title: The role of type of tobacco and type of alcoholic beverage in oral carcinogenesis.
abstract: 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.
authors.affiliation: Institut Català d'Oncologia, Servei d'Epidemiologia i Registre del Càncer, L'Hospitalet de Llobregat, Barcelona, Spain. xcastellsagué@ico.scs.es
authors.forename: Xavier
authors.initials: X
authors.lastname: Castellsagué
authors.forename: Maria Jesús
authors.initials: MJ
authors.lastname: Quintana
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Martínez
authors.forename: Adoración
authors.initials: A
authors.lastname: Nieto
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Amparo
authors.initials: A
authors.lastname: Juan
authors.forename: Antoni
authors.initials: A
authors.lastname: Monner
authors.forename: Marta
authors.initials: M
authors.lastname: Carrera
authors.forename: Antoni
authors.initials: A
authors.lastname: Agudo
authors.forename: Miquel
authors.initials: M
authors.lastname: Quer
authors.forename: Nubia
authors.initials: N
authors.lastname: Muñoz
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Bosch
mesh_terms: 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
chemical_list: D000431:Ethanol