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Carotenoid intake and head and neck cancer: a pooled analysis in the International Head and Neck Cancer Epidemiology Consortium

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Abstract

Food and nutrition play an important role in head and neck cancer (HNC) etiology; however, the role of carotenoids remains largely undefined. We explored the relation of HNC risk with the intake of carotenoids within the International Head and Neck Cancer Epidemiology Consortium. We pooled individual-level data from 10 case–control studies conducted in Europe, North America, and Japan. The analysis included 18,207 subjects (4414 with oral and pharyngeal cancer, 1545 with laryngeal cancer, and 12,248 controls), categorized by quintiles of carotenoid intake from natural sources. Comparing the highest with the lowest quintile, the risk reduction associated with total carotenoid intake was 39 % (95 % CI 29–47 %) for oral/pharyngeal cancer and 39 % (95 % CI 24–50 %) for laryngeal cancer. Intakes of β-carotene equivalents, β-cryptoxanthin, lycopene, and lutein plus zeaxanthin were associated with at least 18 % reduction in the rate of oral and pharyngeal cancer (95 % CI 6–29 %) and 17 % reduction in the rate of laryngeal cancer (95 % CI 0–32 %). The overall protective effect of carotenoids on HNC was stronger for subjects reporting greater alcohol consumption (p < 0.05). The odds ratio for the combined effect of low carotenoid intake and high alcohol or tobacco consumption versus high carotenoid intake and low alcohol or tobacco consumption ranged from 7 (95 % CI 5–9) to 33 (95 % CI 23–49). A diet rich in carotenoids may protect against HNC. Persons with both low carotenoid intake and high tobacco or alcohol are at substantially higher risk of HNC.

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Acknowledgments

The authors would like to thank all of the participants who took part in this research for providing us very insightful and constructive comments, which helped improve this manuscript. The INHANCE core data pooling was supported by NIH Grants (NCI R03CA113157 and NIDCR R03DE016611). The individual studies were supported by the following grants: Milan study (2006–2009): Italian Foundation for Research on Cancer (Italian Ministry of Health, General Directorate of European and International Relations) and Italian Ministry of Education (PRIN 2009 X8YCBN).Italy Multicenter study: Italian Association for Research on Cancer (AIRC), Italian League Against Cancer and Italian Ministry of Research. Swiss study: Swiss League against Cancer and the Swiss Research against Cancer/Oncosuisse (KFS-700, OCS-1633).Boston study: National Institutes of Health (NIH) US (R01CA078609, R01CA100679). Los Angeles study: National Institute of Health (NIH) US (P50CA090388, R01DA011386, R03CA077954, T32CA009142, U01CA096134, R21ES011667) and the Alper Research Program for Environmental Genomics of the UCLA Jonsson Comprehensive Cancer Center. MSKCC study: NIH (R01CA051845). North Carolina (1994–1997): National Institutes of Health (NIH) US (R01CA061188), and in part by a Grant from the National Institute of Environmental Health Sciences (P30ES010126). US Multicenter study: The Intramural Program of the NCI, NIH, United States. Japan (2001–2005): Scientific Research Grant from the Ministry of Education, Science, Sports, Culture and Technology of Japan (17015052) and Grant for the Third-Term Comprehensive 10-year Strategy for Cancer Control from the Ministry of Health, Labor and Welfare of Japan (H20-002). The work of EL was supported by Fondazione Veronesi and Italian Association for Research on Cancer (AIRC, Grant No. 10491 – 2010/2013).

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    Authors and Affiliations

    1. Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, 00168, Rome, Italy

      Emanuele Leoncini & Stefania Boccia

    2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

      Valeria Edefonti, Monica Ferraroni, Adriano Decarli & Carlo La Vecchia

    3. Division of Public Health, Department of Family and Preventive Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA

      Mia Hashibe & Yuan-Chin Amy Lee

    4. Department of Medical and Biological Sciences, Institute of Hygiene and Epidemiology, University of Udine, Udine, Italy

      Maria Parpinel

    5. Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy

      Gabriella Cadoni

    6. Aviano Cancer Centre, Aviano, Italy

      Diego Serraino

    7. Faculty of Medical Sciences, Kyushu University, Kyushu, Japan

      Keitaro Matsuo

    8. School of Public Health, University of North Carolina, Chapel Hill, NC, USA

      Andrew F. Olshan & Jose P. Zevallos

    9. National Cancer Institute, Bethesda, MD, USA

      Deborah M. Winn

    10. Roswell Park Cancer Institute, Buffalo, NY, USA

      Kirsten Moysich

    11. UCLA School of Public Health, Los Angeles, CA, USA

      Zuo-Feng Zhang

    12. Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA

      Hal Morgenstern

    13. Institut Universitaire de Medecine Sociale et Preventive (IUMSP), Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland

      Fabio Levi

    14. Brown University, Providence, RI, USA

      Karl Kelsey

    15. Boston University School of Public Health, Boston, MA, USA

      Michael McClean

    16. Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Itlay

      Cristina Bosetti

    17. New York Eye and Ear Infirmary, New York, NY, USA

      Stimson Schantz

    18. Medical Informatics Center, Peking University, Beijing, China

      Guo-Pei Yu

    19. The Tisch Cancer Institute and Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

      Paolo Boffetta

    20. Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan

      Shu-Chun Chuang

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    1. Emanuele Leoncini
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    Correspondence to Stefania Boccia.

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    Emanuele Leoncini, Valeria Edefonti, Carlo La Vecchia and Stefania Boccia have contributed equally to this work.

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    Leoncini, E., Edefonti, V., Hashibe, M. et al. Carotenoid intake and head and neck cancer: a pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Eur J Epidemiol 31, 369–383 (2016). https://doi.org/10.1007/s10654-015-0036-3

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