Tobacco and Public Health - TCSC Indonesia

TONGZHANG ZHENG ET AL. 419
For example, a case–control study by Franceschi et al. (1990) reported an OR of
20.7 (95% CI 5.6–76.3) for pipe and cigar smokers compared to an OR of 11.1 (95%
CI 3.4–34.8) for cigarette smokers.
Zheng et al. (1990) reported an OR of 5.7 (95% CI 2.4–13.3) for male pipe smokers
compared to 1.6 (95% CI 1.0–2.6) for male cigarette smokers in their case–control
study. Franco et al. (1989) reported a higher risk of oral cancer for pipe smoking
compared to other smoking behaviors, particularly for cancer of other parts of the
mouth (ICD9 143–145).
Pipe smoking also showed a strong dose-dependent relationship with oral cancer
risk in several studies (Blot et al. 1988; Mashberg et al. 1993; Schlecht et al. 1999). For
example, the study by Schlecht et al. (1999) reported an OR of 6.7 (95% CI 3.1–14.8)
for those who smoked 1–20 pack-years of commercial-cigarette equivalents of pipe,
and 8.2 (95% CI 3.7–17.8) for those with more than 20 pack-years of commercialcigarette
equivalents of pipe smoking. Similarly, in a large case–control study, Blot et al.
(1988) reported an OR of 1.9 (9% CI 1.1–3.4) for those exclusively smoking cigars
and/or pipes, with a positive trend associated with increasing numbers of cigars/pipes
smoked. The OR rose to 16.7 (95% CI 3.7–76.7) for men who smoked 40 or more
cigars/week, and to 3.1 (95% CI 1.1–8.7) for those consuming 40+ pipefuls/week.
However, other studies, such as Merletti et al. (1989) reported a higher risk of oral
cancer for cigar smokers (OR = 14.6, 95% CI 4.7–45.6) than pipe smokers (OR = 3.8,
95% CI 1.1–12.6) and than cigarette smokers (OR = 3.9, 95% CI 1.6–9.4) among male
smokers. A strong dose–response relationship has been shown between cigar smoking
and risk of oral cancer. In particular, the study by Garrote et al. (2001) showed a strong
dose–response relationship between cigar smoking and oral cancer risk (P trend < 0.01).
They found that, compared with never smokers, those who smoked 5 cigars per day) for oral and pharyngeal cancer risk. In a case–control study of
oral and esophageal cancers involving only those who never smoked pipe tobacco or
cigarettes, La Vecchia et al. (1998) reported an OR of 6.8 (95% CI 2.5–18.5) for ever
smokers and 8.9 for smokers of more than 3 cigars per day, and 14.9 (95% CI 4.0–55.9)
for current cigar smokers when compared to never cigar smokers.
In either case, pipe and cigar smoking clearly increases the risk of oral cancer. This
risk seems to vary by anatomic subsite. Shapiro et al. (2000) found that, compared with
never smokers, current cigar smokers had an RR of 4.0 (95% CI 1.5–10.3) for cancer of
the oral cavity/pharynx compared to 10.3 (95% CI 2.6–41.0) for cancer of the larynx.
Former smokers had an OR of 2.4 (95% CI 0.8–7.3) for cancer of the oral cavity/pharynx,
but 6.7 (95% CI 1.5–30.0) for cancer of the larynx. In their case–
control study of oral and esophageal cancers, La Vecchia et al. (1998) reported an OR 9.0
(95% CI 2.7–30.0) for oral and pharyngeal cancers, compared to 4.1 (95% CI 0.7–23.0)