1
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Gil GF, Anderson JA, Aravkin A, Bhangdia K, Carr S, Dai X, Flor LS, Hay SI, Malloy MJ, McLaughlin SA, Mullany EC, Murray CJL, O'Connell EM, Okereke C, Sorensen RJD, Whisnant J, Zheng P, Gakidou E. Health effects associated with chewing tobacco: a Burden of Proof study. Nat Commun 2024; 15:1082. [PMID: 38316758 PMCID: PMC10844244 DOI: 10.1038/s41467-024-45074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
Chewing tobacco use poses serious health risks; yet it has not received as much attention as other tobacco-related products. This study synthesizes existing evidence regarding the health impacts of chewing tobacco while accounting for various sources of uncertainty. We conducted a systematic review and meta-analysis of chewing tobacco and seven health outcomes, drawing on 103 studies published from 1970 to 2023. We use a Burden of Proof meta-analysis to generate conservative risk estimates and find weak-to-moderate evidence that tobacco chewers have an increased risk of stroke, lip and oral cavity cancer, esophageal cancer, nasopharynx cancer, other pharynx cancer, and laryngeal cancer. We additionally find insufficient evidence of an association between chewing tobacco and ischemic heart disease. Our findings highlight a need for policy makers, researchers, and communities at risk to devote greater attention to chewing tobacco by both advancing tobacco control efforts and investing in strengthening the existing evidence base.
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Affiliation(s)
- Gabriela F Gil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jason A Anderson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Kayleigh Bhangdia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew J Malloy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chukwuma Okereke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joanna Whisnant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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Gholap D, Dikshit R, Chaturvedi P, Chaturvedi AK, Manjrekar A, Mhatre S. Exclusive use of different types of tobacco products, exposure to secondhand tobacco smoke and risk of subtypes of head and neck cancer among Indian males. Int J Cancer 2023; 152:374-383. [PMID: 36054453 DOI: 10.1002/ijc.34258] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 02/01/2023]
Abstract
Tobacco products are used in vary many forms in India. Although the risk of tobacco uses in developing head and neck cancer (HNC) is known, risk by exclusive use of different tobacco products on HNC and its subtypes is poorly understood. A case-control study was conducted at a tertiary cancer hospital, which receives cases from different geographical regions of India with use of different types of tobacco products. The study included 824 oral cavity (OC), 149 oropharynx (OPX) 104 hypopharyngeal (HPX) and 81 larynx (LX) cancer cases and 1206 visitor controls. Information on 11 different types of tobacco products and exposure to secondhand smoke was collected through structured questionnaires. Odds ratios (OR) and 95% confidence intervals (CI), for the association of various HNC subtypes with exclusive use of each tobacco product compared to nonusers of tobacco were estimated using logistic regression models, after adjusting for potential confounders. Exclusive use of any type of smokeless tobacco product was strongly associated with all subtypes of HNC. Gutka chewing (only) had highest risk (OR = 33.67; 95% CI = 19.8-57.0) while exclusive users of betel quid with tobacco (BQ + T), tobacco quid, Khaini, Mawa and Mishri users had a OR of 14.77, 24.20, 5.33, 2.96 and 3.32, respectively, for development of OC. Bidi smoking and secondhand smoke was independently associated with increased risk of HNC. Our study indicates that tobacco control policies should focus on product specific awareness messaging that switching between tobacco product types is not a safe alternative to complete cessation.
