No abstract

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. Key words: tobacco; alcohol; oral cavity; oropharynx; neoplasiaCancer of the oral cavity and pharynx (oral cancer) is a major and increasing public health problem in Europe. Spain, with a European age-adjusted incidence rate of 31.4 per 100,000 men per year, 1 is, after France, the European country with the second highest incidence rate for these cancer sites.These tumors are prominent among middle-aged adults, and increasing rates are occurring mainly among young and middleaged men. Population-based screening and early detection programs are rare or nonexistent, and in spite of surgical advances, these cancers remain a disfiguring disease associated with a relatively low survival rate. 2,3 Tobacco smoking and alcohol drinking have long and consistently been identified as the 2 major risk factors for oral cancer in most Western populations. 4 -6 Other risk factors that play a role include diets low in fruits and vegetables, 7,8 family history of cancer 9,10 and, to a lesser extent, infection by oncogenic human papillomaviruses (HPV). [11][12][13] Despite the clear role of tobacco and alcohol consumption in the etiology...

A more aggressive molecular phenotype and high breast density were identified in breast tumors that truly arise in the interval between screenings.

Benign breast disease increases the risk of breast cancer. This association has scarcely been evaluated in the context of breast cancer screening programs although it is a prevalent finding in mammography screening. We assessed the association of distinct categories of benign breast disease and subsequent risk of breast cancer, as well as the influence of a family history of breast cancer. A retrospective cohort study was conducted in 545,171 women aged 50–69 years biennially screened for breast cancer in Spain. The median of follow-up was 6.1 years. The age-adjusted rate ratio (RR) of breast cancer for women with benign breast disease, histologically classified into nonproliferative and proliferative disease with and without atypia, compared with women without benign breast disease was estimated by Poisson regression analysis. A stratified analysis by family history of breast cancer was performed in a subsample. All tests were two-sided. The age-adjusted RR of breast cancer after diagnosis of benign breast disease was 2.51 (95 % CI: 2.14–2.93) compared with women without benign breast disease. The risk was higher in women with proliferative disease with atypia (RR = 4.56, 95 % CI: 2.06–10.07) followed by those with proliferative disease without atypia (RR = 3.58; 95 % CI = 2.61–4.91). Women with nonproliferative disease and without a family history of breast cancer remained also at increased risk of cancer (OR = 2.23, 95 % CI: 1.86–2.68). An increased risk of breast cancer was observed among screening participants with proliferative or nonproliferative benign breast disease, regardless of a family history of breast cancer. This information may be useful to explore risk-based screening strategies.