Abstract
Background
Cancers of the upper aerodigestive tract (UADT; including oral cavity, pharynx, larynx and oesophagus) have high incidence rates all over the world, and they are especially frequent in some parts of Latin America. However, the data on the role of the major risk factors in these areas are still limited.
Methods
We have evaluated the role of alcohol and tobacco consumption, based on 2,252 upper aerodigestive squamous-cell carcinoma cases and 1,707 controls from seven centres in Brazil, Argentina, and Cuba.
Results
We show that alcohol drinkers have a risk of UADT cancers that is up to five times higher than that of never-drinkers. A very strong effect of aperitifs and spirits as compared to other alcohol types was observed, with the ORs reaching 12.76 (CI 5.37–30.32) for oesophagus. Tobacco smokers were up to six times more likely to develop aerodigestive cancers than never-smokers, with the ORs reaching 11.14 (7.72–16.08) among current smokers for hypopharynx and larynx cancer. There was a trend for a decrease in risk after quitting alcohol drinking or tobacco smoking for all sites. The interactive effect of alcohol and tobacco was more than multiplicative. In this study, 65% of all UADT cases were attributable to a combined effect of alcohol and tobacco use.
Conclusions
In this largest study on UADT cancer in Latin America, we have shown for the first time that a prevailing majority of UADT cancer cases is due to a combined effect of alcohol and tobacco use and could be prevented by quitting the use of either of these two agents.
Similar content being viewed by others
Abbreviations
- UADT:
-
Upper aerodigestive tract
- SCC:
-
Squamous-cell carcinoma
- OR:
-
Odds ratio
- CI:
-
Confidence interval
References
Ferlay J, Bray FI, Pisani P, Parkin DM (2002) Globocan. http://globocan.iarc.fr
Anonymous (1988) IARC monographs on the evaluation of carcinogenic risks to humans. Alcohol Drinking. http://monographs.iarc.fr
Anonymous (2008) IARC monographs on the evaluation of carcinogenic risks to humans. Alcohol Drinking (in preparation). http://monographs.iarc.fr
Anonymous (2004) IARC monographs on the evaluation of carcinogenic risks to humans. Tobacco Smoke and Involuntary Smoking. http://monographs.iarc.fr
Castellsague X, Munoz N, De Stefani E et al (1999) Independent and joint effects of tobacco smoking and alcohol drinking on the risk of esophageal cancer in men and women. Int J Cancer 82:657–664
Anonymous (2000) International classification of diseases for oncoloy. WHO, Geneva
Hanley JA (2001) A heuristic approach to the formulas for population attributable fraction. J Epidemiol Community Health 55:508–514
De Stefani E, Correa P, Oreggia F et al (1987) Risk factors for laryngeal cancer. Cancer 60:3087–3091
De Stefani E, Correa P, Oreggia F et al (1988) Black tobacco, wine and mate in oropharyngeal cancer. A case-control study from Uruguay. Rev Epidemiol Sante Publique 36:389–394
De Stefani E, Munoz N, Esteve J, Vasallo A, Victora CG, Teuchmann S (1990) Mate drinking, alcohol, tobacco, diet, and esophageal cancer in Uruguay. Cancer Res 50:426–431
Oreggia F, De SE, Correa P, Fierro L (1991) Risk factors for cancer of the tongue in Uruguay. Cancer 67:180–183
Vassallo A, Correa P, De SE et al (1985) Esophageal cancer in Uruguay: a case-control study. J Natl Cancer Inst 75:1005–1009
Castelletto R, Castellsague X, Munoz N, Iscovich J, Chopita N, Jmelnitsky A (1994) Alcohol, tobacco, diet, mate drinking, and esophageal cancer in Argentina. Cancer Epidemiol Biomarkers Prev 3:557–564
Franco EL, Kowalski LP, Oliveira BV et al (1989) Risk factors for oral cancer in Brazil: a case-control study. Int J Cancer 43:992–1000
Schlecht NF, Franco EL, Pintos J et al (1999) Interaction between tobacco and alcohol consumption and the risk of cancers of the upper aero-digestive tract in Brazil. Am J Epidemiol 150:1129–1137
Schlecht NF, Franco EL, Pintos J, Kowalski LP (1999) Effect of smoking cessation and tobacco type on the risk of cancers of the upper aero-digestive tract in Brazil. Epidemiology 10:412–418
Schlecht NF, Pintos J, Kowalski LP, Franco EL (2001) Effect of type of alcoholic beverage on the risks of upper aerodigestive tract cancers in Brazil. Cancer Causes Control 12:579–587
Garrote LF, Herrero R, Reyes RM et al (2001) Risk factors for cancer of the oral cavity and oro-pharynx in Cuba. Br J Cancer 85:46–54
Bosetti C, Gallus S, Franceschi S et al (2002) Cancer of the larynx in non-smoking alcohol drinkers and in non-drinking tobacco smokers. Br J Cancer 87:516–518
Fioretti F, Bosetti C, Tavani A, Franceschi S, La Vecchia C (1999) Risk factors for oral and pharyngeal cancer in never smokers. Oral Oncol 35:375–378
Hashibe M, Boffetta P, Zaridze D et al (2007) Contribution of tobacco and alcohol to the high rates of squamous cell carcinoma of the supraglottis and glottis in Central Europe. Am J Epidemiol 165:814–820
Hashibe M, Boffetta P, Janout V et al (2007) Esophageal cancer in Central and Eastern Europe: tobacco and alcohol. Int J Cancer 120:1518–1522
Zambon P, Talamini R, La Vecchia C et al (2000) Smoking, type of alcoholic beverage and squamous-cell oesophageal cancer in northern Italy. Int J Cancer 86:144–149
Vineis P, Alavanja M, Buffler P et al (2004) Tobacco and cancer: recent epidemiological evidence. J Natl Cancer Inst 96:99–106
Ribeiro KB, Levi JE, Pawlita M et al (2011) Low human papillomavirus prevalence in head and neck cancer: results from two large case-control studies in high-incidence regions. Int J Epidemiol 40:489–502
Acknowledgments
The study was funded by the European Commission INCO-DC programme (grant no IC18-CT97-0222), with additional funding from Fondo para la Investigacion Cientifica y Tecnologica (Argentina) and Fundação de Amparo à Pesquisa no Estado de São Paulo (grant no 01/01768-2). Katarzyna Szymańska undertook the work reported in this paper during the tenure of a Postdoctoral Fellowship awarded by the International Agency for Research on Cancer. The authors thank Valerie Gaborieau from IARC for technical help and Mathieu Boniol from IARC (now at IPRI, France) for valuable statistical advice.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Szymańska, K., Hung, R.J., Wünsch-Filho, V. et al. Alcohol and tobacco, and the risk of cancers of the upper aerodigestive tract in Latin America: a case–control study. Cancer Causes Control 22, 1037–1046 (2011). https://doi.org/10.1007/s10552-011-9779-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-011-9779-7