Tobacco chewing, alcohol and nasal snuff in cancer of the gingiva in Kerala, India

A case-control study of cancer of the gingiva was carried out in Kerala, Southern India, using 187 cases and 895 hospital-based controls. We investigated the effects on risk in males of pan (betel)-tobacco chewing, bidi and cigarette smoking, drinking alcohol and taking snuff. In females only pan-to...

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Bibliographic Details
Published in:British journal of cancer 1989-10, Vol.60 (4), p.638-643
Main Authors: SANKARANARAYANAN, R, DUFFY, S. W, PADMAKUMARY, G, DAY, N. E, PADMANABHAN, T. K
Format: Article
Language:English
Subjects:
Adult
Aged
Alcohol Drinking
Alcoholic Beverages - adverse effects
Biological and medical sciences
Female
Gingival Neoplasms - etiology
Humans
India
Male
Medical sciences
Middle Aged
Otorhinolaryngology. Stomatology
Risk Factors
Tobacco, Smokeless
Tumors
Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
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Summary:A case-control study of cancer of the gingiva was carried out in Kerala, Southern India, using 187 cases and 895 hospital-based controls. We investigated the effects on risk in males of pan (betel)-tobacco chewing, bidi and cigarette smoking, drinking alcohol and taking snuff. In females only pan-tobacco chewing was investigated as very few females indulged in the other habits. Among males, significant positive associations with risk were observed for pan-tobacco chewing (P less than 0.001), bidi smoking (P less than 0.001) alcohol drinking (P less than 0.001) and snuff use (P less than 0.05). In females, pan-tobacco chewing had a similar predisposing effect (P less than 0.001). Daily frequency of pan-tobacco chewing was the strongest predictor of risk in males, with a relative risk of 15.07 associated with chewing ten or more quids per day. The corresponding relative risk among females was 13.69. In males a relative risk of 3.20 was associated with smoking more than 20 bidis per day, and relative risks of 2.62 and 3.90 were associated with regular use of alcohol and snuff respectively. Surprisingly high relative risks were observed in association with occasional use of pan-tobacco, bidi, cigarettes, alcohol and snuff. A stepwise logistic regression analysis yielded four predictors: pan-tobacco daily frequency, duration of bidi use, and alcohol and snuff use (regular versus never). There were also significantly elevated risks associated with occasional indulgence in these four habits. Total lifetime exposure was no better at predicting risk than daily frequency or duration of habits.
ISSN:0007-0920
1532-1827
DOI:10.1038/bjc.1989.330