| Summary: | Introduction
Cancer of the oral cavity is regarded lethal with a fairly low mean
5-year survival rate. The current systematic review and meta-analysis is the first
of its kind to examine, if the evidence from the Middle East and North African
region indicates an association between oral cancer and tobacco; and evaluates
the quality of the evidence that portrays this relationship.
Methods
A search for articles was carried out in October 2017 and then crosschecked
at the end of June 2018 using Medline, Web of Science, CINAHL, and
Cochrane databases. Retrieved articles were later subjected to eligibility criteria.
The search was not limited to any particular research design adopted by the
investigators. However, dissertations, theses and opinion-based reviews generated
from the search were excluded during the screening of titles and abstracts. Quality
of included studies was determined objectively (Newcastle Ottawa Scale) and
subjectively. Revman (Version 5.3) was used for conducting the meta-analysis.
Results
Six studies satisfied the selection criteria of the current review. The New
Castle Ottawa evaluation scale suggested that the three cross-sectional studies and
the three case-control studies included in the current review were of relatively
low to moderate quality. All included studies explored the association of only one
form of smokeless tobacco, i.e. shammah. Three case-control studies revealed a
pooled estimate odds ratio of 38.74 (95% CI: 19.50–76.96), indicating that the
odds for the occurrence of oral cancer among shammah users were nearly 39
times higher compared to the non-users.
Conclusions
Shammah is a potential risk factor for oral cancer; thus, it is necessary
that public health practitioners design and implement effective strategies to
prevent the abuse of shammah.
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