期刊
ORAL ONCOLOGY
卷 60, 期 -, 页码 25-31出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.oraloncology.2016.06.011
关键词
Oral cancer; Betel quid chewing; Dose-response; Nonlinearity; Restricted cubic spline
资金
- Canadian Institutes of Health Research [MOP 81172, MOP111207]
- Ministere du Developpement economique, de l'Innovation et de l'Exportation du Quebec: Programme de soutien a la recherche (PSR), volet: Soutien a des initiatives internationales de recherche et d'innovation (SIIRI)
- Fonds de Recherche du Quebec - Sante. B. Nicolau holds a Canada Research Chair in Life Course Oral Epidemiology
- Fondation Universitaire Armand-Frappier INRS
- Psychosocial Oncology Research Training (PORT) top-up award
Purpose: Betel quid chewing is a major oral cancer risk factor and the human papillomaviruses (HPV) may play an aetiological role in these cancers. However, little is known about the shape of the dose-response relationship between the betel quid chewing habit and oral cancer risk in populations without HPV. We estimate the shape of this dose-response relationship, and discuss implications for prevention. Methods: Cases with oral squamous cell carcinoma (350) and non-cancer controls (371) were recruited from two major teaching hospitals in South India. Information on socio-demographic and behavioral factors was collected using a questionnaire and the life grid technique. The effect of daily amount of use and duration of the habit were estimated jointly as risk associated with cumulative exposure (chew-years). The shape of the dose-response curve was estimated using restricted cubic spline transformation of chew-years in a conditional logistic regression model. Risk estimates for low dose combinations of daily amount and duration of the habit were computed from flexible regression. Results: Most (72%) oral cancer cases were betel quid chewers in contrast to only 18% of controls. A nonlinear dose-response relationship was observed; the risk increased steeply at low doses and plateaued at high exposures to betel quid (>425 chew-years). A threefold increase in risk (OR = 3.92, 95%CI: 1.87-8.21) was observed for the lowest dose; equivalent to the use of one quid per day for one year. Conclusion: Our findings may be used to counsel people to refrain from even low betel quid chewing. (C) 2016 Elsevier Ltd. All rights reserved.
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