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Tobacco and alcohol and the risk of head and neck cancer

Summary

We carried out two case-control studies on the relative risk of head and neck cancer in association with tobacco and alcohol consumption. The first study carried out at the ENT Department of the University hospitals of Heidelberg and Giessen (FRG) comprised 200 male patients with squamous cell cancer of the head and neck and 800 control subjects matched for sex, age, and residential area (1:4 matching design). Of the tumour patients, 4.5% had never smoked, in contrast to 29.5% of the control group. The average tobacco and alcohol consumption of the patients was approximately twice as high as in the control subjects. The highest alcohol and tobacco consumption was observed in patients suffering from oropharyngeal cancer. Tobacco and alcohol increased the risk of head and neck cancer in a dose-dependent fashion and acted as independent risk factors. In heavy smokers (> 60 pack-years) a relative risk of 23.4 (alcohol adjusted) was calculated. Combined alcohol and tobacco consumption showed a synergistic effect. The risk ratio increased more in a multiplicative than in an additive manner. Oral and laryngeal cancer were associated with the highest tobacco-associated risk values. The highest ethanol-associated risk values were associated with oropharyngeal and laryngeal cancer. The second study was carried out at the ENT Department of the University of Heidelberg on 164 males with squamous cell carcinoma of the larynx and 656 control subjects matched for sex, age and residential area (1:4 matching design). Of the cases, 4.2% had never smoked, compared with 28.5% of the control subjects. The risk of laryngeal cancer by tobacco consumption was dose dependent, reaching a maximum value of 9.1 (adjusted for alcohol) for a consumption of more than 50 tobacco-years (TY). The relative risk of laryngeal cancer associated with alcohol intake was also dose dependent, reaching a value of 9.0 (adjusted for tobacco) for a mean daily consumption of more than 75 g alcohol. An analysis of subsite specific risks showed that heavy smokers (> 50 TY) carried a nearly ten times higher risk of supraglottic cancer than of glottic cancer. The risk of supraglottic cancer from alcohol consumption was also higher than that of glottic cancer.

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References

  1. 1.

    Barch DH, Iannaccone PM (1986) Role of zinc deficiency in carcinogenesis. In: Newberne PM, Poirier LA, Pariza MW (eds) Essential nutrients in carcinogenesis. Plenum Press, New York, pp 517–527.

    Chapter  Google Scholar 

  2. 2.

    Blot WJ, McLaughlin JK, Winn DM, Austin DF, Greenberg RS, Preston-Martin S, Bernstein L, Schoenberg JB, Stemhagen A, Fraumeni JF jr (1988) Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 48:1282–1287.

    Google Scholar 

  3. 3.

    Breslow N (1986) Use of the power transform to discriminate between additive and multiplicative models in epidemiologic research. In: Moolgavkar SH, Prentice RL (eds) Modern statistical methods in chronic disease epidemiology. Wiley, New York, pp 181–196.

    Google Scholar 

  4. 4.

    Breslow NE, Storer BE (1985) General risk functions for case-control studies. Am J Epidemiol 122:149–162.

    CAS  PubMed  Google Scholar 

  5. 5.

    Brownson RC, Chang JC (1987) Exposure to alcohol and tobacco and risk of laryngeal cancer. Arch Environ Health 42:192–196.

    CAS  PubMed  Google Scholar 

  6. 6.

    Brugere J, Guenel P, Leclerc A, Rodriguez J (1986) Differential effects of tobacco and alcohol in cancer of the larynx, pharynx and mouth. Cancer 57:391–395.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Dietz A, Heller WD, Maier H (1991) Plattenepithelkarzinome des oberen Aerodigestivtraktes — eine Erkrankung der unteren sozialen Schichten? In: Maier H, Weidauer H (eds) Krebsrisiken im Kopf-/Halsbereich. Springer, Berlin Heidelberg New York.

    Google Scholar 

  8. 8.

    Ellwood JM, Pearson JCG, Skippen DH, Jackson SM (1984) Alcohol, smoking, social and occupational factors in the etiology of cancer of the oral cavity, pharynx and larynx. Int J Cancer 34:603–612.

    Article  Google Scholar 

  9. 9.

    Farinati F, Zhou Z, Bellah J, Lieber CS, Garro AJ (1985) Effect of chronic ethanol consumption on activation of nitrosopyrrolidine to a mutagen by rat upper alimentary tract, lung and hepatic tissue. Drug Metab Dispos 13:210–214.

