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Cancer Causes & Control

, Volume 21, Issue 12, pp 2213–2221 | Cite as

The aetiology of upper aerodigestive tract cancers among young adults in Europe: the ARCAGE study

  • Tatiana V. Macfarlane
  • Gary J. Macfarlane
  • Richard J. Oliver
  • Simone Benhamou
  • Christine Bouchardy
  • Wolfgang Ahrens
  • Hermann Pohlabeln
  • Pagona Lagiou
  • Areti Lagiou
  • Xavier Castellsague
  • Antonio Agudo
  • Franco Merletti
  • Lorenzo Richiardi
  • Kristina Kjaerheim
  • Alena Slamova
  • Miriam Schejbalova
  • Cristina Canova
  • Lorenzo Simonato
  • Renato Talamini
  • Luigi Barzan
  • David I. Conway
  • Patricia A. McKinney
  • Ariana Znaor
  • Raymond J. Lowry
  • Peter Thomson
  • Claire M. Healy
  • Bernard E. McCartan
  • Manuela Marron
  • Mia Hashibe
  • Paul Brennan
Original paper

Abstract

Background

The incidence of cancers of the upper aerodigestive tract (UADT) is increasing throughout the world. To date the increases have been proportionally greatest among young people. Several reports have suggested that they often do not have a history of tobacco smoking or heavy alcohol consumption.

Objective

To determine the contribution of lifestyle factors to the etiology of UADT cancers occurring in those aged less than 50 years.

Methods

A case–control study was conducted in 10 European countries. Cases were cancers of the oral cavity and pharynx, larynx and esophagus, and hospital or population controls were age and sex matched.

Results

There were 356 cases younger than 50 years and 419 controls. Risk was strongly related to current smoking [odds ratio (OR) 5.5 95%; confidence interval (CI) (3.3, 9.2)], and risk increased with number of pack-years smoked. Risk was also related to alcohol consumption for both current (OR 1.8; 0.97, 3.3) and past (OR 3.4; 1.6, 7.4) drinkers, and risk increased with number of drink-years. Persons frequently consuming fruits and vegetables were at significantly reduced risk.

Conclusions

Risk factors already identified as being important for UADT cancers in adults are also important influences on risk in younger adults. The implication of these results is that the public health message in preventing UADT cancers remains the same to young and old alike.

Keywords

Epidemiology Cancer Oral Pharynx Larynx Tobacco Alcohol Diet 

Notes

Acknowledgments

We would like to thank all the patients and their families for their participation. We are also grateful to the support of many clinicians and staff of the hospitals, interviewers, data managers, pathology departments, and primary care clinics. GJM and TVM partly worked on this study while at the University of Manchester. We acknowledge the help of Dr. Ann-Marie Biggs and Professor Martin Tickle in study conducted in the Manchester centre and Professor Phil Sloan and Professor Nalin Thakker who in addition coordinated sample collection and processing for all the UK centers. In Glasgow, we acknowledge the clinical support of Dr. Gerry Robertson and Mr. John Devine and their colleagues. We are deeply thankful to Drs. R. Mele and L. Forner for providing hospital controls and S. Sulfaro for pathology support from General Hospital of Pordenone (Italy). In Dublin, we acknowledge the clinical support of Prof. J. Reynolds, Prof C Timon, and their colleagues.

Financial support

Funding was received from: European Community (5th Framework Programme) grant no QLK1-CT-2001-00182; University of Athens Medical School, for the Athens centre; Padova University (Contract No CPDA057222) for the Padova centre; Compagnia San Paolo, AIRC, for the Turin centre.

