Alcohol consumption and upper aerodigestive tract squamous cell carcinoma: evidence from 28 prospective cohorts

Elmira Ebrahimi¹, Sabine Naudin², Niki Dimou², Ana-Lucia Mayén², Molin Wang^{3

4

5}, Christian C Abnet⁶, Agneta Åkesson⁷, Matthew J Barnett⁸, Rino Bellocco^{9

10}, Amy Berrington de Gonzalez^{11

12}, Stephanie E Bonn¹³, Chu Chen⁸, David C Christiani^{3

14}, Tracy E Crane¹⁵, A Heather Eliassen^{3

5

16}, Jo L Freudenheim¹⁷, Yu-Tang Gao¹⁸, Montse Garcia-Closas^{11

12}, Gretchen Gierach⁶, Edward L Giovannucci^{3

16}, Inger T Gram¹⁹, Niclas Håkansson⁷, Mayo Hirabayashi²⁰, Tao Hou¹⁶, Brian Z Huang²¹, José-Maria Huerta^{22

23}, Harindra Jayasekara^{24

25

26}, Woon-Puay Koh²⁷, James V Lacey²⁸, Ylva Trolle Lagerros²⁹, Erikka Loftfield⁶, Robert J MacInnis^{24

25}, Satu Mannisto³⁰, Maria Elena Martinez³¹, Marjorie L McCullough³², Roger L Milne^{24

25

33}, Steven C Moore⁶, Lorelei A Mucci^{3

34}, Marian L Neuhouser⁸, Elizabeth A Platz³⁵, Jenny N Poynter³⁶, Anna E Prizment³⁷, Samantha Rees¹⁷, Kim Robien³⁸, Thomas E Rohan³⁹, Norie Sawada²⁰, V Wendy Setiawan^{21

40}, Marissa M Shams-White³², Xiao-Ou Shu⁴¹, Rashmi Sinha⁶, Meir J Stampfer^{3

5

16}, Rachael Z Stolzenberg-Solomon⁶, Cynthia A Thomson⁴², Caroline Y Um³², Piet A van den Brandt⁴³, Kala Visvanathan⁴⁴, Renwei Wang⁴⁵, Sophia S Wang²⁸, Emily White⁴⁶, Kami K White⁴⁷, Walter C Willet^{3

16}, Alicja Wolk⁷, Yukiko Yano⁶, Shiaw-Shyuan Yaun¹⁶, Jian-Min Yuan^{48

49}, Wei Zheng⁴¹, Elio Riboli⁵⁰, Stephanie A Smith-Warner^{3

16}, Paul Brennan¹, Pietro Ferrari²

Affiliations

¹ Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
² Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
³ Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁴ Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁵ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
⁷ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁸ Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
⁹ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
¹⁰ Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
¹¹ Division of Genetics and Epidemiology, Institute of Cancer Research, London, MD, UK.
¹² Cancer Epidemiology and Prevention Research Unit, Institute of Cancer Research and Imperial College London, London, UK, UK.
¹³ Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.
¹⁴ Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA.
¹⁵ Medical Oncology, Miller School of Medicine, University of Miami, Miami, FL, USA.
¹⁶ Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
¹⁷ Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
¹⁸ Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁹ Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
²⁰ Division of Prevention, Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
²¹ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
²² Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain.
²³ CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
²⁴ Cancer Epidemiology Division, Cancer Council Victoria, East Melbourne, Victoria, Australia.
²⁵ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
²⁶ Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Clayton, Victoria, Australia.
²⁷ Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Singapore.
²⁸ Beckman Research Institute, City of Hope, Duarte, CA, USA.
²⁹ Department of Medicine (Huddinge), Karolinska Institutet, Stockholm, Sweden.
³⁰ Department of Public Health, Finnish Institute for Health and Welfare, Helsinki, Finland.
³¹ Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
³² Department of Population Science, American Cancer Society, Atlanta, GA, USA.
³³ Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
³⁴ Discovery Sciences, American Cancer Society, Atlanta, GA, USA.
³⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
³⁶ Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
³⁷ Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA.
³⁸ Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
³⁹ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
⁴⁰ Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
⁴¹ Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
⁴² Mel & Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ, USA.
⁴³ Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
⁴⁴ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
⁴⁵ Cancer Epidemiology and Prevention Program, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.
⁴⁶ Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
⁴⁷ Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
⁴⁸ Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
⁴⁹ UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
⁵⁰ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

PMID: 40977057
DOI: 10.1093/jnci/djaf230

Alcohol consumption and upper aerodigestive tract squamous cell carcinoma: evidence from 28 prospective cohorts

Elmira Ebrahimi et al. J Natl Cancer Inst. 2025.

