{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:31:01Z","timestamp":1790361061921,"version":"4.1.0"},"reference-count":65,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Cancer"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Tobacco use has been identified as a risk factor for oral cancer worldwide. However, relative oral cancer incidence among adults who smoke cigarettes, use smokeless tobacco products (ST), have transitioned from cigarettes to ST, quit cigarettes and\/or ST (\u201cquitters\u201d), or never used tobacco has not been well studied.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We aim to present population-based oral cancer incidence rates for adults who smoke cigarettes, use ST, are former smokers who now use ST, or quit.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We estimated cross-sectional incidence rates and incidence rate ratios (IRRs) using data from statewide cancer registries (Colorado, Florida, North Carolina, and Texas) and population counts derived from national surveys using combined data from 2014\u20102017. A random-effect meta-analysis approach was used to summarize estimates among these groups, based on multiple imputation-based IRR estimates by state and age group while considering potential heterogeneity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 19,536 oral cancer cases were identified among adult males 35 years and older in the study geographies and period. The oral cancer incidence rate among adults who smoke was significantly higher than the ST group (2.6 times higher, 95% CI 2.0\u20103.3,\n P<\/jats:italic>\n <.001), 3.6 (95% CI 3.2\u20104.1,\n P<\/jats:italic>\n <.001) times higher than the never users, and 2.4 (95% CI 1.8\u20103.1,\n P<\/jats:italic>\n <.001) times higher compared to former smokers who now use ST. The IRR among the ST group relative to never users was 1.4 (95% CI 1.1\u20101.9,\n P=<\/jats:italic>\n .02). The IRR between former smokers who now use ST and those who quit was 1.4 (95% CI 1.0\u20102.1,\n P=<\/jats:italic>\n .08).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Findings from this population-based study with a large number of oral cancer cases support significantly high oral cancer incidence among adults who smoke and a lower risk of oral cancer incidence among never users, quitters, users of ST, and former smokers who now use ST compared to cigarettes. Future studies with detailed control of tobacco history and other relevant confounders are needed to confirm these findings.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/51936","type":"journal-article","created":{"date-parts":[[2024,9,25]],"date-time":"2024-09-25T14:00:52Z","timestamp":1727272852000},"page":"e51936-e51936","source":"Crossref","is-referenced-by-count":8,"title":["Oral Cancer Incidence Among Adult Males With Current or Former Use of Cigarettes or Smokeless Tobacco: Population-Based Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8818-8737","authenticated-orcid":false,"given":"Brendan","family":"Noggle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7252-5090","authenticated-orcid":false,"given":"Hui","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1167-6140","authenticated-orcid":false,"given":"Mohamadi","family":"Sarkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2024,11,6]]},"reference":[{"issue":"3","key":"R1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","journal-title":"CA Cancer J Clin"},{"key":"R2","unstructured":"SEER Incidence Data, 1975-2021. National Cancer Institute. 2022. URL: https:\/\/seer.cancer.gov\/data\/ [Accessed 22-10-2024]"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33588","article-title":"Cancer statistics for the year 2020: an overview","author":"Ferlay","journal-title":"Int J Cancer"},{"key":"R4","unstructured":"Oral cancer. National Institute of Dental and Craniofacial Research. 2021. URL: https:\/\/www.nidcr.nih.gov\/health-info\/oral-cancer [Accessed 22-10-2024]"},{"key":"R5","unstructured":"Cancer facts & figures 2022. American Cancer Society. 2022. URL: https:\/\/www.cancer.org\/research\/cancer-facts-statistics\/all-cancer-facts-figures\/cancer-facts-figures-2022.html [Accessed 28-10-2024]"},{"issue":"12","key":"R6","doi-asserted-by":"publisher","first-page":"e767","DOI":"10.1016\/S1470-2045(17)30460-6","article-title":"Defining a global research and policy agenda for betel quid and areca nut","volume":"18","author":"Mehrtash","journal-title":"Lancet Oncol"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1080\/21505594.2014.999570","article-title":"HPV and cancer of the oral cavity","volume":"6","author":"H\u00fcbbers","journal-title":"Virulence"},{"issue":"3","key":"R8","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1159\/000485322","article-title":"High-risk human papillomavirus in oral cancer: clinical implications","volume":"94","author":"Yete","journal-title":"Oncology"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1002\/ijc.23033","article-title":"Tobacco smoking and cancer: a meta-analysis","volume":"122","author":"Gandini","journal-title":"Int J Cancer"},{"issue":"9578","key":"R10","doi-asserted-by":"publisher","first-page":"2015","DOI":"10.1016\/S0140-6736(07)60678-3","article-title":"Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study","volume":"369","author":"Luo","journal-title":"Lancet"},{"issue":"4","key":"R11","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1002\/msj.20125","article-title":"The