title: Combined effects of smoking and HPV16 in oropharyngeal cancer.
abstract: Although smoking and HPV infection are recognized as important risk factors for oropharyngeal cancer, how their joint exposure impacts on oropharyngeal cancer risk is unclear. Specifically, whether smoking confers any additional risk to HPV-positive oropharyngeal cancer is not understood.
  
  
  
  Using HPV serology as a marker of HPV-related cancer, we examined the interaction between smoking and HPV16 in 459 oropharyngeal (and 1445 oral cavity and laryngeal) cancer patients and 3024 control participants from two large European multi-centre studies. Odds ratios and credible intervals [CrI], adjusted for potential confounders, were estimated using Bayesian logistic regression.
  
  
  
  Both smoking [odds ratio (OR [CrI]: 6.82 [4.52, 10.29]) and HPV seropositivity (OR [CrI]: 235.69 [99.95, 555.74]) were independently associated with oropharyngeal cancer. The joint association of smoking and HPV seropositivity was consistent with that expected on the additive scale (synergy index [CrI]: 1.32 [0.51, 3.45]), suggesting they act as independent risk factors for oropharyngeal cancer.
  
  
  
  Smoking was consistently associated with increase in oropharyngeal cancer risk in models stratified by HPV16 seropositivity. In addition, we report that the prevalence of oropharyngeal cancer increases with smoking for both HPV16-positive and HPV16-negative persons. The impact of smoking on HPV16-positive oropharyngeal cancer highlights the continued need for smoking cessation programmes for primary prevention of head and neck cancer.
authors.affiliation: Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France.
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authors.affiliation: Department of Community Medicine, Faculty of Health Science, University of Tromsø, Arctic University of Norway, Tromsø, Norway, Cancer Registry of Norway, Oslo, Norway, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, Department of Genetic Epidemiology, Folkhälsan Research Centre, Helsinki, Finland.
authors.forename: Elisabete
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mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D001499:Bayes Theorem; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005060:Europe; D005260:Female; D052162:Human papillomavirus 16; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009959:Oropharyngeal Neoplasms / Q000473:pathology* / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications*; D012307:Risk Factors; D000073869:Tobacco Smoking / Q000473:pathology*
chemical_list: D000914:Antibodies, Viral
keywords: Human papillomavirus; head and neck cancer risk; interaction; oropharynx cancer; tobacco smoking