Waterpipe tobacco smoking associated with higher risk for death from multiple cancers
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Key takeaways:
- Smoking waterpipe tobacco exclusively increased risk for cancer death more than smoking cigarettes only.
- Smoking cessation for at least 10 years significantly reduced mortality risk.
Individuals who smoke tobacco using a waterpipe had a higher risk for death from multiple cancer types compared with those who never smoked, according to data from an ongoing cohort study published in JAMA Oncology.
The study, conducted in Vietnam, showed waterpipe tobacco smoking, commonly called hookah in the U.S., significantly increased mortality risk from liver, lung, nasopharyngeal and stomach cancers.
“Our findings showed a greater risk [for] cancer mortality associated with exclusive waterpipe tobacco smoking than exclusive cigarette smoking,” Ngoan Tran Le, MD, PhD, department of occupational health at Hanoi Medical University, and colleagues wrote.
Background and methodology
The CDC reported 7.8% of high school students and 12.3% of individuals aged 19 to 30 years in the U.S. in 2018 had used a hookah to smoke in the previous year.
The CDC also noted studies found anywhere between 22% and 40% of college students in the U.S. used hookahs.
“The charcoal used to heat the tobacco can raise health risks by producing high levels of carbon monoxide, metals and cancer-causing chemicals,” the CDC wrote. “Even after it has passed through water, the smoke from a hookah has high levels of these toxic agents.”
Previous studies found individuals who smoked waterpipe tobacco had an elevated risk for developing lung, esophageal, nasopharyngeal and gastric cancers, researchers wrote.
“While there have been several efforts to determine the association between waterpipe tobacco smoking and gastric cancer in Vietnam, none has been conducted to evaluate the association between waterpipe tobacco smoking and the risk [for] overall cancer death,” they said.
Le and colleagues investigated using data from the Hanoi Prospective Cohort Study, an ongoing, population-based study that includes 52,325 Vietnamese participants enrolled from April 2007 to November 2008.
Hanoi Prospective Cohort Study investigators gathered information on sociodemographics, lifetime tobacco use and family cancer history, among other topics, in interviews. They followed up with patients quarterly from 2007 to 2019.
Le and colleagues excluded children younger than 15 years and individuals who left the area from their cohort.
They categorized individuals into four smoker subtypes — never smoker, dual waterpipe tobacco and cigarette, exclusive waterpipe tobacco and exclusive cigarette.
The cohort consisted of 39,401 individuals (52.3% women; mean age, 40.4 years), more than three-quarters of whom reported never smoking (76.4%); however, men comprised the overwhelming majority of ever smokers (95.5%).
Results and next steps
Researchers found 554 cancer deaths among the entire cohort.
Ever smokers had an increased risk for cancer mortality compared with never smokers (HR = 1.87; 95% CI, 1.48-2.35).
Exclusive waterpipe tobacco smokers had the highest cancer mortality risk compared with never smokers (HR = 2.66; 95% CI, 2.07-3.43), followed by the dual group, then cigarettes only. Men had the same pattern, but the risk increased across all three subgroups.
Men who exclusively smoked waterpipe tobacco had significantly higher risk for mortality compared with never smokers from liver cancer (HR = 3.92; 95% CI, 2.25-6.85), lung cancer (HR = 3.49; 95% CI, 2.08-5.88), nasopharyngeal cancer (HR = 2.79; 95% CI, 1.27-6.12) and stomach cancer (HR = 4.11; 95% CI, 2.04-8.27).
Exclusive waterpipe tobacco smoker subgroups with the highest risk for cancer mortality included those who smoked 11 to 15 sessions per day (HR = 3.42; 95% CI, 2.03-5.75), began between the ages 26 and 30 years (HR = 4.01; 95% CI, 2.63-6.11), smoked for 9 to 20 years (HR = 4.04; 95% CI, 2.16-7.56) and those who smoked 61 to 160 sessions annually (HR = 3.68; 95% CI, 2.38-5.71).
Men who quit smoking for at least 10 years had significant reduction of cancer mortality risk (HR = 0.27; 95% CI, 0.11-0.66) compared with individuals who stopped for 1 year.
Le and colleagues noted multiple study limitations including lack of data on if participants changed smoking habits over time and self-reported smoking status.
“We believe that the packaging and distribution of waterpipe tobacco products in the Vietnamese market should be in compliance with laws similar to those applied to cigarette products, including a warning stamp on each product, taxation, bans in places where cigarette smoking is banned, and prohibition of selling to or buying by individuals younger than 21 years,” they wrote.
References:
- CDC. Smoking and tobacco use: Hookahs. Available at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/index.htm. Accessed July 12, 2024.
- Le NT, et al. JAMA Oncol. 2024;doi:10.1001/jamaoncol.2024.1939.
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