Interaction between tobacco and alcohol use and the risk of head and neck cancer: Pooled analysis in the international head and neck cancer Epidemiology consortium

Mia Hashibe, Paul Brennan, Shu Chun Chuang, Stefania Boccia, Xavier Castellsague, Chu Chen, Maria Paula Curado, Luigino Dal Maso, Alexander W. Daudt, Eleonora Fabianova, Leticia Fernandez, Victor Wünsch-Filho, Silvia Franceschi, Richard B. Hayes, Rolando Herrero, Karl Kelsey, Sergio Koifman, Carlo La Vecchia, Philip Lazarus, Fabio LeviJuan J. Lence, Dana Mates, Elena Matos, Ana Menezes, Michael D. McClean, Joshua Muscat, Jose Eluf-Neto, Andrew F. Olshan, Mark Purdue, Peter Rudnai, Stephen M. Schwartz, Elaine Smith, Erich M. Sturgis, Neonilia Szeszenia-Dabrowska, Renato Talamini, Qingyi Wei, Deborah M. Winn, Oxana Shangina, Agnieszka Pilarska, Zuo Feng Zhang, Gilles Ferro, Julien Berthiller, Paolo Boffetta

Research output: Contribution to journalArticlepeer-review

884 Scopus citations


Background: The magnitude of risk conferred by the interaction between tobacco and alcohol use on the risk of head and neck cancers is not clear because studies have used various methods to quantify the excess head and neck cancer burden. Methods: We analyzed individual-level pooled data from 17 European and American case-control studies (11,221 cases and 16,168 controls) participating in the International Head and Neck Cancer Epidemiology consortium. We estimated the multiplicative interaction parameter (ψ) and population attributable risks (PAR). Results: A greater than multiplicative joint effect between ever tobacco and alcohol use was observed for head and neck cancer risk (ψ = 2.15; 95% confidence interval, 1.53-3.04). The PAR for tobacco or alcohol was 72% (95% confidence interval, 61-79%) for head and neck cancer, of which 4% was due to alcohol alone, 33% was due to tobacco alone, and 35% was due to tobacco and alcohol combined. The total PAR differed by subsite (64% for oral cavity cancer, 72% for pharyngeal cancer, 89% for laryngeal cancer), by sex (74% for men, 57% for women), by age (33% for cases <45 years, 73% for cases >60 years), and by region (84% in Europe, 51% in North America, 83% in Latin America). Conclusions: Our results confirm that the joint effect between tobacco and alcohol use is greater than multiplicative on head and neck cancer risk. However, a substantial proportion of head and neck cancers cannot be attributed to tobacco or alcohol use, particularly for oral cavity cancer and for head and neck cancer among women and among young-onset cases.

Original languageEnglish (US)
Pages (from-to)541-550
Number of pages10
JournalCancer Epidemiology Biomarkers and Prevention
Issue number2
StatePublished - Feb 2009

All Science Journal Classification (ASJC) codes

  • General Medicine


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