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American Journal of Epidemiology Advance Access published online on January 22, 2007
American Journal of Epidemiology, doi:10.1093/aje/kwk066
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American Journal of Epidemiology Copyright © 2007 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

ORIGINAL CONTRIBUTIONS

Contribution of Tobacco and Alcohol to the High Rates of Squamous Cell Carcinoma of the Supraglottis and Glottis in Central Europe

Mia Hashibe1, Paolo Boffetta1, David Zaridze2, Oxana Shangina2, Neonila Szeszenia-Dabrowska3, Dana Mates4, Eleonóra Fabiánová5, Peter Rudnai6 and Paul Brennan1

1 International Agency for Research on Cancer, Lyon, France
2 Cancer Research Centre, Moscow, Russia
3 Institute of Occupational Medicine, Lodz, Poland
4 Institute of Hygiene, Public Health, Health Services, and Management, Bucharest, Romania
5 Specialized State Health Institute, Banská Bystrica, Slovakia
6 National Institute of Environmental Health, Budapest, Hungary

Correspondence to Dr. Paul Brennan, Genetic Epidemiology Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69008 Lyon, France (e-mail: brennan{at}iarc.fr).

Incidence rates for laryngeal cancer in Central Europe are among the highest in the world. The authors recruited cases and controls between 2000 and 2002 for the Central and Eastern Europe Multicenter Study to investigate the role of tobacco and alcohol as causes of laryngeal cancer in this region. A total of 384 incident squamous cell cases were included, comprising 254 glottic and 108 supraglottic cancers. Hospital controls were chosen from within the same catchment area, from diseases unrelated to tobacco or alcohol (n = 918). Significant dose-response trends for frequency and duration of tobacco use were observed for both supraglottic and glottic cancers, with potentially a more important effect for supraglottic cancer. Quitting smoking was protective against laryngeal cancers after 5 years. Any increases in risk for alcohol drinking were generally moderate and nonsignificant. A greater than multiplicative interaction was observed between tobacco and alcohol on the risk of laryngeal cancer (p = 0.04). Approximately 87% of laryngeal cancer cases in Central Europe are attributable to tobacco use, of which 75% and 12% are due to current and past smoking, respectively. Approximately 39% are attributable to the interaction between alcohol and tobacco. Preventive efforts to encourage current smokers to quit are likely to be the most effective way to reduce the incidence of laryngeal cancer in this region.

alcohol drinking; carcinoma, squamous cell; Europe; glottis; laryngeal neoplasms; tobacco

Abbreviations: CI, confidence interval; ICD-10, International Classification of Diseases, Tenth Revision; OR, odds ratio


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