REVIEW PAPER
Association of smokeless tobacco with oral cancer: A review of systematic reviews
 
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National Institute of Cancer Prevention and Research, Indian Council of Medical Research, India
CORRESPONDING AUTHOR
Satyanarayana Labani   

National Institute of Cancer Prevention and Research, Indian Council of Medical Research, I–7 Near City Centre Metro Station, Sector 39, Noida, Uttar Pradesh 201301, India
Publish date: 2019-10-08
Submission date: 2019-06-25
Final revision date: 2019-08-16
Acceptance date: 2019-09-25
 
Tob. Prev. Cessation 2019;5(October):34
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Various primary studies and systematic reviews have been conducted to explain the association between smokeless tobacco and oral cancer. This study aims to consolidate and summarize the risk estimates from various systematic reviews with or without meta-analysis to provide the spectrum of estimates on the association between smokeless tobacco use and oral cancer.

Methods:
A comprehensive literature search was done on various databases (PubMed, Google Scholar, IndMED, and TOXLINE) by two of the authors independently. Both qualitative and quantitative data extraction and analysis were performed for the included systematic reviews. Range of risk estimates was obtained and analyzed as quantitative findings due to the limitation of an overview of reviews for the pooled estimates. CASP (Critical Appraisals Skills Programme) and AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tools were used for the quality assessment of the studies included.

Results:
In total, 12 systematic reviews with or without meta-analysis were included in the review. There was a positive and strong association of Smokeless Tobacco (SLT) use with oral cancer irrespective of gender, region, and type of smokeless tobacco. The risk estimate for the South–East Asia Region (SEAR) ranged 4.44– 7.90, for Gutkha it was 8.67, while for Paan it ranged 6.3–7.90 and for overall SLT it ranged 1.36–7.90. Risk estimate for females ranged 5.83–14.56.

Conclusions:
The study confirmed the association between SLT use and oral cancer. These findings are of high importance, especially to the South-East Asia Region.

ACKNOWLEDGEMENTS
The authors thank the reviewers and authors of various systematic reviews that were considered in this review article.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
AUTHORS' CONTRIBUTIONS
SA and SL conceived the review idea. SA and PV independently performed the literature search and data extraction. The analysis was done by SL and PV. The first draft was written by PV and all authors contributed to further versions of the manuscript. SL reviewed the final draft and all authors read and approved the manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
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