Joint and independent effect of alcohol and tobacco use on the risk of subsequent cancer incidence among cancer survivors: A cohort study using cancer registries

Abstract

Drinking alcohol and smoking tobacco are major modifiable risk factors for cancer. However, little is known about whether these modifiable factors of cancer survivors are associated with subsequent primary cancer (SPC) incidence, regardless of the first cancer sites. 27,762 eligible cancer survivors diagnosed between 1985 and 2007 were investigated for SPC until the end of 2008, using hospital-based and population-based cancer registries. The association between drinking, smoking and combined drinking and smoking (interaction) at the time of the first cancer diagnosis and incidence of SPCs (i.e., all SPCs, alcohol-related, smoking-related and specific SPCs) was estimated by Poisson regression. Compared with never-drinker/neversmoker, the categories ever-drinker/ever-smoker, current-drinker/current-smoker and heavy-drinker/heavy-smoker had 43-108%, 51-126% and 167-299% higher risk for all, alcohol-related and tobacco-related SPCs, respectively. The interaction of drinking and smoking had significantly high incidence rate ratios (IRRs) for SPCs among ever-drinker/ever-smoker and currentdrinker/current-smoker, although ever drinking did not show a significant risk. Ever-drinker/ever-smoker had also significantly higher IRRs for esophageal and lung SPCs than never-drinker/never-smoker. Among comprehensive cancer survivors, ever and current drinkers only had a SPC risk when combined with smoking, while ever and current smokers had a SPC risk regardless of drinking status. Heavy drinking and heavy smoking were considered to be independent additive SPC risk factors. To reduce SPC incidence, it may be necessary (i) to reduce or stop alcohol use, (ii) to stop tobacco smoking and (iii) dual users, especially heavy users, should be treated as a high-risk population for behavioral-change intervention.Drinking alcohol and smoking tobacco are widespread, representative, modifiable lifestyle factors. Of 834,000 deaths from non-communicable diseases in 2007 in Japan, drinking alcohol and smoking tobacco accounted for 31,000 and 129,000 deaths, respectively.1 There is a large potential health gain if these risk factors are jointly controlled. 2 This may be true not only for the general population but also cancer survivors.In recent years, the number of second or further subsequent primary cancers (SPCs) has been growing, partly due to prolonged survival times for cancer patients: 5-15% of cancer survivors develop a SPC.3,4 Curtis et al. reported that approximately 35% of all excess risk for SPCs may be attributable to behavioral factors, such as drinking and smoking, which underscores the importance of these modifiable risk factors, especially in patients with tobacco-related and alcohol-related cancers. 5,6 For example, in a meta-analysis of early stage non-small-cell lung cancer, Parsons et al. reported a relative risk of 4.3 (95% confidence interval [CI] 1.1-17.0) of SPCs in patients who continued to smoke. 7 Patients with head and neck cancers with heavy alcohol intake at diagnosis showed a relative risk of 2.1 (1.4-3.3) for...

Factors Associated with Single-Use and Co-Use of Tobacco and Alcohol: A Multinomial Modeling Approach

“…Recent research findings have directed public health attention toward bad lifestyle habits, especially smoking and drinking. Previous studies have described that these two lifestyle habits are associated with each other [6,7] and emphasized that the co-use of tobacco and alcohol is a greater risk than the sum of their independent effects [6,7,26]. However, only a few studies have examined the factors associated with co-use of tobacco and alcohol compared with the use of tobacco only and the use of alcohol only.…”

Synchronous and Metachronous Tumors – A Literature Review

“…They compared 27,762 patients with a malignant tumor diagnosed between 1985 and 2007. The risk of developing a second primary cancer is, according to this study, of 43-108% of patients with occasional tobacco / alcohol consuming, 51-126% of those who drink / smoke currently and 167-299% of patients with high consumption of alcoholic beverages / tobacco [16,20]. Of the total survivors of a first cancer, 27% said they did not ever drink or smoke and 44.9% said they were drinking or smoking occasionally [20].…”

“…The risk of developing a second primary cancer is, according to this study, of 43-108% of patients with occasional tobacco / alcohol consuming, 51-126% of those who drink / smoke currently and 167-299% of patients with high consumption of alcoholic beverages / tobacco [16,20]. Of the total survivors of a first cancer, 27% said they did not ever drink or smoke and 44.9% said they were drinking or smoking occasionally [20]. During monitoring, 6.4% of patients were diagnosed with a second primary malignancy, 0.4% with the third and 0.04% with the fourth [20].…”

“…Of the total survivors of a first cancer, 27% said they did not ever drink or smoke and 44.9% said they were drinking or smoking occasionally [20]. During monitoring, 6.4% of patients were diagnosed with a second primary malignancy, 0.4% with the third and 0.04% with the fourth [20].…”

Treatment and survival of second primary early-stage lung cancer, following treatment of head and neck cancer in the Netherlands

“…Cancer survivors are at an increased risk of developing a second primary cancer [1]. In patients treated for head and neck squamous cell cancers (HNSCC), a high incidence of second primary lung cancer (SPLC) has been observed, due to field cancerization and shared risk factors such as heavy alcohol intake and smoking [2][3][4][5]. Estimates from the Surveillance, Epidemiology, and End Results (SEER) database suggests that the actuarial risk of a SPLC following HNSCC is greater than 16% at 10 years [6].…”