Alcohol drinking and head and neck cancer risk: the joint effect of intensity and duration
Gioia Di Credico, Jerry Polesel, Luigino Dal Maso, Francesco Pauli, Nicola Torelli, Danièle Luce, Loredana Radoï, Keitaro Matsuo, Diego Serraino, Paul Brennan, Ivana Holcátová, Wolfgang Ahrens, Παγώνα Λάγιου, Cristina Canova, Lorenzo Richiardi, Claire M. Healy, Kristina Kjærheim, David I. Conway, Gary J. Macfarlane, Peter Thomson, Antonio Agudo, Ariana Znaor, Silvia Franceschi, Rolando Herrero, Tatiana Natasha Toporcov, Raquel Ajub Moysés, Joshua Muscat, Eva Negri, Marta Vilensky, Leticia Fernández, María Paula Curado, Ana Maria Baptista Menezes, Alexander W. Daudt, Rosalina Jorge Koifman, Victor Wünsch‐Filho, Andrew F. Olshan, José P. Zevallos, Erich M. Sturgis, Guojun Li, Fabio Levi, Zuo‐Feng Zhang, Hal Morgenstern, Elaine Smith, Philip Lazarus, Carlo La Vecchia, Werner Garavello, Chu Chen, Stephen M. Schwartz, Tongzhang Zheng, Thomas L. Vaughan, Karl T. Kelsey, Michael D. McClean, Simone Benhamou, Richard B. Hayes, Mark P. Purdue, Maura L. Gillison, Stimson Schantz, Guo-Pei Yu, Shu‐Chun Chuang, Paolo Boffetta, Mia Hashibe, Amy Lee Yuan-Chin, Valeria Edefonti
Abstract
BACKGROUND: Alcohol is a well-established risk factor for head and neck cancer (HNC). This study aims to explore the effect of alcohol intensity and duration, as joint continuous exposures, on HNC risk. METHODS: Data from 26 case-control studies in the INHANCE Consortium were used, including never and current drinkers who drunk ≤10 drinks/day for ≤54 years (24234 controls, 4085 oral cavity, 3359 oropharyngeal, 983 hypopharyngeal and 3340 laryngeal cancers). The dose-response relationship between the risk and the joint exposure to drinking intensity and duration was investigated through bivariate regression spline models, adjusting for potential confounders, including tobacco smoking. RESULTS: For all subsites, cancer risk steeply increased with increasing drinks/day, with no appreciable threshold effect at lower intensities. For each intensity level, the risk of oral cavity, hypopharyngeal and laryngeal cancers did not vary according to years of drinking, suggesting no effect of duration. For oropharyngeal cancer, the risk increased with durations up to 28 years, flattening thereafter. The risk peaked at the higher levels of intensity and duration for all subsites (odds ratio = 7.95 for oral cavity, 12.86 for oropharynx, 24.96 for hypopharynx and 6.60 for larynx). CONCLUSIONS: Present results further encourage the reduction of alcohol intensity to mitigate HNC risk.