risk of upper aero digestive tract cancer associated with smoking, with and without concurrent alcohol consumption","volume":"76","author":"Ansary-Moghaddam","journal-title":"Mt Sinai J Med"},{"issue":"3","key":"R12","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1093\/ije\/dyv175","article-title":"Impact of changing US cigarette smoking patterns on incident cancer: risks of 20 smoking-related cancers among the women and men of the NIH-AARP cohort","volume":"45","author":"Freedman","journal-title":"Int J Epidemiol"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1093\/ntr\/nts120","article-title":"Smoking-attributable mortality by cause in the United States: revising the CDC\u2019s data and estimates","volume":"15","author":"Rostron","journal-title":"Nicotine Tob Res"},{"issue":"8","key":"R14","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1007\/s10552-020-01317-w","article-title":"Cancer mortality risk, fine particulate air pollution, and smoking in a large, representative cohort of US adults","volume":"31","author":"Coleman","journal-title":"Cancer Causes Control"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s12954-019-0294-6","article-title":"Smokeless tobacco mortality risks: an analysis of two contemporary nationally representative longitudinal mortality studies","volume":"16","author":"Fisher","journal-title":"Harm Reduct J"},{"key":"R16","unstructured":"IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Smokeless tobacco and some tobacco-specific N-nitrosamines. In: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. 2007. URL: https:\/\/publications.iarc.fr\/Book-And-Report-Series\/Iarc-Monographs-On-The-Identification-Of-Carcinogenic-Hazards-To-Humans\/Smokeless-Tobacco-And-Some-Tobacco-specific-Em-N-Em--Nitrosamines-2007 [Accessed 28-10-2024]"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2017.09.003","article-title":"Associations between oral hygiene habits, diet, tobacco and alcohol and risk of oral cancer: a case-control study from India","volume":"51","author":"Gupta","journal-title":"Cancer Epidemiol"},{"issue":"2","key":"R18","doi-asserted-by":"publisher","first-page":"458","DOI":"10.4103\/0973-1482.186696","article-title":"Oral cancer: etiology and risk factors: a review","volume":"12","author":"Kumar","journal-title":"J Cancer Res Ther"},{"issue":"4","key":"R19","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1093\/mutage\/geh036","article-title":"Alert for an epidemic of oral cancer due to use of the betel quid substitutes gutkha and pan masala: a review of agents and causative mechanisms","volume":"19","author":"Nair","journal-title":"Mutagenesis"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1186\/s12916-020-01677-9","article-title":"Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries","volume":"18","author":"Siddiqi","journal-title":"BMC Med"},{"issue":"10","key":"R21","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1001\/jamaoncol.2023.2960","article-title":"The global, regional, and national burden of adult lip, oral, and pharyngeal cancer in 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2019","volume":"9","author":"GBD 2019 Lip, Oral, and Pharyngeal Cancer Collaborators","journal-title":"JAMA Oncol"},{"issue":"3","key":"R22","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1111\/jop.12171","article-title":"Molecular and cellular cues of diet-associated oral carcinogenesis--with an emphasis on areca-nut-induced oral cancer development","volume":"44","author":"Li","journal-title":"J Oral Pathol Med"},{"issue":"6","key":"R23","doi-asserted-by":"publisher","first-page":"1366","DOI":"10.1111\/odi.13456","article-title":"Do betel quid and areca nut chewing deteriorate prognosis of oral cancer? A systematic review, meta-analysis, and research agenda","volume":"27","author":"Yang","journal-title":"Oral Dis"},{"issue":"5","key":"R24","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1093\/eurpub\/ckw032","article-title":"Smokeless tobacco use in Sweden and other 17 European countries","volume":"26","author":"Leon","journal-title":"Eur J Public Health"},{"issue":"5","key":"R25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0233111","article-title":"Comparison of tobacco-specific nitrosamine levels in smokeless tobacco products: high levels in products from Bangladesh","volume":"15","author":"Nasrin","journal-title":"PLoS One"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1016\/j.fct.2022.113179","article-title":"Carcinogenic components of tobacco and tobacco smoke: a 2022 update","volume":"165","author":"Li","journal-title":"Food Chem Toxicol"},{"issue":"3","key":"R27","doi-asserted-by":"publisher","DOI":"10.1136\/tc.2010.037465","article-title":"Global surveillance of oral tobacco products: total nicotine, unionised nicotine and tobacco-specific N-nitrosamines","volume":"20","author":"Stanfill","journal-title":"Tob Control"},{"issue":"3","key":"R28","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.yrtph.2012.09.003","article-title":"The chemical composition of smokeless tobacco: a survey of products sold in the United States in 2006 and 2007","volume":"64","author":"Borgerding","journal-title":"Regul