ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In Adults, Transitioning from Cigarette Usage to Smokeless Tobacco Will Not Decrease the Likelihood of Oral Cancer Development
Clinical Question In an adult, does switching to smokeless tobacco lead to decreased likelihood of oral cancer when compared to using cigarettes?
Clinical Bottom Line In adults, transitioning from cigarette usage to smokeless tobacco will not decrease the likelihood of oral cancer development. This is supported by a meta-analysis of 11 US case-controlled studies of head and neck cancer, which analyzed two different forms of smokeless tobacco: chewing and snuff. The collected data indicates that smokeless tobacco use appears to be associated with oral cancers, especially in the oral cavity, along with head and neck variants. Snuff is more closely associated than chewing tobacco but both demonstrate a high association with oral cavity cancers.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27744388Wyss/201611 US case-control studies (1981-2006) with a total of 6,772 cases and 8375 controls (male and female adults)Meta-Analysis
Key resultsWhile "ever" (versus "never") tobacco chewing was found to be weakly associated with head and neck cancers in groups of "never" cigarette smokers (odds ratio [OR] = 1.20; 95% CI: 0.81-1.77), similar analyses focusing on cancers of the oral cavity in the same group demonstrated a stronger association (OR = 1.81; 95% CI 1.04-3.17). Among never cigarette smokers, odds ratios for smokeless tobacco use and head and neck cancer were 1.71 (95% confidence interval (CI): 1.08, 2.70) for ever users of snuff compared with never users.
Evidence Search oral cancer head and neck cancer smokeless tobacco
Comments on
The Evidence
Validity: The trials represented by the pooled data were individually assessed for validity and analyzed to meet specific standards. The selected studies were US-based and reported chewing tobacco and snuff use separately. Studies missing behavioral data such as duration of smoking were excluded. This limited the analysis to 11 studies with 6,772 cases and 8,375 controls. Perspective: The study includes data on cancers of the head and neck region including pharyngeal and laryngeal cancers. This provides accessory data that is important and applicable to the patient, since use of cigarettes as well as smokeless tobacco (such as snuff and chewing tobacco) is associated with cancers other than those of the oral cavity.
Applicability The individuals in the case-control studies represent a wide range of female and male adult with ages ranging from 17-94. The pooled data included several racial ethnicities, and cases were sampled from different states across the country, making the analyzed data representative of the patients I could see in a South Texas dental practice. A patient cannot expect to diminish oral cancer risk by switching from cigarette use to smokeless tobacco. The patient should be informed that quitting tobacco use in every form would be most appropriate when wanting to reduce risk of oral cancer.
Specialty/Discipline (Public Health) (General Dentistry)
Keywords oral cancer, smokeless tobacco, cigarettes
ID# 3188
Date of submission: 03/31/2017spacer
E-mail galvanny@livemail.uthscsa.edu
Author Ninfa Yaritza Galvan
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author David Cappelli, DMD, MPH, PhD
Faculty mentor/Co-author e-mail cappelli@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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