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Evaluation of cancer risk in tobacco chewers and smokers: An epidemiologic assessment

A retrospective study of cancer at high risk sites in the region of the head and neck was undertaken at the Bombay Cancer Registry, in 1968, to evaluate the effects of tobacco when chewed or smoked. There is sufficient evidence available today to indict chewing and smoking of tobacco as factors of great importance in the etiology of oral, pharyngeal, laryngeal, and esophageal cancers—the most common sites affected by the disease in Greater Bombay. This cause/ effect association is probably as intimate as that of cigarette smoking and lung cancer. The carcinogenic action of chewed tobacco is particularly evident at those sites where the bolus is retained in place for any length of time. Likewise, inhalation of tobacco fumes during the act of smoking produces a stream of gas and of solid particles which impinges directly on the oropharynx and especially on the soft palate initially and exposes smokers to the increased risk of developing cancer at exactly these posterior sites in the oropharynx, rather than more anteriorly in the oral cavity where the tissues do not directly bear the brunt of the onslaught from the smoke. It is revealing to find that the high risk sites involved in tobacco chewers appear to be the least affected in smokers, and vice versa.