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Association between smokeless tobacco use and waterpipe smoking and the risk of lung cancer – A systematic review and meta-analysis of current epidemiological evidence

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posted on 2023-06-10, 03:28 authored by Imogen RogersImogen Rogers, Anjum MemonAnjum Memon, Priyamvada Paudyal
Background: Smokeless tobacco and waterpipes are used by hundreds of millions of people worldwide and consumption rates exceed that of cigarette smoking in much of South East Asia and parts of the Middle East. However, the cancer risks of these methods of tobacco consumption are less well-characterized than those of cigarette smoking. The objective of this study was to systematically review the epidemiological evidence on the association between smokeless tobacco use and waterpipe smoking and lung cancer risk. Methods: The MEDLINE, EMBASE, Web of Science and OpenSIGLE databases were searched to identify eligible case-control and cohort studies (published before 1st December 2020 in any language) that adjusted for cigarette smoking or included non-cigarette smokers only. Summary odds ratio/relative risk estimates and confidence intervals were extracted, and pooled risk ratios (RRs) for lung cancer were calculated using random effects meta-analysis. Results: The literature search identified 2,465 publications: of these, 26 studies including 6,903 lung cancer patients were included in the synthesis (20 studies of smokeless tobacco use, five of waterpipe smoking, one of both). Our results suggest that smokeless tobacco use is associated with an increased risk of lung cancer among non-cigarette smokers, and that betel quid tobacco may be particularly hazardous. The random effects meta-analysis showed that exclusive use of any type of smokeless tobacco (pooled RR= 1·53, 95%CI 1·09 – 2·14), betel quid chewing (pooled RR= 1·77, 95%CI 1·06 – 2·95), and waterpipe smoking (pooled RR = 3·25, 95%CI 2.01 – 5·25) were significantly associated with an increased risk of lung cancer. Conclusions: This meta-analysis of case-control/cohort studies supports the hypothesis that use of smokeless tobacco and waterpipe smoking is associated with increased risk of developing lung cancer. Considering the widespread and increasing use of smokeless tobacco in developing countries, and increasing prevalence of waterpipe smoking in almost all societies, these findings inform formulation of public health policy, legislation and tobacco control measures at national and international level to increase awareness and decrease the prevalence of smokeless tobacco use and waterpipe smoking.

History

Publication status

  • Published

File Version

  • Published version

Journal

Asian Pacific Journal of Cancer Prevention (APJCP)

ISSN

1513-7368

Publisher

Asian Pacific Organization for Cancer Prevention

Issue

5

Volume

23

Page range

1451-1463

Department affiliated with

  • Primary Care and Public Health Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2022-05-10

First Open Access (FOA) Date

2022-07-20

First Compliant Deposit (FCD) Date

2022-05-10

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