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Risk of gastroesophageal cancer among smokers and users of Scandinavian moist snuff
Author(s) -
Zendehdel Kazem,
Nyrén Olof,
Luo Juhua,
Dickman Paul W.,
Boffetta Paolo,
Englund Anders,
Ye Weimin
Publication year - 2007
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.23076
Subject(s) - snuff , medicine , cancer , environmental health , pathology
Although Scandinavian moist snuff (“snus”), no doubt, is a safer alternative to smoking, there is limited evidence against an association with gastroesophageal cancers. In a retrospective cohort study, we investigated esophageal and stomach cancer incidence among 336,381 male Swedish construction workers who provided information on tobacco smoking and snus habits within a health surveillance program between 1971 and 1993. Essentially complete follow‐up through 2004 was accomplished through linkage to several nationwide registers. Multivariable Cox proportional hazards regression models estimated relative risks (RR) and 95% confidence intervals (CIs). Compared to never‐users of any tobacco, smokers had increased risks for adenocarcinoma (RR = 2.3, 95% CI 1.4–3.7) and squamous cell carcinoma (RR = 5.2, 95% CI 3.1–8.6) of the esophagus, as well as cardia (RR = 2.1, 95% CI 1.5–3.0) and noncardia stomach (RR = 1.3, 95% CI 1.2–1.6) cancers. We also observed excess risks for esophageal squamous cell carcinoma (RR = 3.5, 95% CI 1.6–7.6) and noncardia stomach cancer (RR = 1.4, 95% CI 1.1–1.9) among snus users who had never smoked. Although confounding by unmeasured exposures, and some differential misclassification of smoking, might have inflated the associations, our study provides suggestive evidence for an independent carcinogenic effect of snus. © 2007 Wiley‐Liss, Inc.