Tobacco and Public Health - TCSC Indonesia

cigarettes as compared to blond-tobacco cigarettes (De Stefani et al. 1987; Tuyns et al.
1988; Lopez-Abente et al. 1992; Schlecht et al. 1999).
Smoking of products other than cigarettes
An increased risk of laryngeal cancer from cigar and pipe smoking was noticed in the
early epidemiological studies (Wynder et al. 1955, 1976) and confirmed in some
(Schlecht et al. 1999) but not all (Freudenheim et al. 1992) recent investigations. The
magnitude of the risk is similar to that of light smokers, possibly reflecting a lower
consumption of tobacco in this group of smokers. Smoking of local tobacco products,
such as bidis in India (Sankaranarayanan et al. 1990) and yaa muan in Thailand
(Simarak et al. 1977), also increases the risk of laryngeal cancer.In particular, the effect of
bidi smoking seems to be similar to that exerted by cigarette smoking (Fig. 21.2). Use
of oral snuff and chewing of tobacco-containing products have also been associated
with an increased risk in Europe, North America, and India (Wynder et al. 1955;
Jussawalla and Deshpande 1971; Lewin et al. 1998), although some studies did not
detect an increased risk (Sankaranarayanan et al. 1990).
Involuntary smoking
PAOLO BOFFETTA 373
Limited data are available on the risk of laryngeal cancer following involuntary exposure
to tobacco smoke. In a study of 59 non-smoking head and neck cancer cases and
matched non-smoking controls, cases had higher exposure to involuntary smoking
than controls (Tan et al. 1997). In a further study of 26 non-smoking cases of head
and neck cancer and 59 non-smoking controls, the relative risk of ever exposure to
RR
10
1
0.1
NS
(Ref)
1–20 21�yrs
NS 1–20 21�yrs
yrs
(Ref) yrs
bidi smoking cigarette smoking
RR, relative risk; NS, non-smoker
Fig. 21.2 Relative risk of laryngeal cancer from bidi and cigarette smoking—India
(Sankaranarayanan et al. 1990).