Comparison of the effect of smoking and alcohol drinking between oral and pharyngeal cancer.
To compare the separate and combined effects of alcohol drinking and smoking between the 2 sites, we evaluated 274 men with oral cancer, 364 with pharyngeal cancer and 1,254 controls, frequency-matched for age and area of residence, from Italy and Switzerland. Extremely elevated risk increases for oral cancer (odds ratio, OR = 228) and pharyngeal cancer (OR = 100) were found for the highest joint level of drinking (>/=77 drinks/week) and smoking (>/=25 cigarettes/day). Ratios of ORs between oral cancer and pharyngeal cancer vs. controls, obtained by polytomous logistic regression, suggested that the risk increase for oral cancer was about 2-fold greater than that for pharyngeal cancer at each combined level of smoking and drinking, except at low levels of drinking in smokers. A clear departure from risk difference additivity was present for both oral and pharyngeal cancer in individuals heavily exposed to both factors versus non-smoking abstainers/light drinkers. Our findings thus help explain observations from descriptive epidemiology that, if smoking level in a population does not change substantially, but alcohol consumption increases, increase in oral cancer would be greater than at any other site in the upper aero-digestive tract, including cancer of the pharynx.
Franceschi
S
S
Servizio di Epidemiologia, Centro di Riferimento Oncologico, Aviano, Italy. epidemiology@ets.it
Levi
F
F
La Vecchia
C
C
Conti
E
E
Dal Maso
L
L
Barzan
L
L
Talamini
R
R
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D016022:Case-Control Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000209:etiology*; D010610:Pharyngeal Neoplasms / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*