Body mass index and risk of head and neck cancer in a pooled analysis of case-control studies in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium.
BACKGROUND
Head and neck cancer (HNC) risk is elevated among lean people and reduced among overweight or obese people in some studies; however, it is unknown whether these associations differ for certain subgroups or are influenced by residual confounding from the effects of alcohol and tobacco use or by other sources of biases.


METHODS
We pooled data from 17 case-control studies including 12 716 cases and the 17 438 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for associations between body mass index (BMI) at different ages and HNC risk, adjusted for age, sex, centre, race, education, tobacco smoking and alcohol consumption.


RESULTS
Adjusted ORs (95% CIs) were elevated for people with BMI at reference (date of diagnosis for cases and date of selection for controls) < or =18.5 kg/m(2) (2.13, 1.75-2.58) and reduced for BMI >25.0-30.0 kg/m(2) (0.52, 0.44-0.60) and BMI > or =30 kg/m(2) (0.43, 0.33-0.57), compared with BMI >18.5-25.0 kg/m(2). These associations did not differ by age, sex, tumour site or control source. Although the increased risk among people with BMI < or =18.5 kg/m(2) was not modified by tobacco smoking or alcohol drinking, the inverse association for people with BMI > 25 kg/m(2) was present only in smokers and drinkers.


CONCLUSIONS
In our large pooled analysis, leanness was associated with increased HNC risk regardless of smoking and drinking status, although reverse causality cannot be excluded. The reduced risk among overweight or obese people may indicate body size is a modifier of the risk associated with smoking and drinking. Further clarification may be provided by analyses of prospective cohort and mechanistic studies.
Gaudet
Mia M
MM
Department of Epidemiology and Population Health and of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.
Olshan
Andrew F
AF
Chuang
Shu-Chun
SC
Berthiller
Julien
J
Zhang
Zuo-Feng
ZF
Lissowska
Jolanta
J
Zaridze
David
D
Winn
Deborah M
DM
Wei
Qingyi
Q
Talamini
Renato
R
Szeszenia-Dabrowska
Neolilia
N
Sturgis
Erich M
EM
Schwartz
Stephen M
SM
Rudnai
Peter
P
Eluf-Neto
Jose
J
Muscat
Joshua
J
Morgenstern
Hal
H
Menezes
Ana
A
Matos
Elena
E
Bucur
Alexandru
A
Levi
Fabio
F
Lazarus
Philip
P
La Vecchia
Carlo
C
Koifman
Sergio
S
Kelsey
Karl
K
Herrero
Rolando
R
Hayes
Richard B
RB
Franceschi
Silva
S
Wunsch-Filho
Victor
V
Fernandez
Leticia
L
Fabianova
Eleonora
E
Daudt
Alexander W
AW
Dal Maso
Luigino
L
Curado
Maria Paula
MP
Chen
Chu
C
Castellsague
Xavier
X
Benhamou
Simone
S
Boffetta
Paolo
P
Brennan
Paul
P
Hashibe
Mia
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013851:Thinness / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult