Association of tobacco habits, including bidi smoking, with overall and site-specific cancer incidence: results from the Mumbai cohort study
- 242 Downloads
Bidis are hand-rolled cigarettes commonly smoked in South Asia and are marketed to Western populations as a safer alternative to conventional cigarettes. This study examined the association between bidis and other forms of tobacco use and cancer incidence in an urban developing country population.
Using data from the large, well-characterized Mumbai cohort study, adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were computed from Cox proportional hazards regression models in order to compare the relative effect of various forms of tobacco use on cancer incidence.
During 649,228 person-years of follow-up 1,267 incident cancers occurred in 87,222 male cohort members. Incident oral cancer in bidi smokers (HR = 3.55; 95% CI = 2.40,5.24) was 42% higher than in cigarette smokers (HR = 2.50;95% CI = 1.65,3.78). For all respiratory and intrathoracic organs combined, the increase was 69% (HR = 5.54; 95% CI = 3.46,8.87 vs. HR = 3.28; 95% CI = 1.99,5.39); for lung and larynx, the increases were 35 and 112%, respectively. Smokeless tobacco use was associated with cancers of the lip, oral cavity, pharynx, digestive, respiratory, and intrathoracic organs.
Despite marketing claims to the contrary, we found that smokeless tobacco use and bidi smoking are at least as harmful as cigarette smoking for all incident cancers and are associated with increased risk of oral and respiratory/intrathoracic cancers.
KeywordsPublic health Disease incidence Cancer Tobacco Cohort study
The authors appreciate the help and input of Cathy Backinger (National Cancer Institute, Bethesda, MD, USA), Paolo Boffetta (International Agency for Research on Cancer (IARC), Lyon, France), Thomas Glynn (American Cancer Society, Atlanta, GA, USA), Alan Lopez (University of Queensland, Australia), D. M. Parkin (Queen Mary University of London, UK), Richard Peto (Clinical Trial Service Unit of the University of Oxford, Oxford, United Kingdom) and R. Sankaranarayanan (the International Agency for Research on Cancer, Lyon, France) in the conduct of the study. The authors also are grateful for the cooperation of the Municipal Corporation of Greater Mumbai (BMC) in providing access to information on cause of death. This work was partly supported by funding from: the International Agency for Research on Cancer, Lyon, France (Collaborative Research Agreement DEP/89/12); the Clinical Trial Service Unit of the University of Oxford, Oxford, United Kingdom; the World Health Organization Geneva, Switzerland; and Narotam Sekhsaria Foundation, Mumbai, India. Dr. Hébert was supported by grant 1 U01 CA114601 from the National Cancer Institute, Center to Reduce Cancer Health Disparities, and a USIA Fulbright Senior Research Fellowship for the 2008–2009 academic year through the US Educational Foundation in India.
