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Nonlinear association between betel quid chewing and oral cancer: Implications for prevention

Abstract : Betel quid chewing is a major oral cancer risk factor and the human papillomaviruses (HPV) may play an aetiological role in these cancers. However, little is known about the shape of the dose-response relationship between the betel quid chewing habit and oral cancer risk in populations without HPV. We estimate the shape of this dose-response relationship, and discuss implications for prevention. Cases with oral squamous cell carcinoma (350) and non-cancer controls (371) were recruited from two major teaching hospitals in South India. Information on socio-demographic and behavioral factors was collected using a questionnaire and the life grid technique. The effect of daily amount of use and duration of the habit were estimated jointly as risk associated with cumulative exposure (chew-years). The shape of the dose-response curve was estimated using restricted cubic spline transformation of chew-years in a conditional logistic regression model. Risk estimates for low dose combinations of daily amount and duration of the habit were computed from flexible regression. Most (72%) oral cancer cases were betel quid chewers in contrast to only 18% of controls. A nonlinear dose-response relationship was observed; the risk increased steeply at low doses and plateaued at high exposures to betel quid (>425 chew-years). A threefold increase in risk (OR = 3.92, 95%CI: 1.87–8.21) was observed for the lowest dose; equivalent to the use of one quid per day for one year. Our findings may be used to counsel people to refrain from even low betel quid chewing.
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https://hal-riip.archives-ouvertes.fr/pasteur-01351458
Contributor : Michel Courcelles <>
Submitted on : Wednesday, August 3, 2016 - 5:15:03 PM
Last modification on : Wednesday, October 14, 2020 - 3:43:44 AM

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Sreenath Arekunnath Madathil, Marie-Claude Rousseau, Willy Wynant, Nicolas F Schlecht, Gopalakrishnan Netuveli, et al.. Nonlinear association between betel quid chewing and oral cancer: Implications for prevention. Oral Oncology, Elsevier, 2016, 60, pp.25-31. ⟨10.1016/j.oraloncology.2016.06.011⟩. ⟨pasteur-01351458⟩

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