Active and involuntary tobacco smoking and upper aerodigestive tract cancer risks in a multicenter case-control study

Yuan Chin Amy Lee, Manuela Marron, Simone Benhamou, Christine Bouchardy, Wolfgang Ahrens, Hermann Pohlabeln, Pagona Lagiou, Dimitrios Trichopoulos, Antonio Agudo, Xavier Castellsague, Vladimir Bencko, Ivana Holcatova, Kristina Kjaerheim, Franco Merletti, Lorenzo Richiardi, Gary J. Macfarlane, Tatiana V. Macfarlane, Renato Talamini, Luigi Barzan, Cristina CanovaLorenzo Simonato, David I. Conway, Patricia A. McKinney, Raymond J. Lowry, Linda Sneddon, Ariana Znaor, Claire M. Healy, Bernard E. McCartan, Paul Brennan, Mia Hashibe

Research output: Contribution to journalArticlepeer-review


Introduction: Several important issues for the established association between tobacco smoking and upper aerodigestive tract (UADT) cancer risks include the associations with smoking by cancer subsite, by type of tobacco, and among never alcohol drinkers and the associations with involuntary smoking among nonsmokers. Our aim was to examine these specific issues in a large-scale case-control study in Europe. Methods: Analysis was done on 2,103 UADT squamous cell carcinoma cases and 2,221 controls in the Alcohol-Related Cancers and Genetic Susceptibility in Europe project, a multicenter case-control study in 10 European countries. Unconditional logistic regression was done to obtain odds ratios (OR) and 95% confidence intervals (95% CI). Results: Compared with never tobacco smoking, current smoking was associated with UADT cancer risks (OR, 6.72; 95% CI, 5.45-8.30 for overall; OR, 5.83; 95% CI, 4.50-7.54 for oral cavity and oropharynx; OR, 12.19; 95% CI, 8.29-17.92 for hypopharynx and larynx; and OR, 4.17; 95% CI, 2.45-7.10 for esophagus). Among never drinkers, dose-response relationships with tobacco smoking pack-years were observed for hypopharyngeal and laryngeal cancers (Ptrend = 0.010) but not for oral cavity and oropharyngeal cancers (Ptrend = 0.282). Among never smokers, ever exposure to involuntary smoking was associated with an increased risk of UADT cancers (OR, 1.60; 95% CI, 1.04-2.46). Conclusion: Our results corroborate that tobacco smoking may play a stronger role in the development of hypopharyngeal and laryngeal cancers than that of oral cavity and oropharyngeal cancers among never drinkers and that involuntary smoking is an important risk factor for UADTcancers. Public health interventions to reduce involuntary smoking exposure could help reduce UADTcancer incidence.

Original languageEnglish
Pages (from-to)3353-3361
Number of pages9
JournalCancer Epidemiology Biomarkers and Prevention
Issue number12
Publication statusPublished - Dec 2009

ASJC Scopus subject areas

  • Epidemiology
  • Oncology


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