Sreenath Arekunnath Madathil1, Marie-Claude Rousseau1, Willy Wynant2, Nicolas F Schlecht3, Gopalakrishnan Netuveli4, Eduardo L Franco5, Belinda Nicolau6. 1. Faculty of Dentistry, 2001 McGill College Ave, Suite 500, McGill University, Montreal, QC H3A 1G1, Canada; Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, 531 boulevard des Prairies, Laval, QC H7V 1B7, Canada. 2. Department of Epidemiology, Biostatistics and Occupational Health, 1020 Pine Avenue West, McGill University, Montreal, QC H3A 1A2, Canada. 3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA. 4. Institute of Health and Human Development, UH250, Stratford Campus, University of East London, Water Lane, London E15 4LZ, UK. 5. Department of Epidemiology, Biostatistics and Occupational Health, 1020 Pine Avenue West, McGill University, Montreal, QC H3A 1A2, Canada; Division of Cancer Epidemiology, Department of Oncology, 546 Pine Avenue West, McGill University, Montreal, QC H2W 1S6, Canada. 6. Faculty of Dentistry, 2001 McGill College Ave, Suite 500, McGill University, Montreal, QC H3A 1G1, Canada. Electronic address: belinda.nicolau@mcgill.ca.
Abstract
PURPOSE: Betel quid chewing is a major oral cancer risk factor and the human papillomaviruses (HPV) may play an aetiological role in these cancers. However, little is known about the shape of the dose-response relationship between the betel quid chewing habit and oral cancer risk in populations without HPV. We estimate the shape of this dose-response relationship, and discuss implications for prevention. METHODS: Cases with oral squamous cell carcinoma (350) and non-cancer controls (371) were recruited from two major teaching hospitals in South India. Information on socio-demographic and behavioral factors was collected using a questionnaire and the life grid technique. The effect of daily amount of use and duration of the habit were estimated jointly as risk associated with cumulative exposure (chew-years). The shape of the dose-response curve was estimated using restricted cubic spline transformation of chew-years in a conditional logistic regression model. Risk estimates for low dose combinations of daily amount and duration of the habit were computed from flexible regression. RESULTS: Most (72%) oral cancer cases were betel quid chewers in contrast to only 18% of controls. A nonlinear dose-response relationship was observed; the risk increased steeply at low doses and plateaued at high exposures to betel quid (>425 chew-years). A threefold increase in risk (OR=3.92, 95%CI: 1.87-8.21) was observed for the lowest dose; equivalent to the use of one quid per day for one year. CONCLUSION: Our findings may be used to counsel people to refrain from even low betel quid chewing.
PURPOSE: Betel quid chewing is a major oral cancer risk factor and the human papillomaviruses (HPV) may play an aetiological role in these cancers. However, little is known about the shape of the dose-response relationship between the betel quid chewing habit and oral cancer risk in populations without HPV. We estimate the shape of this dose-response relationship, and discuss implications for prevention. METHODS: Cases with oral squamous cell carcinoma (350) and non-cancer controls (371) were recruited from two major teaching hospitals in South India. Information on socio-demographic and behavioral factors was collected using a questionnaire and the life grid technique. The effect of daily amount of use and duration of the habit were estimated jointly as risk associated with cumulative exposure (chew-years). The shape of the dose-response curve was estimated using restricted cubic spline transformation of chew-years in a conditional logistic regression model. Risk estimates for low dose combinations of daily amount and duration of the habit were computed from flexible regression. RESULTS: Most (72%) oral cancer cases were betel quid chewers in contrast to only 18% of controls. A nonlinear dose-response relationship was observed; the risk increased steeply at low doses and plateaued at high exposures to betel quid (>425 chew-years). A threefold increase in risk (OR=3.92, 95%CI: 1.87-8.21) was observed for the lowest dose; equivalent to the use of one quid per day for one year. CONCLUSION: Our findings may be used to counsel people to refrain from even low betel quid chewing.
Authors: Ruchika Gupta; Lorena C Mariano; Suzanne T Nethan; Ashwini Kedar; Dhirendra N Sinha; Saman Warnakulasuriya; Luis Monteiro; Shashi Sharma; Sanjay Gupta; Shalini Singh; Kurt Straif Journal: Ann Glob Health Date: 2022-01-11 Impact factor: 2.462