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

Madathil, Sreenath A; Rousseau, Marie-Claude; Wynant, Willy; Schlecht, Nicolas F; Netuveli, Gopalakrishnan; Franco, Eduardo L; Nicolau, Belinda (2016). Nonlinear association between betel quid chewing and oral cancer: Implications for prevention Oral Oncology , vol. 60 . p. 25-31. DOI: 10.1016/j.oraloncology.2016.06.011.

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Résumé

PURPOSE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: Our findings may be used to counsel people to refrain from even low betel quid chewing.

Type de document: Article
Mots-clés libres: Betel quid chewing; Dose-response; Nonlinearity; Oral cancer; Restricted cubic spline
Centre: Centre INRS-Institut Armand Frappier
Date de dépôt: 20 févr. 2019 16:30
Dernière modification: 20 févr. 2019 16:30
URI: http://espace.inrs.ca/id/eprint/4620

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