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Cited by 144Head and Neck Cancer StudiesOral Health Pathology and TreatmentEsophageal Cancer Research and Treatment

The Magnitude of Tobacco Smoking-Betel Quid Chewing-Alcohol Drinking Interaction Effect on Oral Cancer in South-East Asia. A Meta-Analysis of Observational Studies

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Petti, Stefano, Masood, Mohd, Scully, Crispian·2013·PLoS ONE
DOI 10.1371/journal.pone.0078999PMC PMC3832519
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Abstract

Tobacco smoking, betel quid chewing and alcohol drinking are oral cancer risk factors. Observational studies unanimously report that oral cancer risk in smoking-drinking-chewing exposed subjects is exceptionally high. However, none of them assessed the fractions of this risk attributable to the three individual risk factors and to the smoking-drinking-chewing interaction. The present study sought to assess the magnitude of the smoking-drinking-chewing interaction effect on oral cancer. A meta-analysis of observational South-East Asian studies which reported oral cancer odds ratios (ORs) stratified for smoking-drinking-chewing exposures was performed. The pooled ORs were estimated and controlled for quality, heterogeneity, publication bias and inclusion criteria. The smoking-drinking-chewing interaction effect was estimated through the pooled Relative Excess Risk due to Interaction (RERI, excess risk in smoking-drinking-chewing exposed individuals with respect to the risk expected from the addition of the three individual risks of smoking, drinking and chewing). Fourteen studies were included with low between-study heterogeneity. The pooled ORs for smoking, drinking, chewing, smoking-drinking-chewing, respectively were 3.6 (95% confidence interval -95% CI, 1.9-7.0), 2.2 (95% CI, 1.6-3.0), 7.9 (95% CI, 6.7-9.3), 40.1 (95% CI, 35.1-45.8). The pooled RERI was 28.4 (95% CI, 22.9-33.7). Among smoking-drinking-chewing subjects, the individual effects accounted for 6.7% (smoking), 3.1% (drinking), 17.7% (chewing) of the risk, while the interaction effect accounted for the remaining 72.6%. These data suggest that 44,200 oral cancer cases in South-East Asia annually occur among smoking-drinking-chewing exposed subjects and 40,400 of these are exclusively associated with the interaction effect. Effective oral cancer control policies must consider concurrent tobacco smoking, alcohol drinking, betel quid chewing usages as a unique unhealthy lifestyle.

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  • Population attributable fractions generally tend to overestimate the true attributable fraction.

    “PAF generally tends to overestimate the true attributable fraction (94, 95).”

    From Over two hundred million injuries to anterior teeth attributable to large overjet: a meta-analysis (2015) · cites this paper as [95]

    The Methods section uses a population attributable fraction to estimate oral cancer cases attributable to combined exposures, but does not compare that estimate with a true attributable fraction. It also says that attributable proportions in multifactorial models can sum to more than 100%; that is not a claim that PAFs generally overestimate the true attributable fraction. Searches for that comparison and for PAF overestimation found no supporting passage in our copy. (LLM, conf=0.73)

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Authors
Petti, S., Masood, M., & Scully, C.
Affiliations
  • Sapienza University of Rome (IT)
  • Universiti Teknologi MARA System (MY)
  • University College London (GB)
Corresponding author
Petti, Stefano
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2013-11-18
Volume
8
Issue
11
Pages
e78999
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0078999
PMC
PMC3832519
OpenAlex
W2009339327
Cited by
144
References
3
Citations by year
2026: 7 · 2025: 8 · 2024: 4 · 2023: 10 · 2022: 10 · 2021: 16 · 2020: 15 · 2019: 10 · 2018: 11 · 2017: 17 · 2016: 15 · 2015: 15 · 2014: 5 · 2013: 1
FWCI
2.54
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • Greater South Information System
Topics
  • Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
  • Health Sciences › Dentistry › Periodontics › Oral Health Pathology and Treatment
  • Health Sciences › Medicine › Surgery › Esophageal Cancer Research and Treatment
Keywords
oral cancer, smoking, betel quid chewing, alcohol consumption, interaction effects, relative excess risk due to interaction, risk factor attribution, Southeast Asia, oral cancer incidence, lifestyle risk factors
MeSH terms
Alcohol Drinking, Asia, Southeastern, Female, Humans, Male, Mouth Neoplasms, Risk Factors, Smoking

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