title: Population attributable risks of oral cavity cancer to behavioral and medical risk factors in France: results of a large population-based case-control study, the ICARE study.
abstract: BACKGROUND
  Population attributable risks (PARs) are useful tool to estimate the burden of risk factors in cancer incidence. Few studies estimated the PARs of oral cavity cancer to tobacco smoking alone, alcohol drinking alone and their joint consumption but none performed analysis stratified by subsite, gender or age. Among the suspected risk factors of oral cavity cancer, only PAR to a family history of head and neck cancer was reported in two studies. The purpose of this study was to estimate in France the PARs of oral cavity cancer to several recognized and suspected risk factors, overall and by subsite, gender and age.
  
  
  METHODS
  We analysed data from 689 oral cavity cancer cases and 3481 controls included in a population-based case-control study, the ICARE study. Unconditional logistic regression models were used to estimate odds ratios (ORs), PARs and 95% confidence intervals (95% CI).
  
  
  RESULTS
  The PARs were 0.3% (95% CI -3.9%; +3.9%) for alcohol alone, 12.7% (6.9%-18.0%) for tobacco alone and 69.9% (64.4%-74.7%) for their joint consumption. PAR to combined alcohol and tobacco consumption was 74% (66.5%-79.9%) in men and 45.4% (32.7%-55.6%) in women. Among suspected risk factors, body mass index 2 years before the interview <25 kg.m(-2), never tea drinking and family history of head and neck cancer explained 35.3% (25.7%-43.6%), 30.3% (14.4%-43.3%) and 5.8% (0.6%-10.8%) of cancer burden, respectively. About 93% (88.3%-95.6%) of oral cavity cancers were explained by all risk factors, 94.3% (88.4%-97.2%) in men and only 74.1% (47.0%-87.3%) in women.
  
  
  CONCLUSIONS
  Our study emphasizes the role of combined tobacco and alcohol consumption in the oral cavity cancer burden in France and gives an indication of the proportion of cases attributable to other risk factors. Most of oral cavity cancers are attributable to concurrent smoking and drinking and would be potentially preventable through smoking or drinking cessation. If the majority of cases are explained by recognized or suspected risk factors in men, a substantial number of cancers in women are probably due to still unexplored factors that remain to be clarified by future studies.
authors.affiliation: INSERM UMRS 1018, Environmental Epidemiology of Cancer, Centre for research in Epidemiology and Population Health, 16 Avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France. loredana.radoi@inserm.fr.|Oral Medicine and Oral Surgery Department, Paris Descartes University, Montrouge, France. loredana.radoi@inserm.fr.
authors.forename: Loredana
authors.initials: L
authors.lastname: Radoï
authors.affiliation: INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France. gwenn.menvielle@inserm.fr.|Sorbonne Universités, UPMC Univ Paris 6, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France. gwenn.menvielle@inserm.fr.
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
authors.affiliation: INSERM UMS 011, Villejuif, France. diane.cyr@inserm.fr.|Versailles St-Quentin University, Versailles, France. diane.cyr@inserm.fr.
authors.forename: Diane
authors.initials: D
authors.lastname: Cyr
authors.affiliation: Registre du Cancer de la Somme, CHU Amiens, EA Inserm - DGS, EA 4666, Amiens, France. Lapotre-Ledoux.Benedicte@chu-amiens.fr.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Lapôtre-Ledoux
authors.affiliation: INSERM UMRS 1018, Environmental Epidemiology of Cancer, Centre for research in Epidemiology and Population Health, 16 Avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France. isabelle.stucker@inserm.fr.|Paris Sud University, Kremlin-Bicêtre, France. isabelle.stucker@inserm.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Stücker
authors.affiliation: INSERM U 1085, IRSET, Pointe-à-Pitre, French West Indies, Rennes, France. daniele.luce@inserm.fr.|University of Rennes 1, Rennes, France. daniele.luce@inserm.fr.
authors.forename: Danièle
authors.initials: D
authors.lastname: Luce
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D001519:Behavior; D016022:Case-Control Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D016017:Odds Ratio; D011159:Population Surveillance; D012042:Registries; D012307:Risk Factors; D012907:Smoking