Alcohol drinking and head and neck cancer risk: the joint effect of intensity and duration

Gioia Di Credico¹, Jerry Polesel², Luigino Dal Maso³, Francesco Pauli¹, Nicola Torelli¹, Daniele Luce⁴, Loredana Radoï⁵, Keitaro Matsuo^{6

7}, Diego Serraino⁸, Paul Brennan⁹, Ivana Holcatova¹⁰, Wolfgang Ahrens^{11

12}, Pagona Lagiou¹³, Cristina Canova¹⁴, Lorenzo Richiardi¹⁵, Claire M Healy¹⁶, Kristina Kjaerheim¹⁷, David I Conway¹⁸, Gary J Macfarlane¹⁹, Peter Thomson²⁰, Antonio Agudo²¹, Ariana Znaor⁹, Silvia Franceschi²², Rolando Herrero⁹, Tatiana N Toporcov²³, Raquel A Moyses²⁴, Joshua Muscat²⁵, Eva Negri²⁶, Marta Vilensky²⁷, Leticia Fernandez²⁸, Maria Paula Curado²⁹, Ana Menezes³⁰, Alexander W Daudt³¹, Rosalina Koifman³², Victor Wunsch-Filho²³, Andrew F Olshan³³, Jose P Zevallos³⁴, Erich M Sturgis³⁵, Guojun Li³⁵, Fabio Levi³⁶, Zuo-Feng Zhang³⁷, Hal Morgenstern³⁸, Elaine Smith³⁹, Philip Lazarus⁴⁰, Carlo La Vecchia⁴¹, Werner Garavello⁴², Chu Chen⁴³, Stephen M Schwartz⁴³, Tongzhang Zheng⁴⁴, Thomas L Vaughan⁴³, Karl Kelsey⁴⁵, Michael McClean⁴⁶, Simone Benhamou⁴⁷, Richard B Hayes⁴⁸, Mark P Purdue⁴⁹, Maura Gillison⁵⁰, Stimson Schantz⁵¹, Guo-Pei Yu⁵², Shu-Chun Chuang⁵³, Paolo Boffetta^{54

55}, Mia Hashibe⁵⁶, Amy Lee Yuan-Chin⁵⁶, Valeria Edefonti⁴¹

Affiliations

¹ Department of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy.
² Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy. polesel@cro.it.
³ Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy. epidemiology@cro.it.
⁴ Université de Rennes, INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, Pointe-à-Pitre, France.
⁵ INSERM UMR 1018, Centre for Research in Epidemiology and Population Health (CESP), Cancer Epidemiology, Genes and Environment Team, Villejuif, France.
⁶ Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
⁷ Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁸ Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
⁹ International Agency for Research on Cancer, Lyon, France.
¹⁰ Institute of Hygiene & Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
¹¹ Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany.
¹² University of Bremen, Faculty of Mathematics and Computer Science, Bremen, Germany.
¹³ Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
¹⁴ University of Padua, Padova, Italy.
¹⁵ Department of Medical Sciences, University of Turin, Turin, Italy.
¹⁶ Trinity College School of Dental Science, Dublin, Ireland.
¹⁷ Cancer Registry of Norway, Oslo, Norway.
¹⁸ School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK.
¹⁹ School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
²⁰ University of Hong Kong, Hong Kong, China.
²¹ Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, 08908, Spain.
²² Scientific Directorate, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
²³ Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
²⁴ Head and Neck Surgery, School of Medicine, University of São Paulo, São Paulo, Brazil.
²⁵ Penn State College of Medicine, Hershey, PA, USA.
²⁶ Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
²⁷ Instituto de Oncología Ángel H. Roffo, Universidad de Buenos Aires, Buenos Aires, Argentina.
²⁸ Institute of Oncology and Radiobiology, Havana, Cuba.
²⁹ Epidemiology-CIPE/ACCAMARGO, Sao Paulo, Brazil.
³⁰ Universidade Federal de Pelotas, Pelotas, Brazil.
³¹ Hospital Moinhos de Vento, Porto Alegre, Brazil.
³² Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
³³ Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC, USA.
³⁴ Division of Head and Neck Surgical Oncology in the Department of Otolaryngology/Head and Neck Surgery at Washington University School of Medicine, St Louis, MO, USA.
³⁵ Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
³⁶ Institut Universitaire de Médecine Sociale et Préventive (IUMSP), Unisanté, University of Lausanne, Lausanne, Switzerland.
³⁷ UCLA School of Public Health, Los Angeles, CA, USA.
³⁸ Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA.
³⁹ College of Public Health, University of Iowa, Iowa City, IA, USA.
⁴⁰ Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA.
⁴¹ Branch of Medical Statistics, Biometry and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
⁴² Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
⁴³ Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
⁴⁴ Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
⁴⁵ Brown University, Providence, Rhode Island, RI, USA.
⁴⁶ Boston University School of Public Health, Boston, MA, USA.
⁴⁷ National Institute of Health and Medical Research, INSERM U1018, Villejuif, France.
⁴⁸ Division of Epidemiology, New York University School Of Medicine, New York, NY, USA.
⁴⁹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
⁵⁰ "Thoracic/Head and Neck Medical Oncology", The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁵¹ New York Eye and Ear Infirmary, New York, NY, USA.
⁵² Medical Informatics Center, Peking University, Beijing, China.
⁵³ Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
⁵⁴ Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
⁵⁵ The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵⁶ Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT, USA.

PMID: 32830199
PMCID: PMC7592048
DOI: 10.1038/s41416-020-01031-z

Alcohol drinking and head and neck cancer risk: the joint effect of intensity and duration

Gioia Di Credico et al. Br J Cancer. 2020 Oct.

