title: Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck cancer: results from the Netherlands Cohort Study.
abstract: BACKGROUND
  Prospective data on alcohol consumption, cigarette smoking and risk of head-neck cancer (HNC) subtypes, i.e. oral cavity cancer (OCC), oro-/hypopharyngeal cancer (OHPC), and laryngeal cancer (LC), are limited. We investigated these associations within the second largest prospective study on this topic so far, the Netherlands Cohort Study.
  
  
  METHODS
  120,852 participants completed a questionnaire on diet and other cancer risk factors in 1986. After 17.3 years of follow-up, 395 HNC (110 OCC, 83 OHPC, and 199 LC) cases and 4288 subcohort members were available for case-cohort analysis using Cox proportional hazards models.
  
  
  RESULTS
  For total HNC, the multivariable adjusted incidence rate ratio (RR) was 2.74 (95% confidence interval (CI) 1.85-4.06) for those drinking ≥30 g ethanol/day compared with abstainers; in subtypes, RRs were 6.39 for OCC, 3.52 for OHPC, and 1.54 for LC. Compared with never cigarette smokers, current cigarette smokers had a RR of 4.49 (95%CI 3.11-6.48) for HNC overall, and 2.11 for OCC, 8.53 for OHPC, and 8.07 for LC. A significant, positive, multiplicative interaction between categories of alcohol consumption and cigarette smoking was found for HNC overall (P interaction 0.03).
  
  
  CONCLUSIONS
  Alcohol consumption and cigarette smoking were independently associated with risk of HNC overall, with a positive, multiplicative interaction. The strength of these associations differed among HNC-subtypes: OCC was most strongly associated with alcohol consumption but most weakly with cigarette smoking, whereas LC was not statistically significantly associated with alcohol consumption.
authors.affiliation: Department of Epidemiology, GROW - School for Oncology & Developmental Biology, Maastricht University, P,O, Box 616 Maastricht 6200, MD, The Netherlands. denise.maasland@maastrichtuniversity.nl.
authors.forename: Denise H E
authors.initials: DH
authors.lastname: Maasland
authors.forename: Piet A
authors.initials: PA
authors.lastname: van den Brandt
authors.forename: Bernd
authors.initials: B
authors.lastname: Kremer
authors.forename: R Alexandra Sandra
authors.initials: RA
authors.lastname: Goldbohm
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Schouten
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000209:etiology*; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D011795:Surveys and Questionnaires