    CAS  PubMed  Google Scholar 

  10. 10.

    Flanders WD, Rothman KJ (1982) Interaction of alcohol and tobacco in laryngeal cancer. Am J Epidemiol 115:371–379.

    CAS  PubMed  Google Scholar 

  11. 11.

    Garro AJ, Seitz HK, Lieber CS (1981) Enhancement of dimethylnitrosamine metabolism and activation to a mutagen following chronic ethanol consumption. Cancer Res 41:120–124.

    CAS  PubMed  Google Scholar 

  12. 12.

    Hoffmann D, Melkian A, Adams JD, Brunnemann ND, Haley ND (1985) New aspects of tobacco carcinogenesis. Carcinogenesis 8:239–256.

    CAS  Google Scholar 

  13. 13.

    International Agency for Research on Cancer (1988) Alcohol drinking (IARC Mononographs on the evaluation of carcinogenic risks to humans, 44) International Agency for Research on Cancer, Lyons.

    Google Scholar 

  14. 14.

    Ketcham AS, Wexler H, Mantel N (1963) Effects of alcohol on mouse neoplasia. Cancer Res 23:1015–1023.

    Google Scholar 

  15. 15.

    Kissin B, Kaley MM (1974) Alcohol and cancer. In: Kissin B, Begleiter H (eds) The biology of alcoholism, vol 3. Plenum Press, New York, pp 481–511.

    Chapter  Google Scholar 

  16. 16.

    Lieber CS, Garro AJ, Leo MA, Mak KM, Worrier TM (1986) Alcohol and cancer. Hepatology 6:1005–1019.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Mackerras D, Buffler PA, Randall DE, Nichaman MZ, Pickle LW, Mason TJ (1988) Carotene intake and risk of laryngeal cancer in coastal Texas. Am J Epidemiol 128:980–988.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Maier H, Born IA, Veith S, Adler D, Seitz HK (1986) The effect of chronic ethanol consumption on salivary gland morphology and function in the rat. Alcoholism Clin Exp Res 10:425–427.

    CAS  Article  Google Scholar 

  19. 19.

    Maier H, Born IA, Mall G (1988) Effect of chronic ethanol and nicotine consumption on the function and morphology of the salivary glands. Klin Wochenschr [Suppl XI] 66:140–150.

    CAS  PubMed  Google Scholar 

  20. 20.

    Maier H, deVries N, Weidauer H (1990) Beruf und Krebs im Bereich von Mundhöhle, Pharynx und Larynx. HNO 38:271–278.

    CAS  PubMed  Google Scholar 

  21. 21.

    Maier H, Dietz A, Gewelke U, Heller WD (1991) Berufliche Exposition gegenüber Schadstoffen und Krebsrisiko im Bereich von Mundhöhle, Oropharynx, Hypopharynx und Larynx -eine Fall-Kontrollstudie. Laryngol Rhinol Otol 70:93–98.

    CAS  Article  Google Scholar 

  22. 22.

    Mak KM, Leo MA, Lieber CS (1987) Effect of ethanol and vitamine A deficiency on epithelial cell proliferation and structure in the rat esophagus. Gastroenterology 93:362–370.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Marshall E (1979) Carcinogens in Scotch. Science 205:768–769.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    McClain CS, Su LC (1983) Zinc deficiency in the alcoholic: a review. Alcoholism Clin Exp Res 7: 5–10.

    CAS  Article  Google Scholar 

  25. 25.

    McLaughlin JK, Gridley G, Block G, Winn DM, Preston-Martin S,Schoenberg JB, Greenberg RS, StemhagenA, Austin DF, Ershow AG, Blot WJ, Fraumeni JF jr (1988) Dietary factors in oral and pharyngeal cancer. J Natl Cancer Inst 80:1237–1243.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Mufti SJ, Lieber CS, Garro AJ (1981) Effect of chronic ethanol consumption on the extent and persistence of DMN-induced DNA-alkylation (abstract). Cancer Res 21:58.

    Google Scholar 

  27. 27.

