{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T08:32:22Z","timestamp":1748421142046,"version":"3.40.3"},"reference-count":41,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T00:00:00Z","timestamp":1734307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2025,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Smokeless tobacco (SLT) use is an established carcinogen to the nasal cavity, lip, and oropharynx, however, few studies have examined cancer risks in older African women among whom SLT use is common. We investigated snuff use and the risk of site\u2010specific cancers among 15,336 newly diagnosed female cancer patients in the Johannesburg Cancer Study, South Africa. We designed case\u2013control comparisons across multiple cancer outcomes: (a) known SLT\u2010associated cancers; (b) other tobacco\u2010related cancers and (c) genital cancers owing to intravaginal snuff use. Controls (<jats:italic>n<\/jats:italic>\u2009=\u20092961) comprised all other cancer patients. We also investigated (d) each control cancer type versus the remaining controls to explore possible associations with other cancers. Logistic models were fitted to estimate odds ratios adjusted for age, education, tobacco smoking, alcohol, HIV, and language. Overall, ever use of snuff was 22% among control cancers. Ever snuff use was associated with cervical (OR 1.14 [95%CI 1.00\u20131.30]) and eye and adnexa cancer (OR 1.95 [95%CI 1.03\u20133.70]). Associations with vulva cancer were less clear, 95% CI's for the main effects included 1 but a subgroup analysis restricted to never\u2010smokers of current\u2010versus\u2010never users was positive (OR 2.10 [95%CI 1.25\u20133.50]). Surprisingly SLT users have lower risks of stomach cancer (OR 0.60 [95%CI 0.37\u20130.99]) and Hodgkin Lymphoma (OR 0.48 [95%CI 0.23\u20130.97]). Snuff use may increase the risk for cervical and vulva cancer in women, which is plausible via intravaginal use. Further research on the impact of SLT on female genital cancers with more detailed exposure data, including timing, intensity, and routes of use are required.<\/jats:p>","DOI":"10.1002\/ijc.35293","type":"journal-article","created":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T15:22:22Z","timestamp":1734362542000},"page":"1916-1925","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Smokeless tobacco (snuff) and site\u2010specific cancer risks in adult Black South African women: Findings from the Johannesburg Cancer Study"],"prefix":"10.1002","volume":"156","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4703-7057","authenticated-orcid":false,"given":"Melitah","family":"Motlhale","sequence":"first","affiliation":[{"name":"Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC\/WHO)  Lyon France"},{"name":"National Cancer Registry, National Health Laboratory Service  Johannesburg South Africa"},{"name":"Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Services  Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Freddy","family":"Sitas","sequence":"additional","affiliation":[{"name":"Burden of Disease Research Unit South African Medical Research Council  Cape Town South Africa"},{"name":"Centre for Primary Health Care and Equity, School of Population Health University of New South Wales Sydney  Sydney Australia"},{"name":"Menzies Centre for Health Policy and Economics, School of Public Health University of Sydney  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chantal Babb","family":"de Villiers","sequence":"additional","affiliation":[{"name":"Division of Human Genetics, School of Pathology, Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3429-2585","authenticated-orcid":false,"given":"Hannah","family":"Simba","sequence":"additional","affiliation":[{"name":"Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC\/WHO)  Lyon France"},{"name":"Department of Global Health, Faculty of Medicine and Health Sciences Stellenbosch University  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariadna","family":"Feliu","sequence":"additional","affiliation":[{"name":"Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC\/WHO)  Lyon France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3248-4906","authenticated-orcid":false,"given":"Wenlong Carl","family":"Chen","sequence":"additional","affiliation":[{"name":"National Cancer Registry, National Health Laboratory Service  Johannesburg South Africa"},{"name":"Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"},{"name":"Strengthening Oncology Services Research Unit, Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Sch\u00fcz","sequence":"additional","affiliation":[{"name":"Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC\/WHO)  Lyon France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1955-923X","authenticated-orcid":false,"given":"Mazvita","family":"Muchengeti","sequence":"additional","affiliation":[{"name":"National Cancer Registry, National Health Laboratory Service  Johannesburg South Africa"},{"name":"Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health 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