@article { author = {Dandona, Rakhi and Mathur, Manu Raj and Kumar, G Anil and Dandona, Lalit}, title = {Improving Utility of Data on Cancer Mortality Risk Associated with Smokeless Tobacco: Recommendations for Future Research}, journal = {Asian Pacific Journal of Cancer Prevention}, volume = {20}, number = {2}, pages = {581-588}, year = {2019}, publisher = {West Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.}, issn = {1513-7368}, eissn = {2476-762X}, doi = {10.31557/APJCP.2019.20.2.581}, abstract = {Background: We analyzed in detail the studies utilized in most recent global systematic review of risk of cancermortality with smokeless tobacco (SLT) use to report challenges in the available data that limit the understanding ofassociation between SLT use and cancer mortality. Methods: For each study, we documented study design, reporting ofmortality risk by type of SLT variant, SLT use frequency, and sex of SLT user for oral, oesophageal, pharyngeal, laryngealand orolaryngeal cancers. These findings are discussed within the context of prevalence of SLT use by geographic regionsand sex. Results: Majority of studies reported mortality risk for oral (70.6%) followed by oesophageal cancer (38.2%).The availability of population-based evidence was low (35.3%). The geographic distribution of studies did not reflectthe geographic distribution of countries with high SLT consumption; 61.8% of the studies were from India followed bySweden (20.6%). Hospital-based (84.2%) studies reported risk with chewing tobacco and the population-based studies(61.5%) with non-chewing tobacco. Hardly any study reported on a particular type of SLT. Definition of SLT use ascurrent, ever or former was limited without consideration of the wide variations in frequency and duration of use withinthese patterns. Mortality risk reporting for males dominated all cancers other than oral (50% males). Conclusions:Unless the methodological and generalizability challenges identified in this review are addressed in future researchto develop a stronger scientific basis of the association of SLT use and cancer mortality, we would continue to facesignificant challenges in monitoring the health effects of SLT.}, keywords = {smokeless tobacco,chewing tobacco,snuff,cancer mortality,Cancer risk}, url = {https://journal.waocp.org/article_82373.html}, eprint = {https://journal.waocp.org/article_82373_cbe582c31243b50cf7aefc074fc3d9b0.pdf} }