Introduction Oesophageal cancer remains an important public health problem worldwide. This multicenter matched case-control study examined chewing of betel quid, areca nut, snuff dipping and cigarette smoking as the risk factors for oesophageal squamous-cell carcinoma.
Methods We enrolled 91 cases of oesophageal squamous-cell carcinoma and 364 matched controls from three tertiary-care hospitals in Karachi, Pakistan. A structured questionnaire was used for data collection.
Results Multivariable conditional logistic regression model showed that chewing of betel quid (adjusted matched OR (mORadj) =9.7; 95% CI 5.0 to 18.8), areca nut (mORadj =4.3; 95% CI 1.5 to 12.4), snuff dipping (mORadj =3.6; 95% CI 1.3 to 9.8) and ever-smoking (mORadj =2.8; 95% CI 1.3 to 5.8) had significant independent associations with oesophageal squamous-cell carcinoma status. The adjusted summary population attributable risk per cent for all the substances together was 69.0. Furthermore, despite incomplete synergy, there was manifold increase in the risk of oesophageal squamous-cell carcinoma if the respondents were ever smokers and betel quid chewers (mORadj =19.4; 95% CI 6.1 to 62.1) or if they were ever smokers and used oral snuff (mORadj =11.9; 95% CI 1.8 to 77.3). The adjusted population attributable risk (%) was higher for combined use of cigarette smoking with betel quid (68.8) than with snuff dipping (29.3).
Conclusions Public awareness to curtail the addiction to these substances may result in a substantial reduction in the incidence of oesophageal squamous-cell carcinoma and related morbidity and mortality in this and similar settings.
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