Analysis of the relationship between smokeless tobacco and cancer based on data from the National Mortality Followback Survey

J Clin Epidemiol. 1992 Mar;45(3):223-31. doi: 10.1016/0895-4356(92)90082-x.


This study investigates the potential link between the use of smokeless tobacco and oral cancer and cancer of digestive organs. The combined data of the National Mortality Followback Survey (NMFS), a probability sample of the U.S. deaths, and the coincident National Health Interview Survey (NHIS), a probability sample of the living, non-institutionalized U.S. population, are used to compute risk estimates for cancer, oral cancer, and cancer of the digestive organs associated with use of smokeless tobacco based on a cross sectional study design, simultaneously controlled for potential confounding from active smoking, alcohol consumption, and occupational exposure. Use of smokeless tobacco (either as snuff or chewing tobacco) does not increase the risk of oral cancer or cancer of the digestive organs. Alcohol emerges as a major risk factor for oral cancer with a strong dose-response relationship between the amount of drinking and risk. The same is true to a lesser extent for cancer of the digestive organs. Smoking is associated with increased risk of oral cancer but not of cancer of the digestive organs. Blue collar, technical, and service workers have significantly increased risk of cancer of the digestive organs relative to professional, managerial, and clerical workers, but not of oral cancer. Differences between findings based on the NMFS/NHIS and those obtained from other data very likely are due to inadequate control for confounding. Other reasons for differences between the NMFS/NHIS data and other studies are discussed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alcohol Drinking
  • Confidence Intervals
  • Confounding Factors, Epidemiologic
  • Cross-Sectional Studies
  • Digestive System Neoplasms / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mouth Neoplasms / etiology*
  • Occupational Exposure
  • Plants, Toxic*
  • Risk
  • Risk Factors
  • Smoking / adverse effects
  • Tobacco, Smokeless / adverse effects*