无烟烟草与癌症
2010/01/05
目的：讨论无烟烟草与癌症发病的关系
概述：无烟烟草的产品在全球范围正在广泛使用，在某些国家的消费量正在增加，流行病资料显示使用无烟烟草在美国和亚洲有增加口腔癌的风险（总计相对危险度2.6 [95% CI 1.3-5.2])，在北欧等地区的研究结果还有争议(1.0 [0.7-1.3])。在北欧的研究中发现无烟烟草导致食管癌(1.6 [1.1-2.3])和胰腺癌(1.6 [1.1-2.2])的风险同样增加。无烟烟草对肺癌影响的结果尚不一致，北欧的研究显示没有过分增加风险。在印度和苏丹超过50%的口腔癌与使用无烟烟草产品相关，在美国男性中4%的口腔癌与无烟烟草相关，在瑞典男性中20%的食管癌和胰腺癌与无烟烟草相关。无烟烟草是致癌的亚硝胺类的一个主要来源；正在开展暴露的生物标志物测定对暴露程度进行量化并以此作为人群中致癌作用模型的框架。动物致癌性实验研究也强烈支持了临床结果。
总结：无烟烟草的使用者的癌症风险可能会比常规吸烟者降低，但是仍会比非烟草使用者增高致癌风险。
（张永明编译 刘国梁审校）
Lancet Oncol. 2008 Jul;9(7):667-675
Lancet Oncol. 2008 Jul;9(7):667-675
Smokeless tobacco and cancer.
International Agency for Research on Cancer, Lyon, France. boffetta@iarc.fr
Use of smokeless tobacco products is common worldwide, with increasing consumption in many countries. Although epidemiological data from the USA and Asia show a raised risk of oral cancer (overall relative risk 2.6 [95% CI 1.3-5.2]), these are not confirmed in northern European studies (1.0 [0.7-1.3]). Risks of oesophageal cancer (1.6 [1.1-2.3]) and pancreatic cancer (1.6 [1.1-2.2]) have also increased, as shown in northern European studies. Results on lung cancer have been inconsistent, with northern European studies suggesting no excess risk. In India and Sudan, more than 50% of oral cancers are attributable to smokeless tobacco products used in those countries, as are about 4% of oral cancers in US men and 20% of oesophageal and pancreatic cancers in Swedish men. Smokeless tobacco products are a major source of carcinogenic nitrosamines; biomarkers of exposure have been developed to quantify exposure as a framework for a carcinogenesis model in people. Animal carcinogenicity studies strongly support clinical results. Cancer risk of smokeless tobacco users is probably lower than that of smokers, but higher than that of non-tobacco users.
PMID: 18598931 [PubMed - indexed for MEDLINE]
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吸烟特征对泌尿道癌症风险的影响：一个流行病学研究的荟萃分析
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吸烟与结肠直肠癌的发病率和死亡率：系统回顾与荟萃分析
