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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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).
Conflict of interest
The authors declare no conflict of interest.
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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