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Table 3 Oropharyngeal cancer; individual effect (relative risk/odds ratio) estimates

From: Systematic review of the relation between smokeless tobacco and cancer in Europe and North America

  ST use    RR/OR
Sourcea Typeb Exposurec Smoking Sex Id. Casesd Estimate (95%CI) Adjustment factorse
Cohort studies         
US Veterans: Zahm et al. 1992 [17] ST Ever Any Mf 1 129 4.11 (2.90–5.84)g age, time
CPS-I: Henley et al. 2005 [23] ST Current Never M 2 4 2.02 (0.53–7.74) age, alc, asp, bmi, diet, edu, exer, occ, race
CPS-II: Henley et al. 2005 [23] ST Current Never M 3 1 0.90 (0.12–6.71) age, alc, asp, bmi, diet, edu, exer, occ, race
Norway Cohorts: Boffetta et al. 2005 [26] Snuff Current Any M 4 6 1.13 (0.45–2.83) age, smok
   Former    5 3 1.04 (0.31–3.50)  
   Ever    6 9 1.10 (0.50–2.41)  
Swedish construction workers: Luo et al. 2007 [32] Snuff Ever Any M 7 NA 0.70 (0.50–0.90) age, bmi, smok
   Current Never   8 9 0.90 (0.40–1.80) age, bmi
   Former    9 1 0.70 (0.10–5.00)  
   Ever    10 10 0.80 (0.40–1.70)  
Uppsala County: Roosaar et al. 2008 [35] Snuff Ever Any M 11 11 3.10 (1.50–6.60) age, alc, res, smok, time
    Never   12 5 2.30 (0.70–8.30) age, alc, res, time
Case-control studies         
Broders 1920 [37] Chew Use Any M+F 13 128 2.05 (1.48–2.83)g smok
  Snuff     14 2 1.76 (0.12–26.52)g none
  ST     15 130 2.05 (1.48–2.83)g  
Moore et al. 1953 [39] ST Use Any M 16 65 3.00 (1.37–6.54)g none
Wynder et al. 1957 [40] Chew Ever Any M 17 NA no associationh none
Wynder and Bross 1957 [41] Chew Ever Any M 18 91 2.00 (1.16–3.47)g smok
Peacock et al. 1960 [42] ST Use Any M 19 14 3.06 (1.08–8.63)g age, ins
     F 20 11 2.00 (0.66–6.01)g  
Vogler et al. 1962 [36] Chew Ever Any M 21 46 7.38 (4.31–12.62)g none
  Snuff    F 22 54 38.28 (21.49–68.15)g  
Vincent and Marchetta 1963 [45] Snuff Use Any M 23 12 4.22 (1.41–12.63)g none
Martinez et al. 1969 [49] Chew Use Any M 24 4 2.29 (0.62–8.48)g none
     F 25 1 0.34 (0.04–2.79)g  
Keller 1970 [50] ST Use Any M 26 11 3.63 (1.02–12.95)g smok
    Never   27 4 3.04 (0.62–14.99)g  
Browne et al. 1977 [54] Chew Use Any M+F 28 7 0.67 (0.27–1.66)g none
Williams and Horm 1977 [55] ST Ever Any M 29 16 0.91 (0.53–1.56)g none
     F 30 2 1.54 (0.37–6.42)g  
Wynder and Stellman 1977 [56] Chew Ever Any M 31 10 0.62 (0.32–1.21)g none
  Snuff     32 61 1.15 (0.85–1.55)g  
  ST     33 71 1.02 (0.78–1.34)i  
Westbrook et al. 1980 [59] Snuff Ever Any F 34 50 540.00 (60.97–4782.82)g none
Winn et al. 1981 [61] Snuff Ever Any F 35 107 2.67 (1.83–3.90)g race, smok
Wynder et al. 1983 [63] Chew Ever Any M 36 37 1.00 (0.62–1.61)g none
  Snuff     37 12 0.42 (0.11–1.65)g  
  ST     38 49 0.90 (0.57–1.41)i  
Stockwell and Lyman 1986 [70] ST Ever Any M+F 39 11 2.02 (1.01–4.02)g none
Young et al. 1986 [71] ST Ever Any M 40 NA no association none
Blot et al. 1988 [74] ST Ever Any M 41 46 0.85 (0.57–1.26)g none
     F 42 11 3.44 (1.09–10.91)g  
    Never F 43 6 6.20 (1.90–19.80) age, race, res, resp
Spitz et al. 1988 [78] Chew Ever Any M+F 44 23 1.00 (0.54–1.85)g none
  Snuff     45 9 3.40 (1.00–10.90)  
  ST     46 25 1.05 (0.57–1.91)g  
