Association of Non-Tobacco Products (NTP) with Oral, Esophageal, and Pharyngeal Cancer and Oral Potentially Malignant Disorders (OPMD) in Adults - A Systematic Review and Meta-analysis

Sep 21, 2026

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Systematic review and meta-analysis examine whether non-tobacco products (NTP) use is associated with oral, esophageal, and pharyngeal cancers as well as oral potentially malignant disorders (OPMD) in adults. Searches in PubMed, Embase, and Google Scholar identified observational studies published through December 2023 in English. Study quality was appraised with the Newcastle-Ottawa scale, and pooled odds ratios with 95% confidence intervals were calculated using a random-effects model, including heterogeneity assessment and subgroup analyses by publication year, comparator, NTP-user type, and country. Results pooled 49 studies with 132,390 participants, showing increased risks across cancers and OPMD, with an India-specific burden attributable to NTP reported for oral and esophageal cancers. Findings support targeted interventions, stronger regulation, and awareness campaigns.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Methods

Results

Conclusion

REVIEW Editorial Process: Submission:01/29/2024 Acceptance:10/06/2024 Association of Non-Tobacco Products (NTP) with Oral, Esophageal, and Pharyngeal Cancer and Oral Potentially Malignant Disorders (OPMD) in Adults: A Systematic Review and Meta-analysis Pooja Dwivedi1, AyushLohiya1*, SARizwan2, Roy A Daniel3, Ram Shankar Rath4, Ankur Verma5, Devashish Shukla6, Deependra Mishra1, Ashok Kumar Singh5 Abstract Introduction: Non-tobacco products (NTP) are increasingly popular as an alternative to traditional tobacco use, raising concerns about potential health risks. This systematic review and meta-analysis examine the association of NTP use with oral, esophageal, pharyngeal cancer, and oral potentially malignant disorders (OPMD) in adults. Methods: A comprehensive electronic search was conducted in PubMed, Embase, and Google Scholar, for observational studies that evaluated the association between NTP use, and oral, esophageal, pharyngeal cancer and OPMD, published till December 2023 in the English language. The quality of the included studies was assessed using the Newcastle-Ottawa scale. Pooled odds ratio (OR) with a 95% Confidence Interval (CI) was obtained using a random effects model, heterogeneity was assessed using I2 statistic. Sub-group analysis was conducted based on the year of publication, a comparator for association, type of NTP user, and country. Results: Forty-nine studies were included in the meta-analysis with a combined total of 1,32,390 participants, revealing a significant association between NTP use and increased risk of cancers-oral (OR:5.0, 95% CI 3.3-7.7), esophageal (OR:3.0, 95%CI 1.2-7.5), and OPMD (OR:15.3, 95%CI 8.8-26.7) . The proportion of the annual burden of oral and esophageal cancers attributable to NTP was 33%(30,667 cancers), and 19%(8,025 cases) respectively in India. Conclusion: This review provides strong evidence for the association between NTP use and increased risk of oral, and esophageal cancer and OPMD. The findings highlight the need for targeted interventions, firmer regulations, and awareness campaigns addressing NTP. Incorporating NTP as a separate category in national surveys can help reduce their burden, particularly in high-risk populations. Keywords: Oral cancer-pharyngeal cancer-non-tobacco products-systematic review-risk-incidence-mortality Asian Pac J Cancer Prev, 25 (10), 3371-3378 Introduction Non-tobacco products (NTP) users face a diverse range of health risks, with millions of individuals worldwide engaging in the practice of chewing NTP such as betel nut and areca nut [1] . This behaviour is particularly prevalent in many Asian countries and among Asian immigrant communities globally. NTP encompass a diverse range of substances, including betel quid, arecanut, and other culturally rooted oral products [2] . The combination of NTP use with tobacco further heightens the risk of various cancers, such as oral cancer, esophageal cancer, and pharyngeal cancer, and potentially malignant disorders (OPMD) . The areca nut present in betel quid contains carcinogens, such as arecoline and nitrosamines, posing potential pre-neoplastic changes upon chewing. These NTP, when placed in the mouth, lead to prolonged exposure of the oral mucosa to harmful substances. The consumption of betel quid, a popular NTP, serves various purposes, including its stimulating effects, cultural traditions, and breath-sweetening properties. Over the years, the availability of traditional and professionally packaged NTP has extended beyond Asian regions, with the United Kingdom being a notable importer. Alarmingly, even young children start consuming sweetened arecanut products, eventually leading to increased NTP usage, often accompanied by tobacco consumption during adolescence [3] . 1Department of Public Health, Kalyan Singh Super Specialty Cancer Institute, Lucknow, India. 2ICMR-National Institute of Epidemiology, Ayapakkam, Chennai, India. 3Centre for Community Medicine, All Indi

FAQs

What does the review evaluate about non-tobacco products (NTP) in adults?

It evaluates the association between NTP use and risks of oral, esophageal, and pharyngeal cancers, as well as oral potentially malignant disorders (OPMD).

How were studies searched and selected for the systematic review and meta-analysis?

Researchers conducted comprehensive searches in PubMed, Embase, and Google Scholar for observational studies published through December 2023 in English.

What overall findings did the meta-analysis report?

Across 49 studies and 132,390 participants, NTP use was significantly associated with higher risks of oral cancer, esophageal cancer, and OPMD.

Sep 21, 2026

Uploaded by Theodora