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American Journal of Epidemiology Advance Access originally published online on September 10, 2009
American Journal of Epidemiology 2009 170(8):937-947; doi:10.1093/aje/kwp222
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American Journal of Epidemiology Published by the Johns Hopkins Bloomberg School of Public Health 2009.

Total Exposure and Exposure Rate Effects for Alcohol and Smoking and Risk of Head and Neck Cancer: A Pooled Analysis of Case-Control Studies

Jay H. Lubin, Mark Purdue, Karl Kelsey, Zuo-Feng Zhang, Debbie Winn, Qingyi Wei, Renato Talamini, Neonilia Szeszenia-Dabrowska, Erich M. Sturgis, Elaine Smith, Oxana Shangina, Stephen M. Schwartz, Peter Rudnai, Jose Eluf Neto, Joshua Muscat, Hal Morgenstern, Ana Menezes, Elena Matos, Ioan Nicolae Mates, Jolanta Lissowska, Fabio Levi, Philip Lazarus, Carlo La Vecchia, Sergio Koifman, Rolando Herrero, Silvia Franceschi, Victor Wünsch-Filho, Leticia Fernandez, Eleonora Fabianova, Alexander W. Daudt, Luigino Dal Maso, Maria Paula Curado, Chu Chen, Xavier Castellsague, Paul Brennan, Paolo Boffetta, Mia Hashibe and Richard B. Hayes

Correspondence to Dr. Jay H. Lubin, Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Rockville, MD 20852 (e-mail: lubinj{at}mail.nih.gov).

Received for publication November 20, 2008. Accepted for publication July 2, 2009.

Although cigarette smoking and alcohol consumption increase risk for head and neck cancers, there have been few attempts to model risks quantitatively and to formally evaluate cancer site-specific risks. The authors pooled data from 15 case-control studies and modeled the excess odds ratio (EOR) to assess risk by total exposure (pack-years and drink-years) and its modification by exposure rate (cigarettes/day and drinks/day). The smoking analysis included 1,761 laryngeal, 2,453 pharyngeal, and 1,990 oral cavity cancers, and the alcohol analysis included 2,551 laryngeal, 3,693 pharyngeal, and 3,116 oval cavity cancers, with over 8,000 controls. Above 15 cigarettes/day, the EOR/pack-year decreased with increasing cigarettes/day, suggesting that greater cigarettes/day for a shorter duration was less deleterious than fewer cigarettes/day for a longer duration. Estimates of EOR/pack-year were homogeneous across sites, while the effects of cigarettes/day varied, indicating that the greater laryngeal cancer risk derived from differential cigarettes/day effects and not pack-years. EOR/drink-year estimates increased through 10 drinks/day, suggesting that greater drinks/day for a shorter duration was more deleterious than fewer drinks/day for a longer duration. Above 10 drinks/day, data were limited. EOR/drink-year estimates varied by site, while drinks/day effects were homogeneous, indicating that the greater pharyngeal/oral cavity cancer risk with alcohol consumption derived from the differential effects of drink-years and not drinks/day.

alcohol drinking; risk model; smoking

Abbreviations: EOR, excess odds ratio; NNK, nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone; OR, odds ratio


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