. 2020 Oct;123(9):1456-1463.

doi: 10.1038/s41416-020-01031-z. Epub 2020 Aug 24.

Authors

Affiliations

¹ Department of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy.
² Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy. polesel@cro.it.
³ Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy. epidemiology@cro.it.
⁴ Université de Rennes, INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, Pointe-à-Pitre, France.
⁵ INSERM UMR 1018, Centre for Research in Epidemiology and Population Health (CESP), Cancer Epidemiology, Genes and Environment Team, Villejuif, France.
⁶ Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
⁷ Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁸ Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
⁹ International Agency for Research on Cancer, Lyon, France.
¹⁰ Institute of Hygiene & Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
¹¹ Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany.
¹² University of Bremen, Faculty of Mathematics and Computer Science, Bremen, Germany.
¹³ Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
¹⁴ University of Padua, Padova, Italy.
¹⁵ Department of Medical Sciences, University of Turin, Turin, Italy.
¹⁶ Trinity College School of Dental Science, Dublin, Ireland.
¹⁷ Cancer Registry of Norway, Oslo, Norway.
¹⁸ School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK.
¹⁹ School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
²⁰ University of Hong Kong, Hong Kong, China.
²¹ Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, 08908, Spain.
²² Scientific Directorate, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
²³ Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
²⁴ Head and Neck Surgery, School of Medicine, University of São Paulo, São Paulo, Brazil.
²⁵ Penn State College of Medicine, Hershey, PA, USA.
²⁶ Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
²⁷ Instituto de Oncología Ángel H. Roffo, Universidad de Buenos Aires, Buenos Aires, Argentina.
²⁸ Institute of Oncology and Radiobiology, Havana, Cuba.
²⁹ Epidemiology-CIPE/ACCAMARGO, Sao Paulo, Brazil.
³⁰ Universidade Federal de Pelotas, Pelotas, Brazil.
³¹ Hospital Moinhos de Vento, Porto Alegre, Brazil.
³² Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
³³ Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC, USA.
³⁴ Division of Head and Neck Surgical Oncology in the Department of Otolaryngology/Head and Neck Surgery at Washington University School of Medicine, St Louis, MO, USA.
³⁵ Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
³⁶ Institut Universitaire de Médecine Sociale et Préventive (IUMSP), Unisanté, University of Lausanne, Lausanne, Switzerland.
³⁷ UCLA School of Public Health, Los Angeles, CA, USA.
³⁸ Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA.
³⁹ College of Public Health, University of Iowa, Iowa City, IA, USA.
⁴⁰ Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA.
⁴¹ Branch of Medical Statistics, Biometry and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
⁴² Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
⁴³ Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
⁴⁴ Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
⁴⁵ Brown University, Providence, Rhode Island, RI, USA.
⁴⁶ Boston University School of Public Health, Boston, MA, USA.
⁴⁷ National Institute of Health and Medical Research, INSERM U1018, Villejuif, France.
⁴⁸ Division of Epidemiology, New York University School Of Medicine, New York, NY, USA.
⁴⁹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
⁵⁰ "Thoracic/Head and Neck Medical Oncology", The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁵¹ New York Eye and Ear Infirmary, New York, NY, USA.
⁵² Medical Informatics Center, Peking University, Beijing, China.
⁵³ Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
⁵⁴ Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
⁵⁵ The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵⁶ Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT, USA.

PMID: 32830199
PMCID: PMC7592048
DOI: 10.1038/s41416-020-01031-z

Abstract

Background: Alcohol is a well-established risk factor for head and neck cancer (HNC). This study aims to explore the effect of alcohol intensity and duration, as joint continuous exposures, on HNC risk.

Methods: Data from 26 case-control studies in the INHANCE Consortium were used, including never and current drinkers who drunk ≤10 drinks/day for ≤54 years (24234 controls, 4085 oral cavity, 3359 oropharyngeal, 983 hypopharyngeal and 3340 laryngeal cancers). The dose-response relationship between the risk and the joint exposure to drinking intensity and duration was investigated through bivariate regression spline models, adjusting for potential confounders, including tobacco smoking.

Results: For all subsites, cancer risk steeply increased with increasing drinks/day, with no appreciable threshold effect at lower intensities. For each intensity level, the risk of oral cavity, hypopharyngeal and laryngeal cancers did not vary according to years of drinking, suggesting no effect of duration. For oropharyngeal cancer, the risk increased with durations up to 28 years, flattening thereafter. The risk peaked at the higher levels of intensity and duration for all subsites (odds ratio = 7.95 for oral cavity, 12.86 for oropharynx, 24.96 for hypopharynx and 6.60 for larynx).

Conclusions: Present results further encourage the reduction of alcohol intensity to mitigate HNC risk.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1. Cancer risk for the joint exposure to drinking intensity and duration (3D representation).**
Bivariate spline model’s estimates of odds ratios of oral cavity (a), oropharyngeal (b), hypopharyngeal (c), and laryngeal (d) cancers in current drinkers for the joint effect of intensity and duration of alcohol consumption. On the grid, black thicker lines represent knot locations, at 5 drinks/day for oral cavity, at 4 drinks/day for hypopharyngeal cancer and at 28 years for oropharyngeal cancer.

**Fig. 2. Cancer risk for the joint exposure to drinking intensity and duration (2D representation).**
Bivariate spline model’s estimates of odds ratios of oral cavity, oropharyngeal, hypopharyngeal and laryngeal cancers in current drinkers for alcohol intensity and fixed levels of alcohol duration (a–d) and for duration and fixed levels of intensity (e–h).

See this image and copyright information in PMC

References

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Alcohol drinking and head and neck cancer risk: the joint effect of intensity and duration

Affiliations

Alcohol drinking and head and neck cancer risk: the joint effect of intensity and duration

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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