Smokeless tobacco use: A meta-analysis of risk and attributable mortality estimates for India.

BACKGROUND: Use of smokeless tobacco (SLT) is widely prevalent in India and Indian subcontinent. Cohort and case–control studies in India and elsewhere report excess mortality due to its use. OBJECTIVE: The aim was to estimate the SLT use‑attributable deaths in males and females, aged 35 years and older, in India. MATERIALS AND METHODS: Prevalence of SLT use in persons aged 35 years and older was obtained from the Global Adult Tobacco Survey in India and population size and deaths in the relevant age‑sex groups were obtained from UN estimates (2010 revision) for 2008. A meta‑relative risk (RR) based population attributable fraction was used to estimate attributable deaths in persons aged 35 years and older. A random effects model was used in the meta‑analysis on all‑cause mortality from SLT use in India including four cohort and one case–control study. The studies included in the meta‑analysis were adjusted for smoking, age and education. RESULTS: The prevalence of SLT use in India was 25.2% for men and 24.5% for women aged 35 years and older. RRs for females and males were 1.34 (1.27–1.42) and 1.17 (1.05–1.42), respectively. The number of deaths attributable to SLT use in India is estimated to be 368127 (217,076 women and 151,051 men), with nearly three‑fifth (60%) of these deaths occurring among women. CON CLUSION: SLT use caused over 350,000 deaths in India in 2010, and nearly three‑fifth of SLT use‑attributable deaths were among women in India. This calls for targeted public health intervention focusing on SLT products especially among women.

Male breast cancer in Indian patients: Is it the same.

Background: Cancer of the male breast accounts for about 1% of all malignancies in men and 1% of all breast cancers. Poor level of awareness often results in late presentation and delayed diagnosis in our environment. This study was done to analyse the demographic data, management and survival of male breast cancers in Indian subset of patients and compare it with that of western literature. Materials and Methods: A 10 year (2001-2010) retrospective study of all male breast cancers was done. Data regarding the incidence, presentation, histopathology, stage and grade of tumor, management and outcome of patients were analysed. Results: 26 cases of male breast cancer were encountered. This comprised 0.4% of all breast cancers seen in our department during the 10 year period. The ages of patients ranged from 45-75 years with a mean age of 57 years. Family history was present in 4 patients. Clinically, symptoms included self-detected lump in 23 (88.5%) patients, nipple retraction in 12 (46.1%) and pain in 12 (46.1%). All cases were unilateral (16 on right, 10 on left). Disease most commonly involved central quadrant (9 patients). Grade 3 disease was found in 13 patients and Stage 3 disease was most commonly encountered (13 patients). None of our patients received neo adjuvant chemotherapy. 20 (76.9%) patients had modified radical mastectomy and 6 (23.1%) had radical mastectomy. Most of our patients were hormone receptor positive (21 patients). Bilateral orchidectomy, Adjuvant chemotherapy, Adjuvant radiotherapy and Tamoxifen were offered in 3 (11.5%), 16 (61.5%), 17 (65.4%) and 15 (57.7%) patients respectively. Follow up ranged from 1-59 months. Conclusion: Male breast cancer is rare in our centre. Late presentation with advanced disease is a common feature in our environment. Further multiinstitutional, prospective studies are needed for better understanding of management of male breast cancers in Indian subset of patients.