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Low frequency of cigarette smoking and the risk of head and neck cancer in the INHANCE consortium pooled analysis

Lookup NU author(s): Professor Peter Thomson


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Background: Cigarette smoking is a major risk factor for head and neck cancer (HNC). To our knowledge, low cigarette smoking (<10 cigarettes per day) has not been extensively investigated in fine categories or among never alcohol drinkers.Methods: We conducted a pooled analysis of individual participant data from 23 independent case-control studies including 19 660 HNC cases and 25 566 controls. After exclusion of subjects using other tobacco products including cigars, pipes, snuffed or chewed tobacco and straw cigarettes (tobacco product used in Brazil), as well as subjects smoking more than 10 cigarettes per day, 4093 HNC cases and 13 416 controls were included in the analysis. The lifetime average frequency of cigarette consumption was categorized as follows: never cigarette users, >0-3, >3-5, >5-10 cigarettes per day.Results: Smoking >0-3 cigarettes per day was associated with a 50% increased risk of HNC in the study population [ odds ratio (OR) = 1.52, 95% confidence interval (CI): (1.21, 1.90). Smoking >3-5 cigarettes per day was associated in each subgroup from OR = 2.01 (95% CI: 1.22, 3.31) among never alcohol drinkers to OR = 2.74 (95% CI: 2.01, 3.74) among women and in each cancer site, particularly laryngeal cancer (OR = 3.48, 95% CI: 2.40, 5.05). However, the observed increased risk of HNC for low smoking frequency was not found among smokers with smoking duration shorter than 20 years.Conclusion: Our results suggest a public health message that low frequency of cigarette consumption contributes to the development of HNC. However, smoking duration seems to play at least an equal or a stronger role in the development of HNC.

Publication metadata

Author(s): Berthiller J, Straif K, Agudo A, Ahrens W, dos Santos AB, Boccia S, Cadoni G, Canova C, Castellsague X, Chen C, Conway D, Curado MP, Dal Maso L, Daudt AW, Fabianova E, Fernandez L, Franceschi S, Fukuyama EE, Hayes RB, Healy C, Herrero R, Holcatova I, Kelsey K, Kjaerheim K, Koifman S, Lagiou P, La Vecchia C, Lazarus P, Levi F, Lissowska J, Macfarlane T, Mates D, McClean M, Menezes A, Merletti F, Morgenstern H, Muscat J, Olshan AF, Purdue M, Ramroth H, Rudnai P, Schwartz SM, Serraino D, Shangina O, Smith E, Sturgis EM, Szeszenia-Dabrowska N, Thomson P, Vaughan TL, Vilensky M, Wei QY, Winn DM, Wunsch-Filho V, Zhang ZF, Znaor A, Ferro G, Brennan P, Boffetta P, Hashibe M, Lee YCA

Publication type: Article

Publication status: Published

Journal: International Journal of Epidemiology

Year: 2016

Volume: 45

Issue: 3

Pages: 835-845

Print publication date: 01/06/2016

Online publication date: 30/07/2016

Acceptance date: 26/06/2015

ISSN (print): 0300-5771

ISSN (electronic): 1464-3685

Publisher: Oxford University Press


DOI: 10.1093/ije/dyv146


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Funder referenceFunder name
Alper Research Program for Environmental Genomics of the UCLA Jonsson Comprehensive Cancer Center
International Union Against Cancer (UICC)
Intramural Program of the National Cancer Institute, National Institute of Health, United States
Italian Association for Research on Cancer (AIRC)
Italian League Against Cancer
Italian Ministry of Research
National Institutes of Health (NCI) US
Swiss League against Cancer
World Cancer Research Fund
AIRC (Italian Agency for Research on Cancer)
Fondo para la Investigacion Cientifica y Tecnologica (FONCYT) Argentina
IMIM (Barcelona)
NIDCR intramural programs
Veterans Affairs Merit Review Funds
Yamagiwa-Yoshida Memorial International Cancer Study Grant
01/01768-2Fundaco de Amparo a Pesquisa no Estado de Sao Paulo (FAPESP)
01GB9702/3German Ministry of Education and Research
10/51168-0Fundacao de Ampara a Pesquisa no Estado de Sao Paulo (FAPESP)
10068Italian Association for Research on Cancer
BAE 01/5013Fondo de Investigaciones Sanitarias (FIS) of the Spanish Government
FIRCA TW001500National Institute of Health
FIS 97/0024Fondo de Investigaciones Sanitarias (FIS) of the Spanish Government
FIS 97/0662Fondo de Investigaciones Sanitarias (FIS) of the Spanish Government
IC18-CT97-0222European Commission
IC15-CT98-0332European Commission INCO-COPERNICUS Program
K07CA104231National Institute of Health
NIDCR R01DE011979National Institute of Health
KFS-700Swiss Research against Cancer/Oncosuisse
OCS-1633Swiss Research against Cancer/Oncosuisse
P01CA068384 K07CA104231National Institute of Health
QLK1-CT-2001-00182European Community (5th Frame work Programme)
R01DA011386National Institute of Health
NIDCR R01DE013110National Institute of Health
P01CA068384National Institute of Health
P30ES010126National Institute of Environmental Health Sciences
P50CA090388National Institute of Health
R01CA048996National Institute of Health
R01CA061188National Institute of Health
R01DE012609National Institute of Health
R01DE013158National Institute of Health
R03CA077954National Institute of Health
R03CA113157National Cancer Institute
R03DE016611National Institute of Dental and Craniofacial Research