The role of type of tobacco and type of alcoholic beverage in oral carcinogenesis

• Published in: International journal of cancer Vol. 108; no. 5; pp. 741 - 749
• Main Authors: Castellsagué, Xavier, Quintana, Maria Jesús, Martínez, Maria Carmen, Nieto, Adoración, Sánchez, Maria José, Juan, Amparo, Monner, Antoni, Carrera, Marta, Agudo, Antoni, Quer, Miquel, Muñoz, Nubia, Herrero, Rolando, Franceschi, Silvia, Bosch, F. Xavier
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 20.02.2004; Wiley-Liss
• Subjects: Aged; alcohol; Alcohol Drinking - adverse effects; Alcoholic Beverages - adverse effects; Beer - adverse effects; Biological and medical sciences; Case-Control Studies; Ethanol - adverse effects; Humans; Male; Medical sciences; Middle Aged; Mouth Neoplasms - epidemiology; Mouth Neoplasms - etiology; neoplasia; Nicotiana - adverse effects; oral cavity; oropharynx; Otorhinolaryngology. Stomatology; Risk Factors; Smoking - adverse effects; Spain - epidemiology; tobacco; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Wine - adverse effects; Europe; Spain; Human; Ethanol; Stomatology; Multicenter study; Tobacco smoking; Oropharynx; Case control study; Malignant tumor; Carcinogenesis; Epidemiology; Alcoholic beverage; Oral cavity; Type; Risk factor; ENT disease; Oral cavity disease; Pharynx disease; Public health
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.11627

Incidence rates of oral and oropharyngeal cancers (oral cancer) in Spain are among the highest in Europe. Spain has a population heavily exposed to various types of tobacco and alcoholic beverages but the role and impact of tobacco type and beverage type in oral carcinogenesis remain controversial. To estimate the independent and joint effects of tobacco smoking and alcohol drinking habits on the risk of developing oral cancer, we carried out a multicenter, hospital‐based, case‐control study in Spain. Data from 375 patients newly diagnosed with cancer of the oral cavity or oropharynx and 375 matched control subjects were analyzed using multivariate logistic regression procedures. All exposure characteristics of amount, duration and cessation of both tobacco smoking and alcohol drinking were strongly associated with cancer risk following a dose‐dependent relationship. At equal intake or duration levels, black‐tobacco smoking and drinking of spirits were both associated with a 2‐ to 4‐fold increase in cancer risk compared to blond tobacco smoking or drinking of wine or beer, respectively. While ever exposure to smoking only or drinking only was associated with a moderate and nonsignificant increase in cancer risk, a history of simultaneous exposure to both habits was associated with a 13‐fold increase that was compatible with a synergistic effect model (p‐value for interaction: 0.008). Exposure to black tobacco smoking and/or drinking of spirits may account for up to 77% of oral cancer occurrence in Spain. Both black tobacco smoking and drinking of spirits place individuals at a very high risk of developing oral cancer. Simultaneous exposure to tobacco and alcohol consumption increases oral cancer risk in a synergistic fashion, even when consumption levels are moderate. These results underline the importance of type of tobacco and alcohol concentration in oral carcinogenesis. © 2003 Wiley‐Liss, Inc.