irreversible, progressive, potentially malignant condition that develops among habitual areca nut chewers. The role of nicotine due to chewing or smoking tobacco as an independent risk factor for OSF is yet to be fully established. However, the active ingredient, nicotine, in tobacco is addictive, and the chronic use of chewing tobacco increases the risk of mouth cancer. The hypothesis that nicotine promotes fibrosis is based on a customized literature search unraveling the novel pathways and mechanisms of nicotine-induced oral fibrogenesis. Chronic exposure to nicotine has been shown to induce fibrosis in normal rats through α7-nAChR. Nicotine and derived nitrosamines act through nAChR on epithelial cells to upregulate pro-inflammatory cytokines IL-1β, TNF-α, and profibrotic factor TGF-β1. Nicotine promotes fibrosis by the nAchR/AKT/YAP-TEAD/BIP pathway, which promotes EMT and the generation of myofibroblasts. Additionally, nicotine damages the endothelial cells to promote vascular rarefaction and fibrosis. Since profibrogenic nicotine is better absorbed at alkaline pH, chewed tobacco products are made alkaline to increase their addictive power. Nicotine may thus enhance collagen accumulation and ensuing fibrosis in impending OSF. This hypothesis explains the sporadic reports of OSF among individuals who chew tobacco and/or smoke without the habit of chewing areca nut habit.

Phytochemicals as Potential Chemopreventive and Chemotherapeutic Agents for Emerging Human Papillomavirus-Driven Head and Neck Cancer: Current Evidence and Future Prospects.

Head and neck cancer (HNC) usually arises from squamous cells of the upper aerodigestive tract that line the mucosal surface in the head and neck region. In India, HNC is common in males, and it is the sixth most common cancer globally. Conventionally, HNC attributes to the use of alcohol or chewing tobacco. Over the past four decades, portions of human papillomavirus (HPV)-positive HNC are increasing at an alarming rate. Identification based on the etiological factors and molecular signatures demonstrates that these neoplastic lesions belong to a distinct category that differs in pathological characteristics and therapeutic response. Slow development in HNC therapeutics has resulted in a low 5-year survival rate in the last two decades. Interestingly, HPV-positive HNC has shown better outcomes following conservative treatments and immunotherapies. This raises demand to have a pre-therapy assessment of HPV status to decide the treatment strategy. Moreover, there is no HPV-specific treatment for HPV-positive HNC patients. Accumulating evidence suggests that phytochemicals are promising leads against HNC and show potential as adjuvants to chemoradiotherapy in HNC. However, only a few of these phytochemicals target HPV. The aim of the present article was to collate data on various leading phytochemicals that have shown promising results in the prevention and treatment of HNC in general and HPV-driven HNC. The review explores the possibility of using these leads against HPV-positive tumors as some of the signaling pathways are common. The review also addresses various challenges in the field that prevent their use in clinical settings.

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

SummaryBackgroundChewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control.MethodsWe estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period.FindingsIn 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15–19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: –1·21% [–1·26 to –1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (−0·94% [–1·72 to –0·14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period.InterpretationChewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence.FundingBloomberg Philanthropies and the Bill & Melinda Gates Foundation.

Polytobacco use among a nationally-representative sample of black high school students

BackgroundStudies of the patterns of polytobacco use have increased. However, understanding the patterns of using multiple tobacco products among Black adolescents is minimal. This study identified the patterns of polytobacco use among U.S. Black adolescents.MethodsLatent class analysis (LCA) was used to identify patterns of adolescent polytobacco use among a representative sample of Black youth from the 2017 Youth Risk Behavior Survey (n = 2782). Ever and recent (past 30 day) use of cigarettes, electronic cigarettes, cigars, and dip or chewing tobacco were used as latent class indicators. Multinomial regression was conducted to identify the association if smoking adjusting for sex, age, grade, and marijuana use.ResultsMost students were in the 9th grade (29%), e-cigarette users (21%) and were current marijuana users (25%). Three profiles of tobacco use were identified: Class 1: Non-smokers (81%), Class 2: E-cigarette Users (14%), and Class 3: Polytobacco Users (5%). Black adolescent Polytobacco users were the smallest class, but had the highest conditional probabilities of recent cigarette use, e-cigarette use, ever smoking cigars or chewing tobacco. Ever and current use of marijuana were associated with increased odds of being in the e-cigarette user versus non-smoker group, and current marijuana use was associated with increased odds of polytobacco use (aOR = 24.61, CI = 6.95–87.11).ConclusionsFindings suggests the need for targeted interventions for reducing tobacco use and examining the unique effects of polytobacco use on Black adolescents. Findings confirm a significant association of marijuana use with tobacco use.