References

  1. 1.
    Warnakulasuriya S (2009) Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 45:309–316CrossRefPubMedGoogle Scholar
  2. 2.
    Conway DI, Stockton DL, Warnakulasuriya KA, Ogden G, Macpherson LM (2006) Incidence of oral and oropharyngeal cancer in United Kingdom (1990–1999)—recent trends and regional variation. Oral Oncol 42:586–592CrossRefPubMedGoogle Scholar
  3. 3.
    Plesko I, Macfarlane GJ, Evstifeeva TV, Obsitnikova A, Kramarova E (1994) Oral and pharyngeal cancer incidence in Slovakia 1968–1989. Int J Cancer 56:481–486CrossRefPubMedGoogle Scholar
  4. 4.
    Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18:581–592CrossRefPubMedGoogle Scholar
  5. 5.
    Macfarlane GJ, Boyle P, Evstifeeva TV, Robertson C, Scully C (1994) Rising trends of oral cancer mortality among males worldwide: the return of an old public health problem. Cancer Causes Control 5:259–265CrossRefPubMedGoogle Scholar
  6. 6.
    Llewellyn CD, Johnson NW, Warnakulasuriya KA (2001) Risk factors for squamous cell carcinoma of the oral cavity in young people—a comprehensive literature review. Oral Oncol 37:401–418CrossRefPubMedGoogle Scholar
  7. 7.
    Carniol PJ, Fried MP (1982) Head and neck carcinoma in patients under 40 years of age. Ann Otol Rhinol Laryngol 91:152–155PubMedGoogle Scholar
  8. 8.
    Son YH, Kapp DS (1985) Oral cavity and oropharyngeal cancer in a younger population. Review of literature and experience at Yale. Cancer 55:441–444CrossRefPubMedGoogle Scholar
  9. 9.
    Cusumano RJ, Persky MS (1988) Squamous cell carcinoma of the oral cavity and oropharynx in young adults. Head Neck Surg 10:229–234PubMedGoogle Scholar
  10. 10.
    Sankaranarayanan R, Mohideen MN, Nair MK, Padmanabhan TK (1989) Aetiology of oral cancer in patients less than or equal to 30 years of age. Br J Cancer 59:439–440PubMedGoogle Scholar
  11. 11.
    Iype EM, Pandey M, Mathew A, Thomas G, Sebastian P, Nair MK (2001) Oral cancer among patients under the age of 35 years. J Postgrad Med 47:171–176PubMedGoogle Scholar
  12. 12.
    Harris SL, Kimple RJ, Hayes DN, Couch ME, Rosenman JG (2009) Never-smokers, never-drinkers: unique clinical subgroup of young patients with head and neck squamous cell cancers. Head NeckGoogle Scholar
  13. 13.
    Hirota SK, Braga FP, Penha SS, Sugaya NN, Migliari DA (2008) Risk factors for oral squamous cell carcinoma in young and older Brazilian patients: a comparative analysis. Med Oral Patol Oral Cir Bucal 13:E227–E231PubMedGoogle Scholar
  14. 14.
    Lagiou P, Georgila C, Minaki P et al (2009) Alcohol-related cancers and genetic susceptibility in Europe: the ARCAGE project: study samples and data collection. Eur J Cancer Prev 18:76–84CrossRefPubMedGoogle Scholar
  15. 15.
    International Classification of Disease Volume 10 (ICD-10) http://www.who.int/classifications/icd/en/
  16. 16.
    World Health Organisation (WHO) (2000) Obesity: preventing and managing the global epidemic. WHO, GenevaGoogle Scholar
  17. 17.
    Greenland S, Drescher K (1993) Maximum likelihood estimation of the attributable fraction from logistic models. Biometrics 49:865–872CrossRefPubMedGoogle Scholar
  18. 18.
    StataCorp (2009) Stata statistical software: release 10.1. StataCorp LP, College StationGoogle Scholar
  19. 19.
    Llewellyn CD, Linklater K, Bell J, Johnson NW, Warnakulasuriya KA (2003) Squamous cell carcinoma of the oral cavity in patients aged 45 years and under: a descriptive analysis of 116 cases diagnosed in the South East of England from 1990 to 1997. Oral Oncol 39:106–114CrossRefPubMedGoogle Scholar
  20. 20.
    Mackenzie J, Ah-See K, Thakker N et al (2000) Increasing incidence of oral cancer amongst young persons: what is the aetiology? Oral Oncol 36:387–389CrossRefPubMedGoogle Scholar
  21. 21.
    Rodriguez T, Altieri A, Chatenoud L et al (2004) Risk factors for oral and pharyngeal cancer in young adults. Oral Oncol 40:207–213CrossRefPubMedGoogle Scholar
  22. 22.
    Doll R, Peto R, Boreham J, Sutherland I (2005) Mortality in relation to alcohol consumption: a prospective study among male British doctors. Int J Epidemiol 34:199–204CrossRefPubMedGoogle Scholar
  23. 23.
