Combined effect of tobacco smoking and alcohol drinking in the risk of head and neck cancers: a re-analysis of case–control studies using bi-dimensional spline models

Abstract

The synergistic effect of tobacco smoking and alcohol consumption on the risk of head and neck cancers has been mainly investigated as a cross-product of categorical exposure, thus leading to loss of information. We propose a bi-dimensional logistic spline model to investigate the interacting dose-response relationship of two continuous exposures (i.e., ethanol intake and tobacco smoking) on the risk of head and neck cancers, representing results through three-dimensional graphs. This model was applied to a pool of hospital-based case-control studies on head and neck cancers conducted in Italy and in the Vaud Swiss Canton between 1982 and 2000, including 1569 cases and 3147 controls. Among never drinkers and for all levels of ethanol intake, the risk of head and neck cancers steeply increased with increasing smoking intensity, starting from 1 cigarette/day. The risk associated to ethanol intake increased with incrementing exposure among smokers, and a threshold effect at approximately 50 g/day emerged among never smokers. Compared to abstainers from both tobacco and alcohol consumption, the combined exposure to ethanol and/or cigarettes led to a steep increase of cancer risk up to a 35-fold higher risk (95 % confidence interval 27.30-43.61) among people consuming 84 g/day of ethanol and 10 cigarettes/day. The highest risk was observed at the highest levels of alcohol and tobacco consumption. Our findings confirmed a combined effect of tobacco smoking and alcohol drinking on head and neck cancers risk, providing evidence that bi-dimensional spline models could be a feasible and flexible method to explore the pattern of risks associated to two interacting continuous-exposure variables.

Modulation of L-Arginine-Arginase Metabolic Pathway Enzymes: Immunocytochemistry and mRNA Expression in Peripheral Blood and Tissue Levels in Head and Neck Squamous Cell Carcinomas in North East India

“…The cigarette smoking and tobacco chewing habits are highly prevalent among head and neck cancer patients. Tobacco is considered the single most frequent cause of head and neck cancer (Boffetta et al, 2008;Dal Maso et al, 2015). In Northeast India; incidence of tobacco related oral cancers is about 33% (Bhattacharjee et al, 2006).…”

Head and neck cancer: smoking, drinking, eating and…sexual practices

“…Other factors involved are food and nutrition [5] and infection with human papilloma virus (HPV) for oropharyngeal cancer only [6]. In this issue of the European Journal of Epidemiology, we are without a doubt dealing with two crucial studies [7,8] that provide powerful and decisive data on the epidemiology and prevention of head and neck cancers.In the first, Dal Maso et al[7] highlights in figures 1 and 2 mesh plots and contour plots showing the synergy between alcohol (from 0 to 180 g/day) and tobacco (from 0 to 40 cigarettes/day) consumption, estimated applying a bidimensional regression spline, which allow the measurement of continuous exposures. The representation of the risk gradient is truly amazing and extremely illustrative.…”

“…Other factors involved are food and nutrition [5] and infection with human papilloma virus (HPV) for oropharyngeal cancer only [6]. In this issue of the European Journal of Epidemiology, we are without a doubt dealing with two crucial studies [7,8] that provide powerful and decisive data on the epidemiology and prevention of head and neck cancers.…”

“…In the first, Dal Maso et al [7] highlights in figures 1 and 2 mesh plots and contour plots showing the synergy between alcohol (from 0 to 180 g/day) and tobacco (from 0 to 40 cigarettes/day) consumption, estimated applying a bidimensional regression spline, which allow the measurement of continuous exposures. The representation of the risk gradient is truly amazing and extremely illustrative.…”

“…I am convinced that the two groups of researchers (few of them are simultaneously collaborating in both groups and papers published) will continue to help us better understand the epidemiology of head and neck cancers in the near future, as they have demonstrated in these two outstanding studies [7,8] and as they have always done in the past [22].…”