Toxicol Pharmacol"},{"issue":"9","key":"R29","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1093\/ntr\/nty074","article-title":"Association of smokeless tobacco use and oral cancer: a systematic global review and meta-analysis","volume":"21","author":"Asthana","journal-title":"Nicotine Tob Res"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-7-334","article-title":"Meta-analysis of the relation between European and American smokeless tobacco and oral cancer","volume":"7","author":"Weitkunat","journal-title":"BMC Public Health"},{"key":"R31","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-7-36","article-title":"Systematic review of the relation between smokeless tobacco and cancer in Europe and North America","volume":"7","author":"Lee","journal-title":"BMC Med"},{"issue":"7","key":"R32","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1016\/S1470-2045(08)70173-6","article-title":"Smokeless tobacco and cancer","volume":"9","author":"Boffetta","journal-title":"Lancet Oncol"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-9-256","article-title":"The relation between smokeless tobacco and cancer in Northern Europe and North America. A commentary on differences between the conclusions reached by two recent reviews","volume":"9","author":"Lee","journal-title":"BMC Cancer"},{"issue":"3","key":"R34","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkz036","article-title":"Contemporary associations of exclusive cigarette, cigar, pipe, and smokeless tobacco use with overall and cause-specific mortality in the United States","volume":"3","author":"Inoue-Choi","journal-title":"JNCI Cancer Spectr"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1007\/s10552-004-5519-6","article-title":"Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States)","volume":"16","author":"Henley","journal-title":"Cancer Causes Control"},{"issue":"9","key":"R36","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1007\/s10552-005-0247-0","article-title":"Cancer incidence among a cohort of smokeless tobacco users (United States)","volume":"16","author":"Accortt","journal-title":"Cancer Causes Control"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1002\/ijc.30736","article-title":"A longitudinal study of smokeless tobacco use and mortality in the United States","volume":"141","author":"Timberlake","journal-title":"Int J Cancer"},{"key":"R38","unstructured":"What is a cancer registry?National Cancer Registrars Association. 2023. URL: https:\/\/www.ncra-usa.org [Accessed 22-10-2024]"},{"key":"R39","unstructured":"National Program of Cancer Registries (NPCR). Centers for Disease Control and Prevention. 2018. URL: https:\/\/www.cdc.gov\/cancer\/npcr\/about.htm [Accessed 22-10-2024]"},{"issue":"11","key":"R40","doi-asserted-by":"publisher","first-page":"2381","DOI":"10.1002\/cncr.31326","article-title":"Capture of tobacco use among population-based registries: findings from 10 National Program of Cancer Registries states","volume":"124","author":"Siegel","journal-title":"Cancer"},{"key":"R41","unstructured":"2020 NSDUH detailed tables. Substance Abuse and Mental Health Services Administration. 2020. URL: https:\/\/www.samhsa.gov\/data\/report\/2020-nsduh-detailed-tables [Accessed 22-10-2024]"},{"key":"R42","unstructured":"TUS-CPS questionnaires and data files. National Institutes of Health. 2022. URL: https:\/\/cancercontrol.cancer.gov\/brp\/tcrb\/tus-cps\/questionnaires-data [Accessed 22-10-2024]"},{"issue":"Pt A","key":"R43","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.cct.2015.09.002","article-title":"Meta-analysis in clinical trials revisited","volume":"45","author":"DerSimonian","journal-title":"Contemp Clin Trials"},{"issue":"4","key":"R44","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1002\/sim.4780100410","article-title":"Multiple imputation in health-care databases: an overview and some applications","volume":"10","author":"Rubin","journal-title":"Stat Med"},{"issue":"5","key":"R45","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1158\/1055-9965.EPI-16-0748","article-title":"Tobacco use and cancer risk in the Agricultural Health Study","volume":"26","author":"Andreotti","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"10","key":"R46","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1093\/aje\/kww075","article-title":"Smokeless tobacco use and the risk of head and neck cancer: pooled analysis of US studies in the INHANCE Consortium","volume":"184","author":"Wyss","journal-title":"Am J Epidemiol"},{"issue":"1","key":"R47","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-11801-w","article-title":"Modeling mortality risk effects of cigarettes and smokeless tobacco: results from the National Health Interview Survey Linked Mortality File Data","volume":"21","author":"Salazar","journal-title":"BMC Public Health"},{"issue":"13","key":"R48","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1056\/NEJM198103263041301","article-title":"Snuff dipping and oral cancer among women in the southern United States","volume":"304","author":"Winn","journal-title":"N Engl J Med"},{"issue":"8","key":"R49","doi-asserted-by":"publisher","first-page":"930","DOI":"10.14219\/jada.archive.2013.0212","article-title":"Association of smokeless tobacco use and smoking in adolescents