Smokeless tobacco use and the risk of head and neck cancer: Pooled analysis of US studies in the inhance consortium

Annah B. Wyss, Mia Hashibe, Yuan Chin Amy Lee, Shu Chun Chuang, Joshua Muscat, Chu Chen, Stephen M. Schwartz, Elaine Smith, Zuo Feng Zhang, Hal Morgenstern, Qingyi Wei, Guojun Li, Karl T. Kelsey, Michael McClean, Deborah M. Winn, Stimson Schantz, Guo Pei Yu, Maura L. Gillison, Jose P. Zevallos, Paolo BoffettaAndrew F. Olshan

Research output: Contribution to journalReview articlepeer-review

75 Scopus citations


Previous studies on smokeless tobacco use and head and neck cancer (HNC) have found inconsistent and often imprecise estimates, with limited control for cigarette smoking. Using pooled data from 11 US case-control studies (1981-2006) of oral, pharyngeal, and laryngeal cancers (6,772 cases and 8,375 controls) in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium, we applied hierarchical logistic regression to estimate odds ratios and 95% confidence intervals for ever use, frequency of use, and duration of use of snuff and chewing tobacco separately for never and ever cigarette smokers. Ever use (versus never use) of snuff was strongly associated with HNC among never cigarette smokers (odds ratio (OR) = 1.71, 95% confidence interval (CI): 1.08, 2.70), particularly for oral cavity cancers (OR = 3.01, 95% CI: 1.63, 5.55). Although ever (versus never) tobacco chewing was weakly associated with HNC among never cigarette smokers (OR = 1.20, 95% CI: 0.81, 1.77), analyses restricted to cancers of the oral cavity showed a stronger association (OR = 1.81, 95% CI: 1.04, 3.17). Few or no associations between each type of smokeless tobacco and HNC were observed among ever cigarette smokers, possibly reflecting residual confounding by smoking. Smokeless tobacco use appears to be associated with HNC, especially oral cancers, with snuff being more strongly associated than chewing tobacco.

Original languageEnglish
Pages (from-to)703-716
Number of pages14
JournalAmerican journal of epidemiology
Issue number10
StatePublished - Nov 15 2016


  • Chewing tobacco
  • Head and neck neoplasms
  • Smokeless
  • Snuff
  • Tobacco


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