Bidi smoking, poly-tobacco use contribute to cancer burden

Use of bidi either exclusively or along with other tobacco products carries increased cancer risk, as reported in an observational study in India.

Researchers conducted a hospital-based unmatched case-control study across eight tertiary-care centres in seven Indian states. They enrolled 2,307 individuals (56.1 percent female) with histologically confirmed cancer in the case cohort and 2,066 individuals (26.8 percent female) with no history of cancer in the control cohort.

A total 608 participants (29.8 percent) in the case cohort and 364 (17.6 percent) in the control cohort reported tobacco use.

Compared with non-tobacco users, exclusive bidi smokers had threefold increased odds of any cancers (adjusted odds ratio [aOR], 3.11, 95 percent confidence interval [CI], 1.86–5.31), while smokeless tobacco users had 1.5-fold increased odds (aOR, 1.55, 95 percent CI, 1.24–1.95).

The odds of any cancers increased further among dual bidi-smokeless (aOR, 3.88, 95 percent CI, 2.11–7.36) and poly-tobacco users (aOR, 4.54, 95 percent CI, 2.65–7.88) relative to non-tobacco users.

Additional analyses showed that longer duration and more frequent bidi use raised the odds of any cancers by up to sevenfold (≥10 years: aOR, 6.75, 95 percent CI, 4.43–10.47; ≥10 bidis/day: aOR, 7.19, 95 percent CI, 4.57–11.51). Poly-tobacco use was also associated with metastatic presentation and more intensive multimodal cancer treatment.

The findings underscore the need for strengthened bidi regulation and targeted tobacco cessation policies.