Smokeless tobacco (snus) use and colorectal cancer incidence and survival: Results from nine pooled cohorts

Aims: Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use...

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Bibliographic Details
Published in:Scandinavian journal of public health 2017-12, Vol.45 (8), p.741-748
Main Authors: ARAGHI, MARZIEH, GALANTI, MARIA ROSARIA, LUNDBERG, MICHAEL, LIU, ZHIWEI, YE, WEIMIN, LAGER, ANTON, ENGSTRÖM, GUNNAR, MANJER, JONAS, ALFREDSSON, LARS, KNUTSSON, ANDERS, NORBERG, MARGARETA, PALMQVIST, RICHARD, GYLLING, BJÖRN, WENNBERG, PATRIK, LAGERROS, YLVA TROLLE, BELLOCCO, RINO, PEDERSEN, NANCY L., ÖSTERGREN, PER-OLOF, MAGNUSSON, CECILIA
Format: Article
Language:English
Subjects:
Adult
Cancer and Oncology
Cancer och onkologi
Clinical Medicine
Cohort Studies
Colorectal cancer
Colorectal Neoplasms - epidemiology
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Health Sciences
Humans
Hälsovetenskap
Incidence
Klinisk medicin
Male
Medical and Health Sciences
Medicin och hälsovetenskap
Middle Aged
Public Health, Global Health, Social Medicine and Epidemiology
Risk Factors
snus
Substance use: trends, consequences and attitudes
survival
Survival Analysis
Sweden - epidemiology
Tobacco, Smokeless - adverse effects
Tobacco, Smokeless - utilization
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Summary:Aims: Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association. Methods: A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis. Conclusions: Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention.
ISSN:1403-4948
1651-1905
1651-1905
DOI:10.1177/1403494817714191