Published Nov 04, 2026 | 7:10 PM ⚊ Updated Nov 04, 2026 | 7:10 PM
Female smokers had an odds ratio of 9.05 for mouth cancer, compared with 1.25 among male smokers. (iStock)
Synopsis: A study examining tobacco-related head and neck cancers has found substantially higher odds ratios among female smokers for mouth and throat cancers compared with male smokers. It also highlights regional differences in tobacco-attributable cancer burden across southern states and calls for stronger, region-specific tobacco cessation measures.
Women who smoke or chew tobacco have substantially higher odds ratios for certain head and neck cancers than their male counterparts, according to a study published in the Indian Journal of Medical Research.
The study found that female smokers had an odds ratio (OR) of 9.05 for mouth cancer, compared with 1.25 among male smokers. The ratio of these estimates is approximately 7.2.
An OR compares the odds of cancer among tobacco users with non-users of the same sex. An OR of 9.05 means female smokers had 9.05 times the odds of mouth cancer compared with female non-smokers, while the figure was 1.25 for men. The 7.2 ratio compares these estimates, not actual cancer risk between sexes.
For oropharyngeal cancer, which affects the back of the throat, including the tonsils and base of the tongue, the corresponding OR was 35.82 among women and 4.53 among men, a nearly eightfold difference between the estimates.
The findings also showed higher OR among women who consumed smokeless tobacco. Women tobacco chewers had an OR of 18.23 for lip cancer, compared with 6.47 among men. For mouth cancer, the corresponding odds ratios were 17.63 among women and 5.54 among men.
The authors highlighted the importance of examining tobacco-related cancers and their preventable burden across India. “Tobacco use is a well-established major risk factor for head and neck cancers. Substantial evidence links tobacco consumption to cancers of the oral cavity, hypopharynx, and larynx,” the authors wrote.
Explaining the rationale behind their research, they said: “Tobacco use is a modifiable risk factor for head and neck cancers, as its consumption can be prevented or eliminated. Therefore, understanding the extent to which tobacco habits contribute to these cancers is crucial for effective prevention strategies.”
The study included 11,285 individuals diagnosed with head and neck cancers, comprising 8,709 men and 2,576 women, and 7,154 individuals with non-neoplastic conditions who served as controls.
The participants reported to the Regional Cancer Centre (RCC), Thiruvananthapuram, between 2019 and 2024. The researchers examined the association between smoking and smokeless tobacco consumption and different sites of head and neck cancers.
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The study’s multivariable analysis found substantial differences in the OR associated with smoking tobacco among men and women across different head and neck cancer sites.
Apart from mouth cancer, where the OR were 9.05 among women and 1.25 among men, women smokers had an OR of 26.68 for hypopharyngeal cancer, compared with 5.44 among men.
Hypopharyngeal cancer affects the lower part of the throat, just above the food pipe and behind the voice box. The ratio of the two estimates was approximately 4.9.
For laryngeal cancer, which affects the voice box, the OR was 7.32 among women smokers and 4.28 among men.
Among men, smoking was associated with an OR of 4.53 for oropharyngeal cancer, 5.44 for hypopharyngeal cancer and 4.28 for laryngeal cancer. Among women, the corresponding OR were 35.82, 26.68 and 7.32, respectively.
The researchers noted that tobacco consumption patterns and the types of tobacco products used vary across populations, influencing the burden of different cancers. “Tobacco-related cancer risk varies across India due to regional differences in consumption patterns,” the authors said.
They also highlighted the importance of understanding the role of smokeless tobacco in oral cancers. “The practice of chewing tobacco and betel quid, which is common in South and Southeast Asia, poses a particularly high risk for oral cancers,” they wrote.
The researchers cautioned that their findings had limitations. The OR were derived from a hospital-based case-control study conducted at a cancer centre in Keralam and applied to state populations using tobacco prevalence estimates from the Global Adult Tobacco Survey 2 (GATS-2). The confidence intervals for several estimates among women were wide. For instance, the OR for female smokers and oropharyngeal cancer was 35.82, with a 95% confidence interval of 3.16 to 406.05.
The figures represent sex-specific associations between tobacco use and cancer, not direct measurements of how much higher women’s actual cancer risk is compared with men’s.