Chewing tobacco may act as a risk factor for dysplastic transformation of squamous cells in Oral leukoplakia- A cytochemistry based approach

The use of chewing tobacco is a severe risk factor for oral mucosa related diseases including cancer in India as well as USA, although its relationship with Oral Leukoplakia (OL) or related carcinogenicity is still not clear. This work chose two oncogenic pathway proteins- the Epidermal Growth Factor Receptor and the WNT pathway among leukoplakia patients and established their correlation with the individuals’ tobacco chewing habit.89 fresh patients with OL were selected for the work. The samples were classified based on the individual’s tobacco chewing habit. The divided samples were then immunostained with antibodies for both of the EGFR as well as WNT pathway proteins. The samples were further classified based on their proliferation status and the expression of these oncoproteins was also observed. In order to compare the cytological data with histological data, 30 OL patients undergoing biopsy were chosen and immunohistological analysis was performed for the same pathways.Results showed overexpressing EGFR and WNT pathway proteins in all OL samples. Structurally atypic cells had a tendency to overexpress these oncoproteins. However the immunocytochemistry data could not confirm any positive effect of chewing tobacco on the OL’s proliferative state. Statistical data from the immunfluorescence finally revealed the overexpression of both EGFR and WNT pathway proteins on the proliferative population establishing chewing tobacco as a positive risk factor for the onset of OL. Data from biopsy samples followed the same trend of protein expression seen in the cytological samples. Dysplastic zones showed huge overexpression of EGFR and WNT pathway proteins among tobacco chewers. In conclusion, this is the first time report showing the effect of chewing tobacco on the EGFR and WNT pathway in OL and its possible role as a potential risk factor for its proliferative type.

Impact of HIV on treatment and outcome after acute myocardial infarction: a Swedish nationwide observational cohort study

Abstract Background People living with HIV (PLHIV) on antiretroviral therapy (ART) have a higher risk of developing cardiovascular diseases (CVD) at a younger age due to chronic inflammation, higher prevalence of traditional cardiovascular risk factors and side-effects of ART – although the last is controversial. Moreover, recent studies have shown that PLHIV have unfavorable CVD outcomes compared to HIV-negative people. A potential explanation could be differences in acute treatment and in-hospital management. Purpose This study is aimed at investigating patients with and without HIV experiencing an acute myocardial infarction (AMI) in relation to baseline characteristics, in-hospital management and short-term outcomes. Methods The nationwide SWEDEHEART (The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry and Swedish National HIV Registry (InfCareHIV) were used to identify patients with and without HIV experiencing AMI. Primary outcome was the occurrence of a combined composite endpoint of major adverse cardiovascular events (MACE: all-cause mortality, new myocardial infarction or stroke) at 1 year in PLHIV versus HIV-negative people presenting with acute MI. Secondary outcomes were the occurrence of any of the individual components of the above composite endpoint. Kaplan-Meier survival curves and multivariable Cox regression models were used to compare the populations. Results We identified all PLHIV (n=319; 85% male) and HIV-negative people (n=711,506; 59% male) who experienced an AMI during 1996–2017 in Sweden. PLHIV presented with AMI more than ten years younger (median age 54.7 vs 67.1 years), had a higher prevalence of smoking and chewing tobacco use and a lower prevalence of hypertension. PLHIV with AMI had higher risks of MACE (adjusted hazard ratio (adjHR) for age, sex, traditional risk factors, comorbidities, in-hospital treatment and discharge medication = 1.60, 95% confidence interval (CI) 0.98–2.61) and mortality (adjHR = 2.37, 95% CI 1.34–4.16) at 1 year compared to HIV-negative people with AMI. Conclusion PLHIV suffer AMI more than 10 years earlier than HIV-negative people. HIV was independently associated with higher risk of MACE and more than doubled all-cause mortality at 1 year after AMI. Improved primary and secondary prevention (e.g. smoking cessation) may improve outcomes. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Fellowship Gilead Science, Public Health Agency of Sweden

