Analysis of the relationship between smokeless tobacco and cancer based on data from the National Mortality Followback Survey

• Published in: Journal of clinical epidemiology Vol. 45; no. 3; pp. 223 - 231
• Main Authors: Sterling, Theodor D., Rosenbaum, Wilfred L., Weinkam, James J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1992; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Alcohol; Alcohol Drinking; Biological and medical sciences; Chewing tobacco; Confidence Intervals; Confounding Factors (Epidemiology); Cross-Sectional Studies; Digestive System Neoplasms - etiology; Female; Humans; Male; Medical sciences; Middle Aged; Mouth Neoplasms - etiology; Occupation; Occupational Exposure; Oral cancer; Plants, Toxic; Risk; Risk Factors; Smokeless tobacco; Smoking; Smoking - adverse effects; Snuff; Tobacco, Smokeless - adverse effects; Tobacco, tobacco smoking; Toxicology; United States; North America; America; Occupation; Oral cancer; Chewing tobacco; Alcohol; Smokeless tobacco; Snuff; Smoking; Human; Chewing gum; Stomatology; Toxicity; Mortality; Oral administration; Digestive diseases; Malignant tumor; Epidemiology; Intranasally administration; Public health
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/0895-4356(92)90082-X

This study investigates the potential link between the use of smokeless tobacco and oral cancer and cancer of digestive organs. The combined data of the National Mortality Followback Survey (NMFS), a probability sample of the U.S. deaths, and the coincident National Health Interview Survey (NHIS), a probability sample of the living, non-institutionalized U.S. population, are used to compute risk estimates for cancer, oral cancer, and cancer of the digestive organs associated with use of smokeless tabacco based on a cross sectional study design, simultaneously controlled for potential confounding from active smoking, alcohol consumption, and occupational exposure. Use of smokeless tobacco (either as snuff or chewing tobacco) does not increase the risk of oral cancer or cancer of the digestive organs. Alcohol emerges as a major risk factor for oral cancer with a strong dose-response relationship between the amount of drinking and risk. The same is true to a lesser extent for cancer of the digestive organs. Smoking is associated with increased risk of oral cancer but not of cancer of the digestive organs. Blue collar, technical, and service workers have significantly increased risk of cancer of the digestive organs relative to professional, managerial, and clerical workers, but not of oral cancer. Differences between findings based on the NMFS/NHIS and those obtained from other data very likely are due to inadequate control for confounding. Other reasons for differences between the NMFS/NHIS data and other studies are discussed.