The role of type of tobacco and type of alcoholic beverage in oral carcinogenesis.
Incidence rates of oral and oropharyngeal cancers (oral cancer) in Spain are among the highest in Europe. Spain has a population heavily exposed to various types of tobacco and alcoholic beverages but the role and impact of tobacco type and beverage type in oral carcinogenesis remain controversial. To estimate the independent and joint effects of tobacco smoking and alcohol drinking habits on the risk of developing oral cancer, we carried out a multicenter, hospital-based, case-control study in Spain. Data from 375 patients newly diagnosed with cancer of the oral cavity or oropharynx and 375 matched control subjects were analyzed using multivariate logistic regression procedures. All exposure characteristics of amount, duration and cessation of both tobacco smoking and alcohol drinking were strongly associated with cancer risk following a dose-dependent relationship. At equal intake or duration levels, black-tobacco smoking and drinking of spirits were both associated with a 2- to 4-fold increase in cancer risk compared to blond tobacco smoking or drinking of wine or beer, respectively. While ever exposure to smoking only or drinking only was associated with a moderate and nonsignificant increase in cancer risk, a history of simultaneous exposure to both habits was associated with a 13-fold increase that was compatible with a synergistic effect model (p-value for interaction: 0.008). Exposure to black tobacco smoking and/or drinking of spirits may account for up to 77% of oral cancer occurrence in Spain. Both black tobacco smoking and drinking of spirits place individuals at a very high risk of developing oral cancer. Simultaneous exposure to tobacco and alcohol consumption increases oral cancer risk in a synergistic fashion, even when consumption levels are moderate. These results underline the importance of type of tobacco and alcohol concentration in oral carcinogenesis.
Castellsagué
Xavier
X
Institut Català d'Oncologia, Servei d'Epidemiologia i Registre del Càncer, L'Hospitalet de Llobregat, Barcelona, Spain. xcastellsagué@ico.scs.es
Quintana
Maria Jesús
MJ
Martínez
Maria Carmen
MC
Nieto
Adoración
A
Sánchez
Maria José
MJ
Juan
Amparo
A
Monner
Antoni
A
Carrera
Marta
M
Agudo
Antoni
A
Quer
Miquel
M
Muñoz
Nubia
N
Herrero
Rolando
R
Franceschi
Silvia
S
Bosch
F Xavier
FX
D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D000434:Alcoholic Beverages / Q000009:adverse effects*; D001515:Beer / Q000009:adverse effects; D016022:Case-Control Studies; D000431:Ethanol / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013030:Spain / Q000453:epidemiology; D014920:Wine / Q000009:adverse effects; D014026:Nicotiana
D000431:Ethanol