Total exposure and exposure rate effects for alcohol and smoking and risk of head and neck cancer: a pooled analysis of case-control studies.
Although cigarette smoking and alcohol consumption increase risk for head and neck cancers, there have been few attempts to model risks quantitatively and to formally evaluate cancer site-specific risks. The authors pooled data from 15 case-control studies and modeled the excess odds ratio (EOR) to assess risk by total exposure (pack-years and drink-years) and its modification by exposure rate (cigarettes/day and drinks/day). The smoking analysis included 1,761 laryngeal, 2,453 pharyngeal, and 1,990 oral cavity cancers, and the alcohol analysis included 2,551 laryngeal, 3,693 pharyngeal, and 3,116 oval cavity cancers, with over 8,000 controls. Above 15 cigarettes/day, the EOR/pack-year decreased with increasing cigarettes/day, suggesting that greater cigarettes/day for a shorter duration was less deleterious than fewer cigarettes/day for a longer duration. Estimates of EOR/pack-year were homogeneous across sites, while the effects of cigarettes/day varied, indicating that the greater laryngeal cancer risk derived from differential cigarettes/day effects and not pack-years. EOR/drink-year estimates increased through 10 drinks/day, suggesting that greater drinks/day for a shorter duration was more deleterious than fewer drinks/day for a longer duration. Above 10 drinks/day, data were limited. EOR/drink-year estimates varied by site, while drinks/day effects were homogeneous, indicating that the greater pharyngeal/oral cavity cancer risk with alcohol consumption derived from the differential effects of drink-years and not drinks/day.
Lubin
Jay H
JH
Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD 20852, USA. lubinj@mail.nih.gov
Purdue
Mark
M
Kelsey
Karl
K
Zhang
Zuo-Feng
ZF
Winn
Debbie
D
Wei
Qingyi
Q
Talamini
Renato
R
Szeszenia-Dabrowska
Neonilia
N
Sturgis
Erich M
EM
Smith
Elaine
E
Shangina
Oxana
O
Schwartz
Stephen M
SM
Rudnai
Peter
P
Neto
Jose Eluf
JE
Muscat
Joshua
J
Morgenstern
Hal
H
Menezes
Ana
A
Matos
Elena
E
Mates
Ioan Nicolae
IN
Lissowska
Jolanta
J
Levi
Fabio
F
Lazarus
Philip
P
La Vecchia
Carlo
C
Koifman
Sergio
S
Herrero
Rolando
R
Franceschi
Silvia
S
Wünsch-Filho
Victor
V
Fernandez
Leticia
L
Fabianova
Eleonora
E
Daudt
Alexander W
AW
Maso
Luigino Dal
LD
Curado
Maria Paula
MP
Chen
Chu
C
Castellsague
Xavier
X
Brennan
Paul
P
Boffetta
Paolo
P
Hashibe
Mia
M
Hayes
Richard B
RB
D000428:Alcohol Drinking / Q000009:adverse effects*; D016022:Case-Control Studies; D006258:Head and Neck Neoplasms / Q000209:etiology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000209:etiology; D009062:Mouth Neoplasms / Q000209:etiology; D016017:Odds Ratio; D010610:Pharyngeal Neoplasms / Q000209:etiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*