Cancer Causes & Control

, Volume 22, Issue 6, pp 859–868 | Cite as

Association of tobacco habits, including bidi smoking, with overall and site-specific cancer incidence: results from the Mumbai cohort study

  • Mangesh S. Pednekar
  • Prakash C. Gupta
  • Balkrishna B. Yeole
  • James R. Hébert
Original paper



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.


Public 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

None declared.


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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Mangesh S. Pednekar
    • 1
  • Prakash C. Gupta
    • 1
    • 2
  • Balkrishna B. Yeole
    • 3
  • James R. Hébert
    • 1
    • 2
    • 4
  1. 1.Healis, Sekhsaria Institute for Public HealthNavi Mumbai, MaharashtraIndia
  2. 2.Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  3. 3.Indian Cancer Society, Bombay Population-Based Cancer RegistryMumbai, MaharashtraIndia
  4. 4.South Carolina Statewide Cancer Prevention and Control ProgramUniversity of South CarolinaColumbiaUSA

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