title: Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.
abstract: BACKGROUND
  The magnitude of risk conferred by the interaction between tobacco and alcohol use on the risk of head and neck cancers is not clear because studies have used various methods to quantify the excess head and neck cancer burden.
  
  
  METHODS
  We analyzed individual-level pooled data from 17 European and American case-control studies (11,221 cases and 16,168 controls) participating in the International Head and Neck Cancer Epidemiology consortium. We estimated the multiplicative interaction parameter (psi) and population attributable risks (PAR).
  
  
  RESULTS
  A greater than multiplicative joint effect between ever tobacco and alcohol use was observed for head and neck cancer risk (psi = 2.15; 95% confidence interval, 1.53-3.04). The PAR for tobacco or alcohol was 72% (95% confidence interval, 61-79%) for head and neck cancer, of which 4% was due to alcohol alone, 33% was due to tobacco alone, and 35% was due to tobacco and alcohol combined. The total PAR differed by subsite (64% for oral cavity cancer, 72% for pharyngeal cancer, 89% for laryngeal cancer), by sex (74% for men, 57% for women), by age (33% for cases <45 years, 73% for cases >60 years), and by region (84% in Europe, 51% in North America, 83% in Latin America).
  
  
  CONCLUSIONS
  Our results confirm that the joint effect between tobacco and alcohol use is greater than multiplicative on head and neck cancer risk. However, a substantial proportion of head and neck cancers cannot be attributed to tobacco or alcohol use, particularly for oral cavity cancer and for head and neck cancer among women and among young-onset cases.
authors.affiliation: IARC, Lifestyle, Environment and Cancer Group, Genetics and Epidemiology Cluster, Lyon, France. hashibe@iarc.fr
authors.forename: Mia
authors.initials: M
authors.lastname: Hashibe
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Chuang
authors.forename: Stefania
authors.initials: S
authors.lastname: Boccia
authors.forename: Xavier
authors.initials: X
authors.lastname: Castellsague
authors.forename: Chu
authors.initials: C
authors.lastname: Chen
authors.forename: Maria Paula
authors.initials: MP
authors.lastname: Curado
authors.forename: Luigino
authors.initials: L
authors.lastname: Dal Maso
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Daudt
authors.forename: Eleonora
authors.initials: E
authors.lastname: Fabianova
authors.forename: Leticia
authors.initials: L
authors.lastname: Fernandez
authors.forename: Victor
authors.initials: V
authors.lastname: Wünsch-Filho
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hayes
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.forename: Karl
authors.initials: K
authors.lastname: Kelsey
authors.forename: Sergio
authors.initials: S
authors.lastname: Koifman
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Philip
authors.initials: P
authors.lastname: Lazarus
authors.forename: Fabio
authors.initials: F
authors.lastname: Levi
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Lence
authors.forename: Dana
authors.initials: D
authors.lastname: Mates
authors.forename: Elena
authors.initials: E
authors.lastname: Matos
authors.forename: Ana
authors.initials: A
authors.lastname: Menezes
authors.forename: Michael D
authors.initials: MD
authors.lastname: McClean
authors.forename: Joshua
authors.initials: J
authors.lastname: Muscat
authors.forename: Jose
authors.initials: J
authors.lastname: Eluf-Neto
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Olshan
authors.forename: Mark
authors.initials: M
authors.lastname: Purdue
authors.forename: Peter
authors.initials: P
authors.lastname: Rudnai
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: Elaine
authors.initials: E
authors.lastname: Smith
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
authors.forename: Neonilia
authors.initials: N
authors.lastname: Szeszenia-Dabrowska
authors.forename: Renato
authors.initials: R
authors.lastname: Talamini
authors.forename: Qingyi
authors.initials: Q
authors.lastname: Wei
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Winn
authors.forename: Oxana
authors.initials: O
authors.lastname: Shangina
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Pilarska
authors.forename: Zuo-Feng
authors.initials: ZF
authors.lastname: Zhang
authors.forename: Gilles
authors.initials: G
authors.lastname: Ferro
authors.forename: Julien
authors.initials: J
authors.lastname: Berthiller
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology; D016022:Case-Control Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D012307:Risk Factors; D014029:Tobacco Use Disorder / Q000150:complications* / Q000453:epidemiology