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The study also identified a strong association between smokeless tobacco consumption and cancers of the oral cavity, particularly among women.
Women who consumed smokeless tobacco had an OR of 18.23 for lip cancer, compared with 6.47 among men. For mouth cancer, the OR was 17.63 among women and 5.54 among men. For tongue cancer, the corresponding ORs were 3.18 and 2.50, respectively.
The researchers found that smokeless tobacco use was associated with an increased risk of lip, mouth and tongue cancers among both men and women.
“The present study found that the population attributable fraction of mouth cancer due to smokeless tobacco was higher than reported in previous studies, reflecting the widespread use of smokeless tobacco,” the authors said.
They further explained the possible reason for the association between smokeless tobacco and tongue cancer: “This may be because smokeless tobacco directly contacts the oral cavity, causing prolonged exposure of the tongue to carcinogens, whereas smoking produces more diffuse and less concentrated exposure.”
At the national level, the researchers estimated that 68% of mouth cancers among women were attributable to smokeless tobacco, compared with 57.3% among men. For lip cancer, the corresponding estimates were 68.8% among women and 61.8% among men.
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The study also estimated the population attributable fraction (PAF) of different head and neck cancers due to tobacco consumption across states, including Andhra Pradesh, Telangana, Karnataka, Keralam and Tamil Nadu.
Among women, the tobacco-attributable fraction of mouth cancer was 66.7% in Karnataka, 66.3% in Andhra Pradesh, 65.6% in Telangana, 64.4% in Tamil Nadu and 41.2% in Keralam.
Among men, Karnataka again recorded the highest estimate at 52.7%, followed by Tamil Nadu at 49.6%, Andhra Pradesh at 48.7%, Telangana at 45.1% and Keralam at 42.1%.
The figures indicated that the proportion of mouth cancer burden attributable to tobacco was higher among women in four of the five states, with Keralam being the exception.
The authors said that regional differences in tobacco consumption habits influence the distribution of tobacco-related cancers. “Tobacco-related cancer risk varies across India due to regional differences in consumption patterns. In Kerala, smokeless tobacco typically includes betel leaf, areca nut, slaked lime, and tobacco, while commercially prepared products like gutka and pan masala are uncommon.”
They added that smoking habits also differ between regions. “Further, cigarettes and bidis dominate smoking habits in Kerala, whereas in northern and northeastern states, hand-rolled cigarettes and pipes or bamboo devices (E.g., hookah) are more commonly used.”
For pharyngeal cancers, excluding nasopharyngeal cancer, the tobacco-attributable fraction among men was 60.5% in Karnataka, 57.4% in Tamil Nadu, 56.6% in Andhra Pradesh, 52.9% in Telangana and 49.9% in Keralam.
Among women, the corresponding figures were 24.5% in Karnataka, 24.2% in Andhra Pradesh, 23.6% in Telangana, 22.7% in Tamil Nadu and 10.2% in Keralam.
For laryngeal cancer among men, the tobacco-attributable fraction was 44.3% in Karnataka, 41.2% in Tamil Nadu, 40.4% in Andhra Pradesh, 36.9% in Telangana and 34.1% in Keralam.
The researchers, however, acknowledged that their state-wise estimates had limitations because the risk estimates were derived from patients at a cancer centre in Keralam. “Furthermore, since risk estimates were derived from Keralam, their generalisability to other regions is limited, and uniform application may not capture regional differences,” they said.
“Nonetheless, in the absence of state-specific data, this approach provides a reasonable approximation of population attributable fractions, though further region-specific studies are needed to improve accuracy,” the authors added.
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The authors emphasised that tobacco consumption remains a preventable risk factor for head and neck cancers and called for stronger tobacco cessation services, routine screening and region-specific prevention strategies.
They noted that the study provides state-wise estimates of the proportion of cancers attributable to smoking and smokeless tobacco, offering evidence that could help strengthen prevention programmes.
“The findings emphasise the need to strengthen tobacco cessation services, especially for high-risk men in regions with elevated population attributable fractions,” the authors said.
They also recommended that healthcare providers routinely screen patients for tobacco use and offer evidence-based cessation support. “Region-specific policies are essential, including strict implementation of the National Tobacco Control Programme and equitable access to cessation resources,” they added.
(Edited by Majnu Babu).
