Source: Cancer Epidemiology Biomarkers & Prevention, 10.1158/1055-9965.EPI-08-0347
Authors: Mia Hashibe et al.

Background:
The magnitude of risk conferred by the interaction between tobacco and alcohol use on the risk of head and neck cancers is not clear because studies have used various methods to quantify the excess head and neck cancer burden.

Methods:
We analyzed individual-level pooled data from 17 European and American case-control studies (11,221 cases and 16,168 controls) participating in the International Head and Neck Cancer Epidemiology consortium. We estimated the multiplicative interaction parameter ({psi}) and population attributable risks (PAR).

Results:
A greater than multiplicative joint effect between ever tobacco and alcohol use was observed for head and neck cancer risk ({psi} = 2.15; 95% confidence interval, 1.53-3.04). The PAR for tobacco or alcohol was 72% (95% confidence interval, 61-79%) for head and neck cancer, of which 4% was due to alcohol alone, 33% was due to tobacco alone, and 35% was due to tobacco and alcohol combined. The total PAR differed by subsite (64% for oral cavity cancer, 72% for pharyngeal cancer, 89% for laryngeal cancer), by sex (74% for men, 57% for women), by age (33% for cases <45 years, 73% for cases >60 years), and by region (84% in Europe, 51% in North America, 83% in Latin America).

Conclusions:
Our results confirm that the joint effect between tobacco and alcohol use is greater than multiplicative on head and neck cancer risk. However, a substantial proportion of head and neck cancers cannot be attributed to tobacco or alcohol use, particularly for oral cavity cancer and for head and neck cancer among women and among young-onset cases. (Cancer Epidemiol Biomarkers Prev 2009;18(2):541–50)

Authors:
Mia Hashibe 1*, Paul Brennan 1, Shu-chun Chuang 1, Stefania Boccia 2, Xavier Castellsague 3, Chu Chen 4, Maria Paula Curado 1, 5, Luigino Dal Maso 6, Alexander W. Daudt 7, Eleonora Fabianova 8, Leticia Fernandez 9, Victor Wünsch-Filho 10, Silvia Franceschi 1, Richard B. Hayes 11, Rolando Herrero 12, Karl Kelsey 13, 15, Sergio Koifman 16, Carlo La Vecchia 17, Philip Lazarus 18, Fabio Levi 19, Juan J. Lence 9, Dana Mates 20, Elena Matos 21, Ana Menezes 22, Michael D. McClean 14, Joshua Muscat 18, Jose Eluf-Neto 10, Andrew F. Olshan 23, Mark Purdue 11, Peter Rudnai 24, Stephen M. Schwartz 4, Elaine Smith 25, Erich M. Sturgis 26, Neonilia Szeszenia-Dabrowska 27, Renato Talamini 6, Qingyi Wei 26, Deborah M. Winn 11, Oxana Shangina 28, Agnieszka Pilarska 29, Zuo-Feng Zhang 30, Gilles Ferro 1, Julien Berthiller 1, Paolo Boffetta 1

Authors’ affiliations:
1 IARC, Lyon, France; 2 Institute of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy; 3 Institut Català d’Oncologia, Barcelona, Spain; 4 Fred Hutchinson Cancer Research Center, Seattle, Washington; 5 Hospital Araujo Jorge, Goiania, Brazil; 6 Aviano Cancer Centre, Aviano, Italy; 7 Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; 8 Specialized State Health Institute, Banská Bystrica, Slovakia; 9 National Institute of Oncology and Radiobiology, Havana, Cuba; 10 Universidade de Sao Paulo, Sao Paulo, Brazil; 11 National Cancer Institute, Bethesda, Maryland; 12 Instituto de Investigación Epidemiológica, San José, Costa Rica; 13 Harvard School of Public Health; 14 Boston University School of Public Health, Boston, Massachusetts; 15 Brown University, Providence, Rhode Island; 16 Escola Nacional de Saude Publica, Fundaçao Oswaldo Cruz, Rio de Janeiro, Brazil; 17 Istituto di Ricerche Farmacologiche Mario Negri, and University of Milan, Milan, Italy; 18 Penn State College of Medicine, Hershey, Pennsylvania; 19 Institut de médecine sociale et préventive, Université de Lausanne, Lausanne, Switzerland; 20 Institute of Public Health, Bucharest, Romania; 21 Institute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires, Argentina; 22 Universidade Federal de Pelotas, Pelotas, Brazil; 23 University of North Carolina School of Public Health, Chapel Hill, North Carolina; 24 National Institute of Environmental Health, Budapest, Hungary; 25 College of Public Health, University of Iowa, Iowa City, Iowa; 26 University of Texas M. D. Anderson Cancer Center, Houston, Texas; 27 Institute of Occupational Medicine, Lodz, Poland; 28 Cancer Research Centre, Moscow, Russia; 29 2nd Maxillofacial Surgery Clinic, Medical Academy, Warsaw, Poland; and 30 University of California at Los Angeles School of Public Health, Los Angeles, California