The global, regional, and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

SummaryBackgroundOesophageal cancer is a common and often fatal cancer that has two main histological subtypes: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Updated statistics on the incidence and mortality of oesophageal cancer, and on the disability-adjusted life-years (DALYs) caused by the disease, can assist policy makers in allocating resources for prevention, treatment, and care of oesophageal cancer. We report the latest estimates of these statistics for 195 countries and territories between 1990 and 2017, by age, sex, and Socio-demographic Index (SDI), using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD).MethodsWe used data from vital registration systems, vital registration-samples, verbal autopsy records, and cancer registries, combined with relevant modelling, to estimate the mortality, incidence, and burden of oesophageal cancer from 1990 to 2017. Mortality-to-incidence ratios (MIRs) were estimated and fed into a Cause of Death Ensemble model (CODEm) including risk factors. MIRs were used for mortality and non-fatal modelling. Estimates of DALYs attributable to the main risk factors of oesophageal cancer available in GBD were also calculated. The proportion of oesophageal squamous cell carcinoma to all oesophageal cancers was extracted by use of publicly available data, and its variation was examined against SDI, the Healthcare Access and Quality (HAQ) Index, and available risk factors in GBD that are specific for oesophageal squamous cell carcinoma (eg, unimproved water source and indoor air pollution) and for oesophageal adenocarcinoma (gastro-oesophageal reflux disease).FindingsThere were 473 000 (95% uncertainty interval [95% UI] 459 000–485 000) new cases of oesophageal cancer and 436 000 (425 000–448 000) deaths due to oesophageal cancer in 2017. Age-standardised incidence was 5·9 (5·7–6·1) per 100 000 population and age-standardised mortality was 5·5 (5·3–5·6) per 100 000. Oesophageal cancer caused 9·78 million (9·53–10·03) DALYs, with an age-standardised rate of 120 (117–123) per 100 000 population. Between 1990 and 2017, age-standardised incidence decreased by 22·0% (18·6–25·2), mortality decreased by 29·0% (25·8–32·0), and DALYs decreased by 33·4% (30·4–36·1) globally. However, as a result of population growth and ageing, the total number of new cases increased by 52·3% (45·9–58·9), from 310 000 (300 000–322 000) to 473 000 (459 000–485 000); the number of deaths increased by 40·0% (34·1–46·3), from 311 000 (301 000–323 000) to 436 000 (425 000–448 000); and total DALYs increased by 27·4% (22·1–33·1), from 7·68 million (7·42–7·97) to 9·78 million (9·53–10·03). At the national level, China had the highest number of incident cases (235 000 [223 000–246 000]), deaths (213 000 [203 000–223 000]), and DALYs (4·46 million [4·25–4·69]) in 2017. The highest national-level age-standardised incidence rates in 2017 were observed in Malawi (23·0 [19·4–26·5] per 100 000 population) and Mongolia (18·5 [16·4–20·8] per 100 000). In 2017, age-standardised incidence was 2·7 times higher, mortality 2·9 times higher, and DALYs 3·0 times higher in males than in females. In 2017, a substantial proportion of oesophageal cancer DALYs were attributable to known risk factors: tobacco smoking (39·0% [35·5–42·2]), alcohol consumption (33·8% [27·3–39·9]), high BMI (19·5% [6·3–36·0]), a diet low in fruits (19·1% [4·2–34·6]), and use of chewing tobacco (7·5% [5·2–9·6]). Countries with a low SDI and HAQ Index and high levels of indoor air pollution had a higher proportion of oesophageal squamous cell carcinoma to all oesophageal cancer cases than did countries with a high SDI and HAQ Index and with low levels of indoor air pollution.InterpretationDespite reductions in age-standardised incidence and mortality rates, oesophageal cancer remains a major cause of cancer mortality and burden across the world. Oesophageal cancer is a highly fatal disease, requiring increased primary prevention efforts and, possibly, screening in some high-risk areas. Substantial variation exists in age-standardised incidence rates across regions and countries, for reasons that are unclear.FundingBill & Melinda Gates Foundation.