    Notani PN, Jayant K (1987) Role of diet in upper aerodigestive tract cancers. Nutr Cancer 10:103–113.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Olsen J, Sabroe S, Fasting U (1985) Interaction of alcohol and tobacco as risk factors in cancer of the laryngeal region. J Epidemiol Community Health 39:165–168.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Olsen J, Sabroe S, Ipsen J (1985) Effect of combined alcohol and tobacco exposure on risk of cancer of the hypopharynx. J Epidemiol Community Health 39:304–307.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Peto R, Doll R, Buckley JD, Sporn MB (1981) Can dietary beta-carotene materially reduce human cancer rates? Nature 290:201–208.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Phillips RL (1975) Role of life-style and dietary habits in risk of cancer among Seventh Day Adventists. Cancer Res 35:3513–3523.

    CAS  PubMed  Google Scholar 

  32. 32.

    Rothman K, Keller A (1972) The effect of joint exposure to alcohol and tobacco on risk of cancer of the mouth and pharynx. J Chron Dis 25:711–716.

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    SAS Users' Guide: Statistics. SAS Institute Inc, 1985.

  34. 34.

    Seitz HK, Kommerell B (1990) Alkoholismus als häuflgste Ursache für Mangelernährung. Dtsch Ärzteblatt 87:497–500.

    Google Scholar 

  35. 35.

    Seitz HK, Simanowski UA (1987) Metabolic and nutritional effects of ethanol. In: Hathcock JN (ed) Nutritional Toxicology, vol 11. Academic Press, Orlando, pp 63–104.

    Chapter  Google Scholar 

  36. 36.

    Seitz HK, Simanowski UA (1988) Alcohol and carcinogenesis. Annu Rev Nutr 8:99–119.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Smith EM (1979) Epidemiology of oral and pharyngeal cancers in the United States. Review of recent literature. J Natl Cancer Inst 63:1189–1195.

    CAS  PubMed  Google Scholar 

  38. 38.

    Spiegelhalder B, Eisenbrand G, Preussmann R (1979) Contamination of beer with trace quantities of N-nitroso-dimethylamine. Food Cosmet Toxicol 17:29–31.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    SUGI, Supplemental Library Users' Guide, 5th edn. SAS Institute Inc 1985, Cary, North Carolina, USA.

  40. 40.

    Tuyns AJ, Esteve J, Raymond R, Berrino F, Benhamou E, Blanchet F, Boffetta P, Crosignani P, Del Moral A, Lehmann W, Merletti F, Pequignot G, Riboli E, Sancho-Garnier H, Terracini B, Zubiri A, Zubiri L (1988) Cancer of the larynx/hypopharynx, tobacco, and alcohol: IARC international case-control study in Turin and Varese (Italy), Zaragossa and Navarra (Spain), Geneva (Switzerland) and Calvados (France). Int J Cancer 41:483–491.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    de Villiers EM, Weidauer H, Le YJ, Neumann C, zur Hausen H (1986) Papillomviren in benignen und malignen Tumoren des Mundes und des oberen Respirationstraktes. Laryngol Rhinol Otol 65:177–179.

    Article  Google Scholar 

  42. 42.

    de Vries N (1990) The magnitude of the problem. In: de Vries N, Gluckman JL (eds) Multiple primary tumors in the head and neck. Thieme, Stuttgart New York, pp 1–29.

    Google Scholar 

  43. 43.

    Weisburger JH (1975) Chemical carcinogens. In: Casarett LJ, Duoll J (eds) Toxicology, the basic science of poisons. Macmillan, New York, pp 333–378.

    Google Scholar 

  44. 44.

    Wright NA (1983) The histogenesis of gastrointestinal cancer. In: Hodgson HJF, Blum SR (eds) Gastrointestinal and hepatobiliary cancer. Chapman and Hall, London, pp 79–118.

    Google Scholar 

  45. 45.

    Wynder ED, Mabuchi K (1972) Etiological and preventive aspects of human cancer. Prev Med 1:300–334.

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Wynder EL, Bross IDJ, Day E (1956) A study of environmental factors in cancer of the larynx. Cancer 9:86–110.

    CAS  Article  PubMed  Google Scholar 

  47. 47.

    Wynder ED, Bross IJ, Feldmann R (1957) A study of etiological factors in cancer of the mouth. Cancer 10:1300–1323 Received: July 15, 1991.

    CAS  Article  PubMed  Google Scholar 

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Maier, H., Dietz, A., Gewelke, U. et al. Tobacco and alcohol and the risk of head and neck cancer. Clin Investig 70, 320–327 (1992). https://doi.org/10.1007/BF00184668

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Key words

  • Tobacco
  • Alcohol
  • Head and neck cancer
  • Risk factors