Head and neck cancer burden attributable to tobacco use in India: National and region-wise estimates

Background and objectives Measuring the population attributable fraction (PAF) of head and neck cancers due to tobacco provides an estimate of the potential reduction in disease if tobacco use were eliminated. This study aims to estimate the population attributable fraction at national and State levels. Methods Estimated odds ratios using a precisely age-matched, hospital-based case–control study employing a conditional-logistic regression model, and population attributable fraction using tobacco prevalence in India. Results Among men, population attributable fractions from smokeless tobacco were 62% (lip), 31% (tongue), and 57% (mouth), exceeding 70%, 40%, and 65% respectively in Central (Uttar Pradesh and Chhattisgarh), East (Jharkhand Odisha and Bihar), and Northeast (Arunachal Pradesh, Nagaland, Manipur, Tripura, and Assam) regions. For smoking tobacco, men had PAFs of 40.2% (oropharynx), 45.7% (hypopharynx), and 38.4% (larynx), with values Uttarakhand, 50%, and 45% respectively in several Northern States (Jammu and Kashmir, Himachal Pradesh, Uttarakhand and Haryana), Northeastern States (Arunachal Pradesh, Nagaland, Manipur, Mizoram, Tripura, Meghalaya, and Assam), West Bengal in East and Andhra Pradesh in South. Among women, smokeless tobacco PAFs were 69% (lip), 22% (tongue), 68% (mouth), 41% (oropharynx), and 34% (hypopharynx), rising above 80%, 40%, and 70% for lip, tongue, and mouth in Chhattisgarh, Odisha, Arunachal Pradesh, Nagaland, Manipur, Mizoram, Tripura, Meghalaya and Assam. PAFs over 60% (oropharynx) and 50% (hypopharynx) were found in Jammu and Kashmir, Uttarakhand, Haryana, Arunachal Pradesh, Manipur, Mizoram, Tripura, Meghalaya, and Andhra Pradesh. Interpretation and conclusions This national and region-wise population attributable fraction analysis highlights the magnitude of head and neck cancers that could be prevented by reducing tobacco use.