1843 A Rare Case of Large Cell Neuroendocrine Carcinoma of the Esophagus

INTRODUCTION: Neuroendocrine Tumors (NETs) are a rare form of esophageal malignancy with an incidence ranging from 0.4 and 2% of all malignant esophageal tumors (1). Among esophageal NETs, the vast majority are small cell esophageal carcinomas. A recent literature review found only 35 cases of large cell esophageal carcinoma have been reported since 1952 (2). CASE DESCRIPTION/METHODS: Patient is a 48-year-old male with past medical history of HTN, diabetes, and HLD who presented with 6 weeks of progressive dysphagia predominantly to solids. The dysphagia was initially infrequent, but eventually occurred every time he ate. ROS was pertinent for a 20 lb weight loss. Social history was pertinent for 1-2 drinks of alcohol per month and daily use of chewing tobacco. Family history revealed a mother with a brain mass and a grandmother with pancreatic CA. PE was normal. He underwent an EGD which showed a large, ulcerative distal esophageal mass extending into gastric cardia. Biopsies revealed a poorly differentiated carcinoma most compatible with large cell neuroendocrine carcinoma. CT imaging of chest, abdomen, and pelvis showed nonspecific lower esophageal mural thickening with no evidence of esophageal mass. PET scan showed hypermetabolic distal esophageal mass measuring 6 x 5 x 3 cm with peri gastric lymph node involvement. The patient underwent neoadjuvant treatment with radiation, cisplatin and etoposide followed by a distal esophagectomy with gastric pull-through. Surgical path revealed Stage III large cell neuroendocrine carcinoma involving the distal esophagus, proximal stomach, and peri gastric lymph nodes. Patient is currently recovering from the surgery with plans for postoperative chemotherapy. DISCUSSION: This case illustrates an rare form of a malignant esophageal neuroendocrine tumor. Esophageal NETs tend to be more aggressive than NETs found in other parts of the GI tract, so early diagnosis and treatment is critical in order to prolong survival. Due to a paucity of cases in the literature, there is a need for more cases to be presented in order to better understand the course of the disease and determine the best modalities for treatment.

