Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer:: Pooled analysis in the international head and neck cancer epidemiology consortium
Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer:: Pooled analysis in the international head and neck cancer epidemiology consortium
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DOI：
10.1093/jnci/djk179
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发表时间：
2007-05-16
期刊：
影响因子：
--
通讯作者：
Boffetta, Paolo
中科院分区：
文献类型：
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作者：
Hashibe, Mia;Brennan, Paul;Boffetta, Paolo
背景 至少 75% 的头颈癌可归因于吸烟和饮酒的结合。需要准确了解这些因素在缺乏其他因素的情况下与头颈癌风险的独立关联，以阐明头颈癌发生的机制，并评估旨在控制任一风险因素的干预措施的效果。方法我们检查了头颈癌与从不饮酒者中吸烟和从不吸烟者中饮酒的相关程度。我们汇集了 15 项病例对照研究的个体水平数据，其中包括 10244 名头颈癌病例受试者和 15227 名对照受试者，其中 1072 名病例受试者和 5775 名对照受试者从未吸烟，1598 名病例受试者和 4051 名对照受试者从未饮酒。使用无条件逻辑回归模型估计优势比 (OR) 和 95% 置信区间 (Cls)。所有统计检验都是双向的。 结果 在从不饮酒者中，吸烟与头颈癌风险增加相关（永远与从不吸烟的 OR = 2.13，95% Cl = 1.52 至 2.98），并且吸烟频率、持续时间和吸烟包年数之间存在明确的剂量反应关系。在这项研究中，如果这些人不吸烟，大约 24%（95% Cl = 16% 至 31%）的非饮酒者的头颈癌病例是可以预防的。在从不吸烟的人中，只有当饮酒频率较高时，饮酒才与头颈癌风险增加相关（或者每天喝三杯或更多酒与从不饮酒= 2.04，95% Cl = 1.29至3.21）。与高频酒精摄入的关联仅限于口咽/下咽和喉癌。结论我们的结果代表了头颈癌两个主要危险因素各自独立关联的最精确估计，并且它们体现了癌症流行病学中大规模联盟的优势。
Background At least 75% of head and neck cancers are attributable to a combination of cigarette smoking and alcohol drinking. A precise understanding of the independent association of each of these factors in the absence of the other with the risk of head and neck cancer is needed to elucidate mechanisms of head and neck carcinogenesis and to assess the efficacy of interventions aimed at controlling either risk factor.Methods We examined the extent to which head and neck cancer is associated with cigarette smoking among never drinkers and with alcohol drinking among never users of tobacco. We pooled individual-level data from 15 case-control studies that included 10244 head and neck cancer case subjects and 15227 control subjects, of whom 1072 case subjects and 5775 control subjects were never users of tobacco and 1598 case subjects and 4051 control subjects were never drinkers of alcohol. Odds ratios (ORs) and 95% confidence intervals (Cls) were estimated using unconditional logistic regression models. All statistical tests were two-sided.Results Among never drinkers, cigarette smoking was associated with an increased risk of head and neck cancer (OR for ever versus never smoking = 2.13, 95% Cl = 1.52 to 2.98), and there were clear dose-response relationships for the frequency, duration, and number of pack-years of cigarette smoking. Approximately 24% (95% Cl = 16% to 31%) of head and neck cancer cases among nondrinkers in this study would have been prevented if these individuals had not smoked cigarettes. Among never users of tobacco, alcohol consumption was associated with an increased risk of head and neck cancer only when alcohol was consumed at high frequency (OR for three or more drinks per day versus never drinking = 2.04, 95% Cl = 1.29 to 3.21). The association with high-frequency alcohol intake was limited to cancers of the oropharynx/hypopharynx and larynx.Conclusions Our results represent the most precise estimates available of the independent association of each of the two main risk factors of head and neck cancer, and they exemplify the strengths of large-scale consortia in cancer epidemiology.