Smoking addiction and the risk of upper-aerodigestive-tract cancer in a multicenter case-control study

Yuan Chin Amy Lee, Daniela Zugna, Lorenzo Richiardi, Franco Merletti, Manuela Marron, Wolfgang Ahrens, Hermann Pohlabeln, Pagona Lagiou, Dimitrios Trichopoulos, Antonio Agudo, Xavier Castellsague, Jaroslav Betka, Ivana Holcatova, Kristina Kjaerheim, Gary J. Macfarlane, Tatiana V. Macfarlane, Renato Talamini, Luigi Barzan, Cristina Canova, Lorenzo SimonatoDavid I. Conway, Patricia A. McKinney, Peter Thomson, Ariana Znaor, Claire M. Healy, Bernard E. McCartan, Paolo Boffetta, Paul Brennan, Mia Hashibe

Research output: Contribution to journalArticlepeer-review


Although previous studies on tobacco and alcohol and the risk of upper-aerodigestive-tract (UADT) cancers have clearly shown dose-response relations with the frequency and duration of tobacco and alcohol, studies on addiction to tobacco smoking itself as a risk factor for UADT cancer have not been published, to our knowledge. The aim of this report is to assess whether smoking addiction is an independent risk factor or a refinement to smoking variables (intensity and duration) for UADT squamous cell carcinoma (SCC) risk in the multicenter case-control study (ARCAGE) in Western Europe. The analyses included 1,586 ever smoking UADT SCC cases and 1,260 ever smoking controls. Addiction was measured by a modified Fagerström score (first cigarette after waking up, difficulty refraining from smoking in places where it is forbidden and cigarettes per day). Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for UADT cancers with addiction variables were estimated with unconditional logistic regression. Among current smokers, the participants who smoked their first cigarette within 5 min of waking up were two times more likely to develop UADT SCC than those who smoked 60 min after waking up. Greater tobacco smoking addiction was associated with an increased risk of UADT SCC among current smokers (OR = 3.83, 95% CI: 2.56-5.73 for score of 3-7 vs. 0) but not among former smokers. These results may be consistent with a residual effect of smoking that was not captured by the questionnaire responses (smoking intensity and smoking duration) alone, suggesting addiction a refinement to smoking variables. What's new? Previous studies have clearly shown dose-response relationships between tobacco/alcohol use and the risk of upper-aerodigestive- tract (UADT) cancers, but these studies have focused only on the variables of frequency and duration of use. In this study, the authors asked whether addiction to smoking might be an independent risk factor. They found that addiction was indeed associated with UADT cancer risk among current smokers. This addiction-cancer association suggests that it is important to include questions that elicit information regarding smoking addiction when accounting for smoking effect through questionnaire information.

Original languageEnglish
Pages (from-to)2688-2695
Number of pages8
JournalInternational Journal of Cancer
Issue number11
Publication statusPublished - Dec 1 2013


  • Fagerström
  • smoking addiction
  • upper-aerodigestive-tract cancer

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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