title: The joint effect of asbestos exposure, tobacco smoking and alcohol drinking on laryngeal cancer risk: evidence from the French population-based case-control study, ICARE.
abstract: OBJECTIVE
  The objective of the study was to investigate the joint effect of occupational exposure to asbestos, and tobacco and alcohol consumption, on the risk of laryngeal cancer among men.
  
  
  METHODS
  We used data from a large population-based case-control study conducted in France. We estimated two-way and three-way interactions between asbestos exposure (never vs ever exposed), tobacco consumption (<20 vs. ≥20 pack-years) and alcohol consumption (<5 vs. ≥5 drinks per day). The interaction on an additive scale was assessed by estimating the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction, and the interaction on a multiplicative scale was assessed by estimating the multiplicative interaction parameter (ψ). Multiplicative interactions were also assessed using fractional polynomials for alcohol drinking, tobacco smoking and asbestos exposure.
  
  
  RESULTS
  When compared with light-to-moderate smokers and drinkers never exposed to asbestos, the increase in laryngeal cancer risk was smallest among light-to-moderate drinkers and smokers exposed to asbestos (OR=2.23 (1.08 to 4.60)), and highest among heavy smokers and drinkers ever exposed to asbestos (OR=69.39 (35.54 to 135.5)). We found an additive joint effect between asbestos exposure and alcohol consumption (RERI=4.75 (-4.29 to 11.12)), whereas we observed a more than additive joint effect between asbestos exposure and tobacco consumption (RERI=8.50 (0.71 to 23.81)), as well as between asbestos exposure, and tobacco and alcohol consumption (RERI=26.57 (11.52 to 67.88)). However, our results did not suggest any interaction on a multiplicative scale.
  
  
  CONCLUSIONS
  Our results suggest that asbestos exposure, in combination with tobacco and alcohol exposure, accounted for a substantial number of laryngeal cancer cases. Our findings therefore highlight the need for prevention in activities, such as construction work, where exposure to asbestos-containing materials remains.
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
authors.affiliation: Inserm U 1085-IRSET, Pointe-à-Pitre, France University of Rennes 1, Rennes, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Fayossé
authors.affiliation: Inserm UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer, Villejuif, France University of Paris Descartes, Paris, France.
authors.forename: Loredana
authors.initials: L
authors.lastname: Radoï
authors.affiliation: Inserm UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer, Villejuif, France University of Paris Sud 11, Kremlin-Bicêtre, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Guida
authors.affiliation: Inserm UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer, Villejuif, France University of Paris Sud 11, Kremlin-Bicêtre, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Sanchez
authors.affiliation: Inserm Epidemiologic Cohorts Unit-UMS 011 INSERM-UVSQ, Villejuif, France University of Versailles St-Quentin, Villejuif, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Carton
authors.affiliation: Inserm Epidemiologic Cohorts Unit-UMS 011 INSERM-UVSQ, Villejuif, France University of Versailles St-Quentin, Villejuif, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Cyr
authors.affiliation: Inserm Epidemiologic Cohorts Unit-UMS 011 INSERM-UVSQ, Villejuif, France University of Versailles St-Quentin, Villejuif, France.
authors.forename: Annie
authors.initials: A
authors.lastname: Schmaus
authors.affiliation: Inserm UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer, Villejuif, France University of Paris Sud 11, Kremlin-Bicêtre, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cénée
authors.affiliation: Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE), Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Fevotte
authors.affiliation: Isère Cancer Registry, Grenoble, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Delafosse
authors.affiliation: Inserm UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer, Villejuif, France University of Paris Sud 11, Kremlin-Bicêtre, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Stücker
authors.affiliation: Inserm U 1085-IRSET, Pointe-à-Pitre, France University of Rennes 1, Rennes, France.
authors.forename: Danièle
authors.initials: D
authors.lastname: Luce
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D000437:Alcoholism; D001194:Asbestos / Q000009:adverse effects*; D016022:Case-Control Studies; D000431:Ethanol / Q000009:adverse effects*; D005602:France; D015438:Health Behavior; D006801:Humans; D007822:Laryngeal Neoplasms / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D014026:Nicotiana
chemical_list: D001194:Asbestos; D000431:Ethanol