Systematic review of the relation between smokeless tobacco and cancer in Europe and North America.
Systematic review of the relation between smokeless tobacco and cancer in Europe and North America.
复制标题
DOI：
10.1186/1741-7015-7-36
复制
发表时间：
2009-07-29
期刊：
影响因子：
9.3
通讯作者：
Hamling J
中科院分区：
文献类型：
--
作者：
Lee PN;Hamling J
人们对无烟烟草作为吸烟的安全替代品的兴趣正在上升，但发表的关于无烟烟草与癌症的评论有限。我们回顾了北美和欧洲的研究，并比较了无烟烟草和吸烟的影响。我们从MEDLINE检索、发表的综述和二次参考文献中获得了描述流行病学队列和病例对照研究的论文，这些研究涉及任何形式的癌症与无烟烟草的使用。对于每项研究，都提取了关于设计、无烟烟草暴露、所研究的癌症、分析方法以及吸烟和其他因素的调整的细节。对于每种癌症，以95%的可信区间列出了相对风险或优势比。总体而言，也分别对美国和斯堪的纳维亚进行了荟萃分析，使用了所有可用的估计值、吸烟调整后的估计值或从不吸烟者的估计值。就7种癌症而言，2005年美国男性因吸烟导致的死亡与非吸烟男性引入无烟烟草导致的死亡进行了比较。确定了89项研究；62项美国研究和18项斯堪的纳维亚研究。46人(52%)控制吸烟。对大多数网站的随机效应荟萃分析估计显示，相关性很小。经吸烟调整后的估计值仅对口咽癌(1.36，CI 1.04-1.77，n=19)和前列腺癌(1.29，1.07-1.55，n=4)有显著意义。自1990年以来发表的估计值(1.00，0.83-1.20，n=14)、斯堪的纳维亚地区(0.97，0.68-1.37，n=7)和酒精调整后的估计值(1.07，0.84-1.37，n=10)中，口咽联合消失了。当前美国产品或斯堪的纳维亚鼻烟的任何影响似乎都非常有限。前列腺癌的数据不足以得出明确的结论。一些荟萃分析表明，无烟烟草可能对食道癌、胰腺癌、喉癌和肾癌有影响，但其他癌症没有任何效果。在斯堪的纳维亚半岛，任何可能的影响都不明显。2005年，在142205例与吸烟有关的美国男性癌症死亡病例中，有104737例与吸烟有关。如果使用无烟烟草的人数与吸烟的人数一样多，则可归因于无烟烟草的死亡人数为1102人(1.1%)，如果每个人都使用无烟烟草，则可归因于无烟烟草的死亡人数为2081人(2.0%)。口咽癌风险的增加在美国过去使用无烟烟草的情况下最为明显，但对于斯堪的纳维亚人的鼻烟却不是。无烟烟草的使用对其他癌症的影响没有得到明确的证明。现代产品的风险比吸烟小得多。
Interest is rising in smokeless tobacco as a safer alternative to smoking, but published reviews on smokeless tobacco and cancer are limited. We review North American and European studies and compare effects of smokeless tobacco and smoking. We obtained papers from MEDLINE searches, published reviews and secondary references describing epidemiological cohort and case-control studies relating any form of cancer to smokeless tobacco use. For each study, details were abstracted on design, smokeless tobacco exposure, cancers studied, analysis methods and adjustment for smoking and other factors. For each cancer, relative risks or odds ratios with 95% confidence intervals were tabulated. Overall, and also for USA and Scandinavia separately, meta-analyses were conducted using all available estimates, smoking-adjusted estimates, or estimates for never smokers. For seven cancers, smoking-attributable deaths in US men in 2005 were compared with deaths attributable to introducing smokeless tobacco into a population of never-smoking men. Eighty-nine studies were identified; 62 US and 18 Scandinavian. Forty-six (52%) controlled for smoking. Random-effects meta-analysis estimates for most sites showed little association. Smoking-adjusted estimates were only significant for oropharyngeal cancer (1.36, CI 1.04–1.77, n = 19) and prostate cancer (1.29, 1.07–1.55, n = 4). The oropharyngeal association disappeared for estimates published since 1990 (1.00, 0.83–1.20, n = 14), for Scandinavia (0.97, 0.68–1.37, n = 7), and for alcohol-adjusted estimates (1.07, 0.84–1.37, n = 10). Any effect of current US products or Scandinavian snuff seems very limited. The prostate cancer data are inadequate for a clear conclusion. Some meta-analyses suggest a possible effect for oesophagus, pancreas, larynx and kidney cancer, but other cancers show no effect of smokeless tobacco. Any possible effects are not evident in Scandinavia. Of 142,205 smoking-related male US cancer deaths in 2005, 104,737 are smoking-attributable. Smokeless tobacco-attributable deaths would be 1,102 (1.1%) if as many used smokeless tobacco as had smoked, and 2,081 (2.0%) if everyone used smokeless tobacco. An increased risk of oropharyngeal cancer is evident most clearly for past smokeless tobacco use in the USA, but not for Scandinavian snuff. Effects of smokeless tobacco use on other cancers are not clearly demonstrated. Risk from modern products is much less than for smoking.
登录
查看更多内容
影响因子：
2.3
作者：
Accortt, NA;Waterbor, JW;Howard, G
通讯作者：
Howard, G
DOI：
10.1001/jama.1920.02620100016007
发表时间：
1920-01-01
影响因子：
--
作者：
Broders, AC
通讯作者：
Broders, AC
影响因子：
3.8
作者：
Alguacil, J;Silverman, DT
通讯作者：
Silverman, DT
影响因子：
1.9
作者：
BLOMQVIST, G;HIRSCH, JM;ALBERIUS, P
通讯作者：
ALBERIUS, P
影响因子：
8.8
作者：
ARMSTRONG, B;GARROD, A;DOLL, R
通讯作者：
DOLL, R