Age at start of using tobacco on the risk of head and neck cancer: Pooled analysis in the International Head and Neck Cancer Epidemiology Consortium (INHANCE)

Chun Pin Chang, Shen Chih Chang, Shu Chun Chuang, Julien Berthiller, Gilles Ferro, Keitaro Matsuo, Victor Wünsch-Filho, Tatiana N. Toporcov, Marcos Brasilino de Carvalho, Carlo La Vecchia, Andrew F. Olshan, Jose P. Zevallos, Diego Serraino, Joshua Muscat, Erich M. Sturgis, Guojun Li, Hal Morgenstern, Fabio Levi, Luigino Dal Maso, Elaine SmithKarl Kelsey, Michael McClean, Thomas L. Vaughan, Philip Lazarus, Heribert Ramroth, Chu Chen, Stephen M. Schwartz, Deborah M. Winn, Cristina Bosetti, Valeria Edefonti, Werner Garavello, Eva Negri, Richard B. Hayes, Mark P. Purdue, Stefania Boccia, Gabriella Cadoni, Oxana Shangina, Rosalina Koifman, Maria Paula Curado, Marta Vilensky, Beata Swiatkowska, Rolando Herrero, Silvia Franceschi, Simone Benhamou, Leticia Fernandez, Ana M.B. Menezes, Alexander W. Daudt, Dana Mates, Stimson Schantz, Guo Pei Yu, Jolanta Lissowska, Hermann Brenner, Eleonora Fabianova, Peter Rudnai, Paul Brennan, Paolo Boffetta, Zuo Feng Zhang, Mia Hashibe, Yuan Chin Amy Lee

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Tobacco use is a well-established risk factor for head and neck cancer (HNC). However, less is known about the potential impact of exposure to tobacco at an early age on HNC risk. Methods: We analyzed individual-level data on ever tobacco smokers from 27 case-control studies (17,146 HNC cases and 17,449 controls) in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random-effects logistic regression models. Results: Without adjusting for tobacco packyears, we observed that younger age at starting tobacco use was associated with an increased HNC risk for ever smokers (OR<10 years vs. ≥30 years: 1.64, 95% CI: 1.35, 1.97). However, the observed association between age at starting tobacco use and HNC risk became null after adjusting for tobacco packyears (OR<10 years vs. ≥30 years: 0.97, 95% CI: 0.80, 1.19). In the stratified analyses on HNC subsites by tobacco packyears or years since quitting, no difference in the association between age at start and HNC risk was observed. Conclusions: Results from this pooled analysis suggest that increased HNC risks observed with earlier age at starting tobacco smoking are largely due to longer duration and higher cumulative tobacco exposures.

Original languageEnglish (US)
Article number101615
JournalCancer Epidemiology
StatePublished - Dec 2019

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Oncology
  • Cancer Research


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