Incense use and respiratory tract carcinomas: a prospective cohort study.
BACKGROUND
Incense use is an integral part of daily life in large parts of Asia. The burning of incense is a powerful producer of particulate matter and the smoke contains a multitude of well-characterized carcinogens. However, to the authors' knowledge, no convincing association has been reported between exposure to incense smoke and the development of cancer. Therefore, the relation between incense use and the risk of respiratory tract carcinomas was analyzed in a prospective cohort study.


METHODS
Between 1993 and 1998, a population-based cohort of 61,320 Singapore Chinese who were free of cancer and ages 45 to 74 years completed a comprehensive interview regarding living conditions and dietary and lifestyle factors. Through linkage to population-based registries, the cohort was followed through 2005 and cancer occurrence determined. The relative risk for these cancers associated with incense use was estimated using a Cox proportional hazards model.


RESULTS
A total of 325 upper respiratory tract (UPT) carcinomas and 821 lung carcinomas were observed during follow-up. Incense use was associated with a significantly increased risk of UPT carcinomas other than nasopharyngeal, whereas no overall effect was observed on lung cancer. The duration and intensity of incense use were associated with an increased risk of squamous cell carcinomas in the entire respiratory tract (P for trend = .004), whereas there was no significant association noted between incense use and nonsquamous cell carcinomas. The relative risk of squamous cell carcinomas among long-term incense users was 1.8 (95% confidence interval [95% CI], 1.2-2.6; P = .004) in the entire respiratory tract.


CONCLUSIONS
The results of the current study indicate that long-term use of incense is associated with an increased risk of squamous cell carcinoma of the respiratory tract.
Friborg
Jeppe T
JT
The Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA. jfr@ssi.dk
Yuan
Jian-Min
JM
Wang
Renwei
R
Koh
Woon-Puay
WP
Lee
Hin-Peng
HP
Yu
Mimi C
MC
D000328:Adult; D000368:Aged; D044466:Asian People; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012142:Respiratory Tract Neoplasms / Q000209:etiology* / Q000473:pathology; D018570:Risk Assessment; D012846:Singapore; D012906:Smoke / Q000009:adverse effects*
D012906:Smoke