title: Smokeless Tobacco Use and the Risk of Head and Neck Cancer: Pooled Analysis of US Studies in the INHANCE Consortium.
abstract: Previous studies on smokeless tobacco use and head and neck cancer (HNC) have found inconsistent and often imprecise estimates, with limited control for cigarette smoking. Using pooled data from 11 US case-control studies (1981-2006) of oral, pharyngeal, and laryngeal cancers (6,772 cases and 8,375 controls) in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium, we applied hierarchical logistic regression to estimate odds ratios and 95% confidence intervals for ever use, frequency of use, and duration of use of snuff and chewing tobacco separately for never and ever cigarette smokers. Ever use (versus never use) of snuff was strongly associated with HNC among never cigarette smokers (odds ratio (OR) = 1.71, 95% confidence interval (CI): 1.08, 2.70), particularly for oral cavity cancers (OR = 3.01, 95% CI: 1.63, 5.55). Although ever (versus never) tobacco chewing was weakly associated with HNC among never cigarette smokers (OR = 1.20, 95% CI: 0.81, 1.77), analyses restricted to cancers of the oral cavity showed a stronger association (OR = 1.81, 95% CI: 1.04, 3.17). Few or no associations between each type of smokeless tobacco and HNC were observed among ever cigarette smokers, possibly reflecting residual confounding by smoking. Smokeless tobacco use appears to be associated with HNC, especially oral cancers, with snuff being more strongly associated than chewing tobacco.
authors.forename: Annah B
authors.initials: AB
authors.lastname: Wyss
authors.forename: Mia
authors.initials: M
authors.lastname: Hashibe
authors.forename: Yuan-Chin Amy
authors.initials: YA
authors.lastname: Lee
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Chuang
authors.forename: Joshua
authors.initials: J
authors.lastname: Muscat
authors.forename: Chu
authors.initials: C
authors.lastname: Chen
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: Elaine
authors.initials: E
authors.lastname: Smith
authors.forename: Zuo-Feng
authors.initials: ZF
authors.lastname: Zhang
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
authors.forename: Qingyi
authors.initials: Q
authors.lastname: Wei
authors.forename: Guojun
authors.initials: G
authors.lastname: Li
authors.forename: Karl T
authors.initials: KT
authors.lastname: Kelsey
authors.forename: Michael
authors.initials: M
authors.lastname: McClean
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Winn
authors.forename: Stimson
authors.initials: S
authors.lastname: Schantz
authors.forename: Guo-Pei
authors.initials: GP
authors.lastname: Yu
authors.forename: Maura L
authors.initials: ML
authors.lastname: Gillison
authors.forename: Jose P
authors.initials: JP
authors.lastname: Zevallos
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Olshan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000073865:Cigarette Smoking / Q000453:epidemiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology; D064424:Tobacco Use / Q000009:adverse effects* / Q000453:epidemiology; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D055815:Young Adult