Conflict of interest
- 4.McMichael A (1993) Planetary overload: global environmental change and the health of the human species. Cambridge University Press, CambridgeGoogle Scholar
- 8.Garcia M, Jemal A, Ward E, Center M, Hao Y, Siegel R, Thun M (2007) Global cancer facts and figures 2007. American Cancer Society, AtlantaGoogle Scholar
- 10.Pednekar MS (2008) The impact of tobacco use and/or body composition on adult mortality in urban developing country population. Acta Universitatis Tamperensis 1340, Tampere University Press, Tampere 2008. Available at url:http://www.acta.uta.fi/pdf/978-951-44-7431-6.pdf
- 13.Tobacco exports up by 7.4% in April. Times of India, (PTI), May 31, 2010, 04.33 pm IST accessed on June 2010 available at url: http://www.timesofindia.indiatimes.com/business/india-business/Tobacco-exports-up-by-74-in-April/articleshow/5994747.cms
- 14.India’s tobacco exports up 29% in FY2010 personal finance magazine—Moneylife. April 28, 2010 access on June 2010 available at url: http://www.moneylife.in/article/8/5082.html
- 15.India, The tax treatment of bidis. International Union Against Tuberculosis and Lung Disease, January 2008. Accessed on May 2010 available at url:http://www.tobaccofreeunion.org/files/44.pdf
- 18.Gupta PC, Asma S (2008) Bidi smoking and public health, 2008, Ministry of Health and Family Welfare, Government of India, New DelhiGoogle Scholar
- 19.Rahman M, Sakamoto J, Fukui T (2003) Bidi smoking and oral cancer: a meta-analysis. Int J Cancer 106(4):600–604Google Scholar
- 23.Celebucki C, Turner-Bowker DM, Connolly G, Koh HK (1999) Bidi use among urban youth—Massachusetts. MMWR 48(36):796–799Google Scholar
- 25.Delnevo CD, Pevzner ES, Hrywna M, Lewis MJ (2004) Bidi cigarette use among young adults in 15 states. Prev Med 39(1):207–211Google Scholar
- 32.Yeole BB (2001) An assessment of improvement in reliability and completeness of Mumbai cancer registry data from 1965–1997. Asian Pac J Cancer Prev Bangkok 2:225–232Google Scholar
- 33.Gupta PC, Hamner JE, Murti PR, eds (1992) Proceedings of an international symposium on control of tobacco-related cancers and other diseases: proceedings of an international symposium in Bombay, India, 15–19 Jan 1990. Oxford University Press, Oxford, pp 25–46Google Scholar
- 35.Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York CityGoogle Scholar
- 36.Thrasher JF, Johnson TP (2008) IARC handbooks of cancer prevention: tobacco control. Volume 12. Methods for evaluating tobacco control policies: developing and assessing comparable questions in cross-cultural survey research on tobacco. International Agency for Research on Cancer, Lyon, FranceGoogle Scholar
- 37.Chu KC, Miller BA, Springfield SA (2007) Measures of racial/ethnic health disparities in cancer mortality rates and the influence of socioeconomic status. J National Med Assoc 99(10):1092–1104Google Scholar
- 40.World Health Organization. India (1997) In: Tobacco or Health: a global status report. GenevaGoogle Scholar
- 41.International Labor Organization (2003) Appendix: special cases: bidi and kretek. In: Employment trends in the tobacco sector: challenges and prospects. Report for discussion at the tripartite meeting on the future of employment in the Tobacco Sector. Geneva [cited 2004 Jun 5]; pp 85–93. Available from: http://www.ilo.org/public/englishdialogue/sectortechmeet/tmets03/tmets-r.pdf
- 42.Reddy KS, Gupta PC (2004) Report on tobacco control in India. Ministry of Health and Family Welfare, Government of India, New DelhiGoogle Scholar
- 43.Ray CS, Gupta PC, de Beyer J (2003) Research on tobacco in India (including betel quid and areca nut). Health, Nutrition and Population (HNP) discussion paper. Economics of tobacco control Paper no. 9. World Bank, pp 33–167Google Scholar
- 44.International Agency for Research on Cancer (1986) IARC Monographs on the evaluation of carcinogenic risk of chemicals to humans—tobacco smoking. Vol 38. IARC, LyonGoogle Scholar
- 45.International Agency for Research on Cancer (2002) IARC Monographs on the evaluation of carcinogenic risk of chemicals to humans—tobacco smoking and tobacco smoke. Vol 83. IARC, Lyon. Available from: http://www.monographs.iarc.fr/htdocs/monographsvol83/01-smoking.html
- 46.World Health Organization (2002) Reducing risks, promoting healthy life. In: The world health report, 2002. Geneva, p 225Google Scholar
- 47.US FDA, in first tobacco action, bans flavors access on May 13, 2010 available at url:http://www.reuters.com/article/idUSN2236998020090922
- 48.Canada bans fruit-flavored cigarettes accessed on May 13, 2010 available at url:http://www.reuters.com/article/idUSTRE5975GD20091008?loomia_ow=t0:s0:a49:g43:r1:c1.000000:b30639980:z0