in the United States: an analysis of data from the Youth Risk Behavior Surveillance System survey, 2011","volume":"144","author":"Wiener","journal-title":"J Am Dent Assoc"},{"issue":"6","key":"R50","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1006\/pmed.2002.1032","article-title":"Concomitant use of cigarettes and smokeless tobacco: prevalence, correlates, and predictors of tobacco cessation","volume":"34","author":"Wetter","journal-title":"Prev Med"},{"issue":"14","key":"R51","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1001\/jama.2014.13183","article-title":"Tobacco use and oral HPV-16 infection","volume":"312","author":"Fakhry","journal-title":"JAMA"},{"issue":"1","key":"R52","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.yrtph.2013.02.010","article-title":"The effect on health of switching from cigarettes to snus - a review","volume":"66","author":"Lee","journal-title":"Regul Toxicol Pharmacol"},{"issue":"3","key":"R53","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1002\/(sici)1097-0215(19980729)77:3<341::aid-ijc6>3.0.co;2-o","article-title":"Oral snuff, smoking habits and alcohol consumption in relation to oral cancer in a Swedish case-control study","volume":"77","author":"Schildt","journal-title":"Int J Cancer"},{"key":"R54","unstructured":"Smokeless tobacco products, including dip, snuff, snus, and chewing tobacco. Food and Drug Administration. 2020. URL: https:\/\/www.fda.gov\/tobacco-products\/products-ingredients-components\/smokeless-tobacco-products-including-dip-snuff-snus-and-chewing-tobacco [Accessed 22-10-2024]"},{"key":"R55","unstructured":"Smokeless tobacco: products and marketing. Centers for Disease Control and Prevention. 2021. URL: https:\/\/www.cdc.gov\/tobacco\/other-tobacco-products\/smokeless-product-use-in-the-us.html [Accessed 22-10-2024]"},{"issue":"11","key":"R56","doi-asserted-by":"publisher","first-page":"397","DOI":"10.15585\/mmwr.mm7111a1","article-title":"Tobacco product use among adults - United States, 2020","volume":"71","author":"Cornelius","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"4","key":"R57","doi-asserted-by":"publisher","first-page":"S537","DOI":"10.1080\/14622200701679040","article-title":"Developing the science base for reducing tobacco harm","volume":"9 Suppl 4","author":"Hatsukami","journal-title":"Nicotine Tob Res"},{"issue":"5","key":"R58","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1159\/000360220","article-title":"Estimating the harms of nicotine-containing products using the MCDA approach","volume":"20","author":"Nutt","journal-title":"Eur Addict Res"},{"issue":"4","key":"R59","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1136\/tc.2008.027318","article-title":"The Strategic Dialogue on Tobacco Harm Reduction: a vision and blueprint for action in the US","volume":"18","author":"Zeller","journal-title":"Tob Control"},{"key":"R60","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.26762.2","article-title":"Nicotine products relative risk assessment: an updated systematic review and meta-analysis [version 2; peer review: 1 approved, 1 approved with reservations]","author":"Murkett","journal-title":"Syst rev"},{"issue":"5","key":"R61","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1080\/10810730.2015.1012237","article-title":"Risk perceptions of smokeless tobacco among adolescent and adult users and nonusers","volume":"20","author":"Liu","journal-title":"J Health Commun"},{"issue":"2","key":"R62","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1093\/ntr\/ntr168","article-title":"Young adults\u2019 perceptions about established and emerging tobacco products: results from eight focus groups","volume":"14","author":"Wray","journal-title":"Nicotine Tob Res"},{"issue":"e1","key":"R63","doi-asserted-by":"publisher","first-page":"e49","DOI":"10.1136\/tobaccocontrol-2016-053060","article-title":"How do consumers perceive differences in risk across nicotine products? A review of relative risk perceptions across smokeless tobacco, e-cigarettes, nicotine replacement therapy and combustible cigarettes","volume":"26","author":"Czoli","journal-title":"Tob Control"},{"issue":"2","key":"R64","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1111\/j.1465-3362.2009.00143.x","article-title":"University faculty perceptions of the health risks related to cigarettes and smokeless tobacco","volume":"29","author":"Peiper","journal-title":"Drug Alcohol Rev"},{"issue":"2","key":"R65","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1093\/ntr\/ntab167","article-title":"Absolute and relative smokeless tobacco product risk perceptions: developing and validating new measures that are up-to-snuff","volume":"24","author":"O\u2019Brien","journal-title":"Nicotine Tob Res"}],"container-title":["JMIR Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/cancer.jmir.org\/2024\/1\/e51936","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:36:15Z","timestamp":1782840975000},"score":1,"resource":{"primary":{"URL":"https:\/\/cancer.jmir.org\/2024\/1\/e51936"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,6]]},"references-count":65,"URL":"https:\/\/doi.org\/10.2196\/51936","relation":{},"ISSN":["2369-1999"],"issn-type":[{"value":"2369-1999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,6]]},"article-number":"v10i3e51936"}}