Soft tissue sarcoma and tobacco use: data from a prospective cohort study of United States veterans

A report of an increased risk of soft tissue sarcoma (STS) among users of smokeless tobacco led us to evaluate this association and the role of other types of tobacco in a prospective cohort mortality-study of United States veterans. A total of 248,046 veterans provided tobacco-use histories on a mail questionnaire in 1954 or 1957. Data on subsequent tobacco use were not collected. By 1980, 119 deaths from STS had occurred among the cohort members. Veterans who had ever chewed tobacco or used snuff had a nonsignificant 40 percent excess of STS (95 percent confidence interval CI]=0.8–2.6; 21 deaths) in comparison with veterans who had never used any tobacco products. Risk was limited to former users (relative risk RR]=1.5) with no excess seen among current users (RR=0.9). Frequent former users had higher risk (RR=1.9) than infrequent users (RR=1.3). Risk was slightly higher in persons who started using smokeless tobacco at younger ages, but did not increase with duration of use or with late age at cessation of use. Most veterans who used chewing tobacco or snuff also used some other form of tobacco. No STS deaths occurred among the 2,308 veterans who used smokeless tobacco only. An unexpected finding of the study was the significant excess of STS deaths among cigarette smokers (RR=1.8, CI=1.1–2.9). Risk was higher among ex-smokers (RR=2.2) than among current smokers (RR=1.5) and was not related to number of cigarettes per day, age started smoking, duration, or pack-years. Pipe and cigar smokers also experienced a nonsignificant excess risk (RR=1.6). The study findings may have been affected by limitations in the histories of tobacco use, the quality of death certificate data on STS, and the small number of STS deaths, particularly among users of smokeless tobacco.Drs Zahm and heineman are with the Occupational Studies Section, Environmental Epidemiology Branch, Epidemiology and Biostatistics Program, National Cancer Institute, Rockville, MD, USA. Dr Vaught is with Westat, Inc., Rockville, MD. USA. Address correspondence to Dr Zahm, Occupational Studies Section, National Cancer Institute, Executive Plaza North, Room 418, Rockville, MD 20892, USA.