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Affiliation(s)
- Devyani Gholap
- Division of Molecular Epidemiology and Population Genetics, Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India
| | - Rajesh Dikshit
- Division of Molecular Epidemiology and Population Genetics, Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Chaturvedi
- Homi Bhabha National Institute, Mumbai, India.,Head and Neck Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Ankita Manjrekar
- Division of Molecular Epidemiology and Population Genetics, Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Sharayu Mhatre
- Division of Molecular Epidemiology and Population Genetics, Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
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3
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Tavakoli Pirzaman A, Ebrahimi P, Niknezhad S, Vahidi T, Hosseinzadeh D, Akrami S, Ashrafi AM, Moeen Velayatimehr M, Hosseinzadeh R, Kazemi S. Toxic mechanisms of cadmium and exposure as a risk factor for oral and gastrointestinal carcinomas. Hum Exp Toxicol 2023; 42:9603271231210262. [PMID: 37870872 DOI: 10.1177/09603271231210262] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Incidence and mortality rates of gastrointestinal (GI) and oral cancers are among the highest in the world, compared to other cancers. GI cancers include esophageal, gastric, colon, rectal, liver, and pancreatic cancers, with colorectal cancer being the most common. Oral cancer, which is included in the head and neck cancers category, is one of the most important causes of death in India. Cadmium (Cd) is a toxic element affecting humans and the environment, which has both natural and anthropogenic sources. Generally, water, soil, air, and food supplies are reported as some sources of Cd. It accumulates in organs, particularly in the kidneys and liver. Exposure to cadmium is associated with different types of health risks such as kidney dysfunction, cardiovascular disease, reproductive dysfunction, diabetes, cerebral infarction, and neurotoxic effects (Parkinson's disease (PD) and Alzheimer's disease (AD)). Exposure to Cd is also associated with various cancers, including lung, kidney, liver, stomach, hematopoietic system, gynecologic and breast cancer. In the present study, we have provided and summarized the association of Cd exposure with oral and GI cancers.
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Affiliation(s)
| | - Pouyan Ebrahimi
- Student Research Committee, Babol University of Medical Science, Babol, Iran
| | - Shokat Niknezhad
- Student Research Committee, Babol University of Medical Science, Babol, Iran
| | - Turan Vahidi
- Student Research Committee, Babol University of Medical Science, Babol, Iran
| | | | - Sousan Akrami
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Arash M Ashrafi
- Student Research Committee, Babol University of Medical Science, Babol, Iran
| | | | - Rezvan Hosseinzadeh
- Student Research Committee, Babol University of Medical Science, Babol, Iran
| | - Sohrab Kazemi
- Cellular and Molecular Biology Research Center, Health Research Center, Babol University of Medical Science, Babol, Iran
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4
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Satir S. The relationship between oral cancer and cadmium: a review. Mol Biol Rep 2022; 49:2413-2419. [PMID: 34822067 DOI: 10.1007/s11033-021-07000-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
Cadmium (Cd) has been classified as a type I carcinogen. Since it is ingested orally through food and tobacco use, Cd is likely to be closely related to oral cancers. The relationship between cadmium and oral cancer was investigated using papers on Pubmed and Web of Science. Thus a total of 11 studies from these databases were included in the review. Cd concentrations were significantly higher in both the blood and hair of oral cancer patients than in controls. Additionally, it has been reported that Cd increases the activity of reactive oxygen species. Tobacco plants contain varying levels of Cd. The presence of high Cd concentrations in patients who use tobacco products and develop oral cancer is strong evidence that Cd is directly related to oral cancer. While planning a study to determine the Cd concentrations in biological samples, it is advisable to examine the methodologies of previous studies and to avoid technical deficiencies. New cell line studies are required to explain the relationship between Cd and autophagy-apoptosis.
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Affiliation(s)
- Samed Satir
- Faculty of Dentistry, Oral and Maxillofacial Radiology, Alanya Alaaddin Keykubat University, Konaklı, Mustafa Kemal Boulevard, Alanya, 07490, Antalya, Turkey.
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5
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Hecht SS, Hatsukami DK. Smokeless tobacco and cigarette smoking: chemical mechanisms and cancer prevention. Nat Rev Cancer 2022; 22:143-155. [PMID: 34980891 PMCID: PMC9308447 DOI: 10.1038/s41568-021-00423-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
Tobacco products present a deadly combination of nicotine addiction and carcinogen exposure resulting in millions of cancer deaths per year worldwide. A plethora of smokeless tobacco products lead to unacceptable exposure to multiple carcinogens, including the tobacco-specific nitrosamine N'-nitrosonornicotine, a likely cause of the commonly occurring oral cavity cancers observed particularly in South-East Asian countries. Cigarettes continue to deliver a large number of carcinogens, including tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons and volatile organic compounds. The multiple carcinogens in cigarette smoke are responsible for the complex mutations observed in critical cancer genes. The exposure of smokeless tobacco users and smokers to carcinogens and toxicants can now be monitored by urinary and DNA adduct biomarkers that may be able to identify those individuals at highest risk of cancer so that effective cancer prevention interventions can be initiated. Regulation of the levels of carcinogens, toxicants and nicotine in tobacco products and evidence-based tobacco control efforts are now recognized as established pathways to preventing tobacco related cancer.
