title: Oral cancer in southern India: the influence of smoking, drinking, paan-chewing and oral hygiene.
abstract: Between 1996 and 1999 we carried out a case-control study in 3 areas in Southern India (Bangalore, Madras and Trivandrum) including 591 incident cases of cancer of the oral cavity (282 women) and 582 hospital controls (290 women), frequency-matched with cases by age and gender. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from unconditional multiple logistic regressions and adjusted for age, gender, center, education, chewing habit and (men only) smoking and drinking habits. Low educational attainment, occupation as a farmer or manual worker and various indicators of poor oral hygiene were associated with significantly increased risk. An OR of 2.5 (95% CI 1.4-4.4) was found in men for smoking > or = 20 bidi or equivalents versus 0/day. The OR for alcohol drinking was 2.2 (95% CI 1.4-3.3). The OR for paan chewing was more elevated among women (OR 42; 95% CI 24-76) than among men (OR 5.1; 95% CI 3.4-7.8). A similar OR was found among chewers of paan with (OR 6.1 in men and 46 in women) and without tobacco (OR 4.2 in men and 16.4 in women). Among men, 35% of oral cancer is attributable to the combination of smoking and alcohol drinking and 49% to pan-tobacco chewing. Among women, chewing and poor oral hygiene explained 95% of oral cancer.
authors.affiliation: Regional Cancer Center, Trivandrum, Kerala, India.
authors.forename: Prabha
authors.initials: P
authors.lastname: Balaram
authors.forename: Hema
authors.initials: H
authors.lastname: Sridhar
authors.forename: Thangarajan
authors.initials: T
authors.lastname: Rajkumar
authors.forename: Salvatore
authors.initials: S
authors.lastname: Vaccarella
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.forename: Ambakumar
authors.initials: A
authors.lastname: Nandakumar
authors.forename: Kandaswamy
authors.initials: K
authors.lastname: Ravichandran
authors.forename: Kunnambath
authors.initials: K
authors.lastname: Ramdas
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
authors.forename: Vendhan
authors.initials: V
authors.lastname: Gajalakshmi
authors.forename: Nubia
authors.initials: N
authors.lastname: Muñoz
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D001114:Areca; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology* / Q000209:etiology; D016017:Odds Ratio; D009910:Oral Hygiene; D010946:Plants, Medicinal; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*