title: Meat and heme iron intake and risk of squamous cell carcinoma of the upper aero-digestive tract in the European Prospective Investigation into Cancer and Nutrition (EPIC).
abstract: BACKGROUND
  Evidence from prospective studies on intake of meat and fish and risk of squamous cell carcinoma (SCC) of the upper aero-digestive tract (UADT) is scarce. We prospectively investigated the association of meat and fish intake with risk of SCC of the UADT and the possible mechanism via heme iron in the large multicenter European Prospective Investigation into Cancer and Nutrition (EPIC) study.
  
  
  METHODS
  Multivariable proportional hazards models were used to estimate relative risks (RR) of SCC of the UADT in relation to intake of total meat, as well as subtypes of meat, fish, and heme iron among 348,738 individuals from 7 European countries.
  
  
  RESULTS
  During an average follow-up of 11.8 years, a total of 682 incident cases of UADT SCC were accrued. Intake of processed meat was positively associated with risk of SCC of the UADT in the total cohort [highest vs. lowest quintile: RR = 1.41; 95% confidence interval (CI) = 1.03-1.94], however, in stratified analyses, this association was confined to the group of current smokers (highest vs. lowest quintile: RR = 1.89; 95% CI = 1.22-2.93). Red meat, poultry, fish, and heme iron were not consistently related to UADT SCC.
  
  
  CONCLUSIONS
  Higher intake of processed meat was positively associated with SCC of the UADT among smokers. Although this finding was stable in various sensitivity analyses, we cannot rule out residual confounding by smoking. Confirmation in future studies and identification of biologic mechanisms is warranted.
  
  
  CONCLUSIONS
  Smokers may further increase their risk for SCC of the UADT if they additionally consume large amounts of processed meat.
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition-DIfE-Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany. annika.steffen@dife.de
authors.forename: Annika
authors.initials: A
authors.lastname: Steffen
authors.forename: Manuela M
authors.initials: MM
authors.lastname: Bergmann
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Maria-Dolores
authors.initials: MD
authors.lastname: Chirlaque
authors.forename: Paula
authors.initials: P
authors.lastname: Jakszyn
authors.forename: Pilar
authors.initials: P
authors.lastname: Amiano
authors.forename: J Ramón
authors.initials: JR
authors.lastname: Quirós
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte Gurrea
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.forename: Veronika
authors.initials: V
authors.lastname: Fedirko
authors.forename: H B As
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nick
authors.initials: N
authors.lastname: Wareham
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Allen
authors.forename: Francesca L
authors.initials: FL
authors.lastname: Crowe
authors.forename: Guri
authors.initials: G
authors.lastname: Skeie
authors.forename: Göran
authors.initials: G
authors.lastname: Hallmanns
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Johansson
authors.forename: Signe
authors.initials: S
authors.lastname: Borgquist
authors.forename: Ulrika
authors.initials: U
authors.lastname: Ericson
authors.forename: Rikke
authors.initials: R
authors.lastname: Egeberg
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Verena
authors.initials: V
authors.lastname: Grote
authors.forename: Kuanrong
authors.initials: K
authors.lastname: Li
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Despoina
authors.initials: D
authors.lastname: Oikonomidou
authors.forename: Menelaos
authors.initials: M
authors.lastname: Pantzalis
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.forename: Alessio
authors.initials: A
authors.lastname: Naccarati
authors.forename: Traci
authors.initials: T
authors.lastname: Mouw
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Vergnaud
authors.forename: Teresa
authors.initials: T
authors.lastname: Norat
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D006418:Heme / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D019266:Iron, Dietary / Q000008:administration & dosage* / Q000009:adverse effects; D007822:Laryngeal Neoplasms / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008460:Meat; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D018570:Risk Assessment
chemical_list: D019266:Iron, Dietary; D006418:Heme