    Wynder EL, Kabat G, Rosenberg S, Levenstein M (1983) Oral cancer and mouthwash use. J Natl Cancer Inst 70:255–260PubMedGoogle Scholar
  24. 24.
    Winn DM, Blot WJ, McLaughlin JK et al (1991) Mouthwash use and oral conditions in the risk of oral and pharyngeal cancer. Cancer Res 51:3044–3047PubMedGoogle Scholar
  25. 25.
    Carretero Pelaez MA, Esparza Gomez GC, Figuero Ruiz E, Cerero Lapiedra R (2004) Alcohol-containing mouthwashes and oral cancer. Critical analysis of literature. Med Oral 9(120–3):116–120Google Scholar
  26. 26.
    McCullough MJ, Farah CS (2008) The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes. Aust Dent J 53:302–305CrossRefPubMedGoogle Scholar
  27. 27.
    Kabat GC, Hebert JR, Wynder EL (1989) Risk factors for oral cancer in women. Cancer Res 49:2803–2806PubMedGoogle Scholar
  28. 28.
    Yokoyama A, Omori T (2003) Genetic polymorphisms of alcohol and aldehyde dehydrogenases and risk for esophageal and head and neck cancers. Jpn J Clin Oncol 33:111–121CrossRefPubMedGoogle Scholar
  29. 29.
    Hashibe M, McKay JD, Curado MP et al (2008) Multiple ADH genes are associated with upper aerodigestive cancers. Nat Genet 40:707–709CrossRefPubMedGoogle Scholar
  30. 30.
    Herrero R, Castellsague X, Pawlita M et al (2003) Human papillomavirus and oral cancer: the International Agency for Research on Cancer multicenter study. J Natl Cancer Inst 95:1772–1783PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Tatiana V. Macfarlane
    • 1
  • Gary J. Macfarlane
    • 1
  • Richard J. Oliver
    • 2
  • Simone Benhamou
    • 3
    • 4
  • Christine Bouchardy
    • 5
  • Wolfgang Ahrens
    • 6
  • Hermann Pohlabeln
    • 6
  • Pagona Lagiou
    • 7
  • Areti Lagiou
    • 7
    • 8
  • Xavier Castellsague
    • 9
  • Antonio Agudo
    • 9
  • Franco Merletti
    • 10
  • Lorenzo Richiardi
    • 10
  • Kristina Kjaerheim
    • 11
  • Alena Slamova
    • 12
  • Miriam Schejbalova
    • 12
  • Cristina Canova
    • 13
  • Lorenzo Simonato
    • 13
  • Renato Talamini
    • 14
  • Luigi Barzan
    • 15
  • David I. Conway
    • 16
  • Patricia A. McKinney
    • 17
  • Ariana Znaor
    • 18
  • Raymond J. Lowry
    • 19
  • Peter Thomson
    • 19
  • Claire M. Healy
    • 20
  • Bernard E. McCartan
    • 20
  • Manuela Marron
    • 21
  • Mia Hashibe
    • 22
  • Paul Brennan
    • 21
  1. 1.School of Medicine and DentistryUniversity of AberdeenAberdeenUK
  2. 2.University of ManchesterManchesterUK
  3. 3.INSERM, U946, Fondation Jean Dausset, CEPHParisFrance
  4. 4.CNRS FRE2939Gustave Roussy InstituteVillejuifFrance
  5. 5.Cancer registryGenevaSwitzerland
  6. 6.Bremen Institute for Prevention Research and Social Medicine (BIPS)University of BremenBremenGermany
  7. 7.Department of Hygiene, Epidemiology and Medical StatisticsUniversity of Athens Medical SchoolAthensGreece
  8. 8.Faculty of Health Professions, Athens Technological Educational Institute and Department of Hygiene, Epidemiology and Medical StatisticsUniversity of Athens Medical SchoolAthensGreece
  9. 9.Institut Catala d’OncologiaBarcelonaSpain
  10. 10.Unit of Cancer EpidemiologyCeRMS and University of TurinTurinItaly
  11. 11.Cancer Registry of NorwayOsloNorway
  12. 12.1st Faculty of Medicine, Institute of Hygiene and EpidemiologyCharles University in PraguePragueCzech Republic
  13. 13.Department of Environmental Medicine and Public HealthUniversity of PadovaPadovaItaly
  14. 14.Unit of Epidemiology and BiostatisticsNational Cancer Institute, IRCCSAvianoItaly
  15. 15.General Hospital of PordenonePordenoneItaly
  16. 16.Dental School, Faculty of MedicineUniversity of Glasgow and NHS NSS, ISDEdinburghUK
  17. 17.Centre for Epidemiology and BiostatisticsUniversity of Leeds and NHS NSS, ISDEdinburghUK
  18. 18.Croatian National Cancer RegistryZagrebCroatia
  19. 19.Dental SchoolUniversity of Newcastle on TyneNewcastleUK
  20. 20.Dublin Dental School and HospitalTrinity College DublinDublinIreland
  21. 21.International Agency for Research on CancerLyonFrance
  22. 22.Department of Family & Preventive MedicineUniversity of Utah School of MedicineSalt Lake CityUSA

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