UADT cancers

Interim results

HSFU/UADT cancer CRA

Databases: EnglishDatabases: Spanish

Databases: Chinese

Databases searched

Search results filtered

Papers identified & obtained for full review

Data extraction

Independent Quality Assessment

Cross-checking references & citations

Awaited

Meta-analysis Interim results only

The combined organs and tissues of the respiratory tract and the upper part of the digestive tract (including the lips, mouth, tongue, nose, throat, vocal cords, and part of the esophagus and windpipe).

Search strategy• “Nasopharynx” OR “nasopharyngeal” OR “NPC” OR “Oropharynx” OR

“oropharyngeal” OR “Hypopharynx” OR “hypopharyngeal” OR “pharynx” OR “larynx” OR “laryngeal” OR “paranasal” OR “head and neck” OR “UADT” OR “aerodigestive” OR “upper respiratory” OR “ENT” OR “otorhinolaryngologic*”

• Cancer OR cancers OR carcinoma OR carcinomata OR neoplasm OR neoplasms OR tumor OR tumors OR tumour OR tumours

• "IAP" OR "Indoor air" OR "pollution" OR "pollutant" OR "fuel" OR "fuels" OR "dung" OR "agricultural waste" OR "crop waste" OR "crop residue" OR "charcoal" OR "coal" OR "biomass" OR "wood" OR "stove" OR "stoves" OR "chula" OR "chulla" OR "oven" OR "ovens" OR "smoke" OR "smoky" OR heat* OR cook* OR light* OR burn*

Databases• PubMed (Medline)• Embase (Scopus & Ovid)• Cochrane Controlled Trials Register• CINAHL (Ovid)• Global Health (Ovid)• DARE (Database of Abstracts of Reviews of Effects) – for reviews• LILACS (Latin American and Caribbean literature)• Scielo• Index Medicus Africanus• Chinese databases CNKI – by Ray Liu @UCB

Search results (English)

• 11,627 search results• 703 abstracts screened• 55 full papers reviewed• 9 papers with relevant data• Did not capture all references from IARC

monograph – 2 or 3 additional papers• Need to cross-check references and citations

plus await results from Chinese databases

9 studies

• 3 China, 1 Singapore, 1 Malaysia, 2 India, 1 Germany, 1 Brazil– 1 kerosene exposure only (not for M/A)– 2 insufficient data for M/A Armstrong 1983,

Shanmugaratnam 2000

OutcomesCancer site Studies

Nasopharyngeal cancer Zheng 1994, Chelleng 2000, Armstrong 1983, Shanmugaratnam 2000

Nasal cavity, paranasal sinuses and middle ear

Zheng 1992

Oral cavity/hypopharynx/ larynx-mainly SCC carcinomas

Dietz 1995, Zheng 1992b, Pintos 1998, Sapkota 2008

Exposure assessmentIndirect assessment Study

Current use of wood for cooking Chelleng 2000,

Use of wood as domestic fuel in 1 year preceding diagnosis

Zheng 1994;

Always use wood for cookingAlways use coal for cooking

Sapkota 2008

Ever use wood/straw OR coal OR kerosene as cooking fuel

Zheng 1992

Main cooking fuel for last ten years – charcoal, firewood, kerosene

Shanmugaratnam 2000 (not for M/A)

“Exposure to domestic smoke” Armstrong 1983 (not for M/A)

Current use wood stove for heating or cooking Pintos 1998

Use fossil fuel stove for heating Use fossil fuel stove for cooking

Dietz 1995

Ever use kerosene stove Zheng 1992b (not for M/A)

Quality issuesQuality IssuesShanmugaratnam 2000

Exposure – main cooking fuel (firewood/kerosene /charcoal) used over last ten years but no clear comparison category

Only OR and chi2 provided

Insufficient data to use for meta-analysis

Armstrong 1983Malaysia

“No positive association with domestic smoke” – no data provided

Insufficient data to use for meta-analysis

Zheng 1992b Crude data for use of kerosene stove No other comparable study therefore not included in M/A

Dietz 1995Heidelberg, Germany

Use of fossil fuel single stoves for cooking or heating – combines clean and solid fuels

Remove in sensitivity analysis

Zheng 1992 Ever use of wood/straw as cooking fuelNo clear comparison fuel

Remove in sensitivity analysis

Zheng 1994 Use of wood as domestic fuel 1 year preceding diagnosisNo clear comparison fuel

Remove in sensitivity analysis

Chelleng 2000:Nagaland, India

Cooking fuel used gas vs. wood– 72% of cases were men and a lot of cooking was done outside main home

? Remove in sensitivity analysis

Sapkota 2008 Always coal or Always wood for cooking vs. modern fuel.But 93% larynx ca and 83% hypopharynx cases men.

? Remove in sensitivity analysis

All studies (n=6)

Publication Bias• Begg's Test• • adj. Kendall's Score (P-Q) = 20• Std. Dev. of Score = 14.58 • Number of Studies = 12• z = 1.37• Pr > |z| = 0.170• z = 1.30 (continuity corrected)• Pr > |z| = 0.193 (continuity corrected)• • Egger's test• ------------------------------------------------------------------------------• Std_Eff | Coef. Std. Err. t P>|t| [95% Conf. Interval]• -------------+----------------------------------------------------------• -------------+------• slope | .0139528 .2934942 0.05 0.963 -.6399932 .6678987• bias | 2.185734 1.016875 2.15 0.057 -.0800038 4.451472• ------------------------------------------------------------------------------

NPC (n=2)

NPC plus nasal cavity/middle ear n=3

Excluding nasopharynx (n=3)

Key assumptions/issues

• Heterogeneous outcomes• Combine fuel categories

– Fossil fuel stoves

• Unclear reference categories – Ever wood vs. never wood

• Cooking as exposure when most of subjects are men