title: Population attributable risk of tobacco and alcohol for upper aerodigestive tract cancer.
abstract: Tobacco and alcohol are major risk factors for upper aerodigestive tract (UADT) cancer and significant variation is observed in UADT cancer rates across Europe. We have estimated the proportion of UADT cancer burden explained by tobacco and alcohol and how this varies with the incidence rates across Europe, cancer sub-site, gender and age. This should help estimate the minimum residual burden of other risk factors to UADT cancer, including human papillomavirus. We analysed 1981 UADT cancer cases and 1993 controls from the ARCAGE multicentre study. We estimated the population attributable risk (PAR) of tobacco alone, alcohol alone and their joint effect. Tobacco and alcohol together explained 73% of UADT cancer burden of which nearly 29% was explained by smoking alone, less than 1% due to alcohol on its own and 44% by the joint effect of tobacco and alcohol. Tobacco and alcohol together explained a larger proportion of hypopharyngeal/laryngeal cancer (PAR=85%) than oropharyngeal (PAR=74%), esophageal (PAR=67%) and oral cancer (PAR=61%). Tobacco and alcohol together explain only about half of the total UADT cancer burden among women. Geographically, tobacco and alcohol explained a larger proportion of UADT cancer in central (PAR=84%) than southern (PAR=72%) and western Europe (PAR=67%). While the majority of the UADT cancers in Europe are due to tobacco or the joint effect of tobacco and alcohol, our results support a significant role for other risk factors in particular, for oral and oropharyngeal cancers and also for UADT cancers in southern and western Europe.
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Devasena
authors.initials: D
authors.lastname: Anantharaman
authors.forename: Manuela
authors.initials: M
authors.lastname: Marron
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.forename: Evangelia
authors.initials: E
authors.lastname: Samoli
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ahrens
authors.forename: Hermann
authors.initials: H
authors.lastname: Pohlabeln
authors.forename: Alena
authors.initials: A
authors.lastname: Slamova
authors.forename: Miriam
authors.initials: M
authors.lastname: Schejbalova
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Richiardi
authors.forename: Kristina
authors.initials: K
authors.lastname: Kjaerheim
authors.forename: Xavier
authors.initials: X
authors.lastname: Castellsague
authors.forename: Antonio
authors.initials: A
authors.lastname: Agudo
authors.forename: Renato
authors.initials: R
authors.lastname: Talamini
authors.forename: Luigi
authors.initials: L
authors.lastname: Barzan
authors.forename: Tatiana V
authors.initials: TV
authors.lastname: Macfarlane
authors.forename: Martin
authors.initials: M
authors.lastname: Tickle
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Simonato
authors.forename: Cristina
authors.initials: C
authors.lastname: Canova
authors.forename: David I
authors.initials: DI
authors.lastname: Conway
authors.forename: Patricia A
authors.initials: PA
authors.lastname: McKinney
authors.forename: Peter
authors.initials: P
authors.lastname: Thomson
authors.forename: Ariana
authors.initials: A
authors.lastname: Znaor
authors.forename: Claire M
authors.initials: CM
authors.lastname: Healy
authors.forename: Bernard E
authors.initials: BE
authors.lastname: McCartan
authors.forename: Mia
authors.initials: M
authors.lastname: Hashibe
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Macfarlane
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D010039:Otorhinolaryngologic Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*