Franco et al. 1989 [80] ST Use Any M+F 47 9 1.40 (0.59–3.33)g none
Blomqvist et al. 1991 [83] Snuff Ever Never M+F 48 2 0.67 (0.08–5.75)g none
Maden et al. 1992 [85] ST Ever Any M 49 19 4.50 (1.50–14.30) age
Marshall et al. 1992 [86] Chew Use Any M 50 NA no significant association none
Sterling et al. 1992 [89] ST Ever Any M+F 51 28g 1.04 (0.41–2.68)g age, alc, occ, race, sex, smok
  Snuff Ever Any M+F 52 NA 2.42 (1.28–4.59) age, race, sex
Mashberg et al. 1993 [90] Chew Ever Any Mf 53 NA 1.00 (0.70–1.40) age, alc, race, smok
  Snuff     54 NA 0.80 (0.40–1.90)  
  ST     55 52 0.96 (0.70–1.33)i  
Perry et al. 1993j ST Use Any M+F 56 10 1.43 (0.64–3.21)g age, alc, occ, race, sex, smok
Spitz et al. 1993 [92] Chew Use Any M+F 57 NA 1.20 (not significant) none
Kabat et al. 1994 [97] Chew Ever Any M 58 67 1.11 (0.81–1.53)g smok
  Snuff Ever Never M+F 59 4 4.79 (1.19–19.30)g none
Bundgaard et al. 1995 [98] Chew Ever Any M+F 60 8 1.44 (0.59–3.51)g none
Lewin et al. 1998 [102] Snuff Current Any M 61 18 0.84 (0.47–1.50)g age, alc, res, smok
   Former    62 22 1.28 (0.70–2.35)g  
   Ever    63 40 0.98 (0.63–1.50)g  
Muscat et al. 1998 [103] Chew Ever Any M+F 64 3 0.89 (0.18–4.49)g none
  ST     65 4 1.19 (0.26–5.45)i  
Schildt et al. 1998 [104] Chew Use Any M+F 66 5 0.60 (0.20–2.00) age, sex, res
  Snuff Current    67 39 0.70 (0.40–1.10)  
   Former    68 28 1.50 (0.80–2.90)  
   Ever    69 67 0.80 (0.50–1.30) age, alc, sex, smok, res
   Current Never   70 19 0.70 (0.40–1.20) age, sex, res
   Former    71 9 1.80 (0.90–3.50)  
   Ever    72 28 1.01 (0.64–1.57)g  
  ST Ever Any   73 72 0.87 (0.61–1.25)i none
Schwartz et al. 1998 [105] ST Ever Any M 74 NA 1.00 (0.40–2.30) age, alc, smok
Rosenquist et al. 2005 [113] Snuff Current Any M+F 75 13 1.10 (0.50–2.50) alc, smok
   Former    76 7 0.30 (0.10–0.90)  
   Ever    77 20 0.70 (0.30–1.30)  
  1. a Fuller details of the studies are given in Tables 1 and 2.
  2. b ST implies smokeless tobacco unspecified, or combined snuff use or chewing.
  3. c Ever, former and current ST use were compared with never ST. Use indicates timing not given and comparison is with non use.
  4. d 'Id.' is the RR/OR identification number used in Table 4, and 'Cases' is the number of cases in ST users as defined. NA = not available.
  5. e Abbreviations used: alc = alcohol, asp = aspirin, bmi = body mass index, edu = education, exer = exercise, ins = insurance status, occ = occupation, res = area of residence, resp = respondent, smok = smoking.
  6. f The population included < 0.5% females.
  7. g RR/OR and/or 95% CI estimated from data provided in the source.
  8. h The average ridit duration of chewing did not differ significantly from the controls for any type of oral cancer.
  9. i RR/OR and/or 95% CI estimated from data provided in the source assuming that no one both chewed and used snuff.
  10. j "Attributable oral cancer risk due to smokeless tobacco use based on a case-control study at Sinai Hospital in Detroit", Perry et al., unpublished. Cited by Gross et al. 1995 [91].
  11. CI = confidence interval; ST = smokeless tobacco; OR = odds ratio; RR = relative risk.