RACIAL-DIFFERENCES IN RISK OF ORAL AND PHARYNGEAL CANCER - ALCOHOL, TOBACCO, AND OTHER DETERMINANTS
RACIAL-DIFFERENCES IN RISK OF ORAL AND PHARYNGEAL CANCER - ALCOHOL, TOBACCO, AND OTHER DETERMINANTS
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DOI：
10.1093/jnci/85.6.465
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发表时间：
1993-03-17
影响因子：
10.3
通讯作者：
FRAUMENI, JF
中科院分区：
文献类型：
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作者：
DAY, GL;BLOT, WJ;FRAUMENI, JF
背景资料：在美国，黑人的口腔癌和咽癌（口腔癌）发病率越来越高，但种族差异的决定因素尚不清楚。目的：探讨黑人口腔癌发病率高于白人的原因。方法：我们使用了在美国四个地区进行的一项大型、基于人群的口腔癌危险因素病例对照研究的数据。基于对1065名口腔癌患者（871名白人和194名黑人）和1182名对照（979名白人和203名黑人）的访谈，我们研究了暴露患病率和一些已知病因因素的相对风险的种族差异，包括烟草和酒精消费，饮食，社会经济和其他变量。为了评估主要危险因素在多大程度上解释了黑人口腔癌的过度风险，计算了人群归因风险。结果：酒精消费方面的差异，特别是在目前的吸烟者，出现了最重要的解释变量。在调整吸烟因素后，大量饮酒（每周超过或等于30杯）导致黑人的风险增加了17倍，白人增加了9倍。在饮酒者中，黑人往往比白人喝得多。此外，黑人（37%）比白人（28%）更高（P = 0.01）的百分比是当前吸烟者，尽管其他吸烟变量的相对风险或使用模式几乎没有种族差异，包括每天吸烟的香烟数量，吸烟年数和开始吸烟的年龄。根据人群归因风险计算，我们估计酒精和烟草使用的差异是美国黑人口腔癌发病率较高的主要原因，在没有酒精和烟草的情况下，根据种族（黑人，白色）和性别，这种癌症的发病率几乎相等。关于其他潜在的病因因素，由水果和维生素C的较高饮食摄入量提供的保护作用对白人更为明显，而黑人更经常倾向于与风险增加相关的社会人口统计学和医疗或牙齿健康类别。结论：这些分析提供的证据表明，口腔癌的各种环境或生活方式决定因素可能导致美国黑人口腔癌发病率高于白人，但与饮酒相关的模式和风险，特别是在当前吸烟者中，是黑人过度风险的最重要因素。含义：这些研究结果表明，黑人和白人预防口腔癌和咽癌的关键是减少酒精饮料的摄入量，并且由于强烈的相互作用，戒烟。
Background: In the United States, Blacks have increasingly higher rates of oral and pharyngeal cancer (oral cancer) than Whites, but determinants of the racial disparity have not been clear. Purpose: The purpose of this study was to explore reasons for the higher incidence of oral cancer among Blacks than Whites. Methods: We used data from a large, population-based case-control study of oral cancer risk factors conducted in four areas of the United States. On the basis of interviews that ascertained characteristics of 1065 oral cancer patients (871 Whites and 194 Blacks) and 1182 controls (979 Whites and 203 Blacks), we examined racial differences in exposure prevalences and relative risks for a number of known etiologic factors, including tobacco and alcohol consumption, diet, and socioeconomic and other variables. To evaluate the extent to which the major risk factors explained the excess risk of oral cancer among Blacks, population-attributable risks were calculated. Results: Differences with respect to alcohol consumption, especially among current smokers, emerged as the most important explanatory variables. After adjusting for smoking, heavy drinking (greater-than-or-equal-to 30 drinks/week) resulted in a 17-fold increased risk among Blacks and a ninefold increase among Whites. Among drinkers, Blacks tended to drink more than Whites. Also, a higher (P = .01) percentage of Blacks (37%) than Whites (28%) were current smokers, although there were little or no racial differences in relative risks or patterns of use for other smoking variables, including number of cigarettes smoked per day, years of smoking, and age started smoking. From population-attributable risk calculations, we estimated that differences in alcohol and tobacco use account for the bulk of the higher incidence of oral cancer among Blacks in the United States and that, in the absence of alcohol and tobacco, the rates of this cancer according to race (Black, White) and gender would be nearly equal. With regard to other potential etiologic factors, protective effects provided by higher dietary intake of fruits and vitamin C were more pronounced for Whites, while Blacks more often tended to be in socio-demographic and medical or dental health categories associated with increased risk. Conclusions: These analyses provide evidence that various environmental or lifestyle determinants of oral cancer may contribute to the higher oral cancer rates in Blacks than in Whites in the United States, but that patterns and risks associated with alcohol consumption, particularly among current smokers, are the most important contributors to the excess risk in Blacks. Implications: These findings suggest that the key to prevention of oral and pharyngeal cancers among both Blacks and Whites is reduced intake of alcoholic beverages and, because of strong interactive effects, the cessation of smoking.