. 2025 Sep 22:djaf230.

doi: 10.1093/jnci/djaf230. Online ahead of print.

Authors

Affiliations

¹ Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
² Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
³ Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁴ Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁵ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
⁷ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁸ Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
⁹ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
¹⁰ Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
¹¹ Division of Genetics and Epidemiology, Institute of Cancer Research, London, MD, UK.
¹² Cancer Epidemiology and Prevention Research Unit, Institute of Cancer Research and Imperial College London, London, UK, UK.
¹³ Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.
¹⁴ Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA.
¹⁵ Medical Oncology, Miller School of Medicine, University of Miami, Miami, FL, USA.
¹⁶ Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
¹⁷ Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
¹⁸ Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁹ Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
²⁰ Division of Prevention, Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
²¹ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
²² Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain.
²³ CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
²⁴ Cancer Epidemiology Division, Cancer Council Victoria, East Melbourne, Victoria, Australia.
²⁵ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
²⁶ Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Clayton, Victoria, Australia.
²⁷ Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Singapore.
²⁸ Beckman Research Institute, City of Hope, Duarte, CA, USA.
²⁹ Department of Medicine (Huddinge), Karolinska Institutet, Stockholm, Sweden.
³⁰ Department of Public Health, Finnish Institute for Health and Welfare, Helsinki, Finland.
³¹ Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
³² Department of Population Science, American Cancer Society, Atlanta, GA, USA.
³³ Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
³⁴ Discovery Sciences, American Cancer Society, Atlanta, GA, USA.
³⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
³⁶ Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
³⁷ Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA.
³⁸ Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
³⁹ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
⁴⁰ Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
⁴¹ Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
⁴² Mel & Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ, USA.
⁴³ Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
⁴⁴ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
⁴⁵ Cancer Epidemiology and Prevention Program, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.
⁴⁶ Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
⁴⁷ Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
⁴⁸ Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
⁴⁹ UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
⁵⁰ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

PMID: 40977057
DOI: 10.1093/jnci/djaf230

Abstract

Background: This study aimed to investigate the association between alcohol consumption and squamous cell cancers of the upper aerodigestive tract (UADT), using data from 28 cohorts within the Pooling Project of Prospective Studies of Diet and Cancer (DCPP).

Methods: Individual-level data from 2,365,437 participants were pooled. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models to quantify the association between alcohol consumption (grams/day) and UADT cancers risk, adjusting for potential confounders. Analyses were conducted by sex, smoking status, geographic region, and alcoholic beverages.

Results: Over a median follow-up of 15.5 years, 6,903 UADT cancer cases were identified. Alcohol consumption was positively associated with UADT cancers risk overall. Even at intakes as low as 5-<15 g/day the HR estimate was 1.12 (95% CI 1.03,1.21) compared with the reference group (0.1-<5 g/day). The HR10g/day (95% CI) was 1.16 (1.14,1.18) for women and 1.12 (1.11,1.13) for men (pheterogeneity<0.0001). HR10g/day estimates were 1.14 (1.13,1.15) in current, 1.10 (1.09,1.12) in former, and 1.15 (1.12,1.18) in never-smokers. Consistent UADT HR10g/day estimates were observed across all beverage types. HR10g/day estimates varied across geographic regions, with HR10g/day (95% CI) equal to 1.15 (1.14,1.17) in Europe-Australia, 1.13 (1.11,1.15) in Asia, and 1.11 (1.09,1.12) in North America (pheterogeneity<0.0001).

Conclusion: Alcohol consumption was associated with UADT cancer risk, irrespective of smoking status or beverage type. However, due to differential baseline risks, alcohol is expected to impact the UADT cancer burden more in smokers than never-smokers. These findings support public health strategies to reduce alcohol consumption.

Keywords: Alcohol Drinking; Cohort Studies; Neoplasms; Smoking; Upper aero-digestive tract cancers.

© The Author(s) 2025. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Alcohol consumption and upper aerodigestive tract squamous cell carcinoma: evidence from 28 prospective cohorts

Affiliations

Alcohol consumption and upper aerodigestive tract squamous cell carcinoma: evidence from 28 prospective cohorts

Authors

Affiliations

Abstract

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