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Affiliation(s)
- Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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Rezapour M, Rezapour HA, Chegeni M, Khanjani N. Exposure to cadmium and head and neck cancers: a meta-analysis of observational studies. REVIEWS ON ENVIRONMENTAL HEALTH 2021; 36:577-584. [PMID: 33544537 DOI: 10.1515/reveh-2020-0109] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/10/2021] [Indexed: 06/12/2023]
Abstract
Cadmium (Cd) is a widespread environmental pollutant. A number of observational studies have reported that Cd might be a cause of nasopharyngeal (NPC), pharyngeal (PC), or laryngeal cancers (LC). In this study evidence about the relation of Cd and NPC, PC, and LC has been summarized. A literature review was conducted until 20 June 2020 in PubMed, Ovid, Scopus, Web of Science and Google scholar databases to investigate the epidemiologic evidence for the relation between cadmium exposure and cancers of the nasopharynx, pharynx, and larynx. Ten articles were selected after careful screening of retrieved studies. All of these studies obtained a Newcastle-Ottawa Scale (NOS) quality score from 6 to 8. Due to high heterogeneity, in all analyses, random effect was used. The pooled results showed that cadmium levels in NPC (standard mean difference (SMD=0.55; 95% CI=0.20, 0.89; p=0.002) and PC (SMD=9.79; 95% CI=0.62, 18.96; p=0.036) patients/tissues were significantly higher than their controls. But cadmium levels were not significantly different between LC cases/tissues and their controls. (SMD=-0.05; 95% CI=-0.99, 0.89; p=0.921). Exposure to cadmium is likely to cause nasopharyngeal and pharyngeal cancer.
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Affiliation(s)
- Maysam Rezapour
- Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Habib Allah Rezapour
- Mahmood Abad Health and Care Network, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Chegeni
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Narges Khanjani
- Environmental Health Engineering Research Center & Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, 76169-13555, Iran
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Fan T, Chen Y, He Z, Wang Q, Yang X, Ren Z, Zhang S. Inhibition of ROS/NUPR1-dependent autophagy antagonises repeated cadmium exposure -induced oral squamous cell carcinoma cell migration and invasion. Toxicol Lett 2019; 314:142-152. [PMID: 31319114 DOI: 10.1016/j.toxlet.2019.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/18/2019] [Accepted: 07/09/2019] [Indexed: 12/22/2022]
Abstract
Cadmium (Cd), an established carcinogen, is a risk factor for oral squamous cell carcinoma (OSCC). Macroautophagy/autophagy is proposed to play a pivotal role in Cd-mediated carcinogenic activity. However, the mechanisms underlying Cd-induced autophagy are poorly understood. In the present study, a CAL27 OSCC cell line exposed to 10-6 M Cd for 8 weeks was used as a model system. Repeated Cd exposure induced significant migration and invasion of CAL27 cells. Furthermore, we showed that Cd increased the autophagic flux in CAL27 cells, as evidenced by the upregulation of LC3-II and the downregulation of P62/SQSTM1. The genetic blocking of autophagy inhibited Cd-induced migration and invasion, indicating a carcinogenic role of autophagy in Cd-treated CAL27 cells. Cd-induced NUPR1 expression, which contributes to lysosomal biogenesis and expression of autophagy-related gene, was found to mechanistically initiate autophagy in CAL27 cells. Of note, NUPR1 shRNA abolished Cd-induced autophagy both in vitro and in vivo. We also found that Cd triggered the generation of MDA in a xenograft tumour model and that N-acetyl-l-cysteine, a reactive oxygen species (ROS) scavenger, abrogated the effects of Cd on NUPR1-dependent autophagy in vivo. Taken together, these results demonstrate that ROS-dependent NUPR1-mediated autophagy plays an important role in repeated Cd exposure -induced cell growth, migration and invasion in OSCC cells.
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Affiliation(s)
- Tengfei Fan
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanrong Chen
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhijing He
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qing Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xi Yang
- Department of Oral Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenhu Ren
- Department of Oral Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Sheng Zhang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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