3005 Pancreatitis: An Unusual Initial Presentation of Duodenal Adenocarcinoma

INTRODUCTION: Duodenal adenocarcinoma is rare. The clinical presentation is often nonspecific, and the diagnosis is made incidentally. We present a case of a 73 year old female presenting with pancreatitis, who was subsequently found to have duodenal adenocarcinoma. CASE DESCRIPTION/METHODS: 73 year old african american woman with hypertension presented with persistent nausea and vomiting of two weeks associated with burning epigastric pain and ten pound weight loss. She was previously treated for dyspepsia without improvement. She denied alcohol or non-steroidal use. She reports use of chewing tobacco. She denied fever, hematemesis, melena, hematochezia, or change in bowel habits. On physical examination, she was hypotensive and tachycardic. She had dry mucous membranes and delayed skin turgor. Laboratory examination revealed an unremarkable complete blood count. Comprehensive metabolic panel was remarkable for hypokalemia of 2.8 mEq/L, bicarbonate of 37 mEq/L, elevated creatinine of 1.23 mg/dL, elevated alanine aminotransferase of 58 U/L, and an elevated lipase of 369 U/L. Due to persistent abdominal symptoms, computed tomography of the abdomen and pelvis with contrast was performed, which was suggestive of pancreatitis or duodenitis. Patient was admitted for presumed pancreatitis. Intravenous fluids and antiemetics were initiated. Electrolytes were repleted. Right upper quadrant ultrasound and magnetic resonance cholangiopancreatography was without evidence of gallstones, cholecystitis, or biliary obstruction. Esophagogastroduodenoscopy and subsequent endoscopic ultrasound was performed and demonstrated diffuse moderately congested mucosa and an ulcerated mucosa with moderate stenosis found in the third portion of the duodenum. Biopsies were taken, which later revealed adenocarcinoma. Patient was started on total parenteral nutrition and followed-up with surgical oncology. DISCUSSION: Considering the rarity of duodenal adenocarcinoma, an early diagnosis is crucial. Clinicians should be aware of the nonspecific clinical and laboratory presentation, such as in our patient who presented with pancreatitis. A higher degree of suspicion and thorough investigation can lead to prompt diagnosis and earlier management and treatment.

Abstract 4223: Conducting community oral cancer screening among South Asians in British Columbia

Abstract Introduction: Globally, more than 300,000 cases of oral cancer are diagnosed annually. South Asian countries, such as India, bear the brunt of this disease due to rampant use of chewing tobacco, betel quid and areca nut. BC has a high proportion of South Asian immigrants. Oral cancer has a high mortality rate (~50% 5-year survival) due to the advanced stage at which it is often diagnosed. It is purported that the majority of oral cancers develop from oral potentially malignant lesions (OPML). While lesions can be easily detected by oral health care providers, it can be challenging to differentiate benign lesions from OPML. DNA aneuploidy has been shown to be an effective marker to predict malignant transformation in OPML. Quantitative cytology (QC) studies DNA content (ploidy) and nuclear morphometric changes within the cell. The aim of this project is to assess the need for oral cancer screening in South Asians in BC and to validate QC as an adjunct screening device in a predominantly South Asian community screening setting to assess its effectiveness in identifying high-risk lesions among visually suspicious lesions. Methods: Demographic information (gender, age, country of birth, ethnicity, risk habit information and dental usage) were collected at the time of screening. Extraoral, intraoral and fluorescence visualization (FV) examinations were conducted. Buccal mucosal brushings were collected from each participant. Brushings were also collected from lesions or areas that had a loss of fluorescence. Thin-layer cytology slides were prepared and stained using Feulgen Eosin. Slides were scanned using the Cancer Imaging Scanner at BC Cancer using machine learning classification algorithms to identify single, in-focus epithelial nucleus. Cells are classified based on DNA ploidy and malignant associated changes. Results: 307 participants were screened of which 303 were eligible. More than 99% of the participants were South Asian or Asian. 104 (34%) lesions were documented: 45 (15%) were high risk (white or red lesions, lichen planus (LP)) and 59 (19%) were low risk (trauma, candidiasis, aphthous ulcers). Twenty participants (7%) were suspected to have high-risk OPMLs (not LP): 12 were referred directly to our Next Gen Oral Dysplasia clinic for biopsy, while 8 were reassessed at 3 weeks. Chewing tobacco was found to be strongly associated with lesion presence (p<0.01). QC analysis is ongoing for 320 samples. To date, 5 biopsies have been performed resulting in 1 mild dysplasia, 1 severe dysplasia and 3 hyperplasia. Conclusion: South Asians in BC were found to be at high risk for OPMLs. QC may help to improve the sensitivity and specificity of oral cancer screening by distinguishing false FV positive inflammatory lesions from high-risk lesions. Citation Format: Leigha D. Rock, Madhurima Datta, Denise M. Laronde, Anita Carraro, Jagoda Korbelik, Alan Harrison, Martial Guillaud. Conducting community oral cancer screening among South Asians in British Columbia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4223.