Alcohol drinking and head and neck cancer risk: the joint effect of intensity and duration

Gioia Di Credico, Jerry Polesel* (Corresponding Author), Luigino Dal Maso* (Corresponding Author), Francesco Pauli, Nicola Torelli, Daniele Luce, Loredana Radoï, Keitaro Matsuo, Diego Serraino, Paul Brennan, Ivana Holcatova, Wolfgang Ahrens, Pagona Lagiou, Cristina Canova, Lorenzo Richiardi, Claire M Healy, Kristina Kjaerheim, David I Conway, Gary J Macfarlane, Peter ThomsonAntonio Agudo, Ariana Znaor, Silvia Franceschi, Rolando Herrero, Tatiana N Toporcov, Raquel A Moyses, Joshua Muscat, Eva Negri, Marta Vilensky, Leticia Fernandez, Maria Paula Curado, Ana Menezes, Alexander W Daudt, Rosalina Koifman, Victor Wunsch-Filho, Andrew F Olshan, Jose P Zevallos, Erich M Sturgis, Guojun Li, Fabio Levi, Zuo-Feng Zhang, Hal Morgenstern, Elaine Smith, Philip Lazarus, Carlo La Vecchia, Werner Garavello, Chu Chen, Stephen M Schwartz, Tongzhang Zheng, Thomas L Vaughan, Karl Kelsey, Michael McClean, Simone Benhamou, Richard B Hayes, Mark P Purdue, Maura Gillison, Stimson Schantz, Guo-Pei Yu, Shu-Chun Chuang, Paolo Boffetta, Mia Hashibe, Amy Lee Yuan-Chin, Valeria Edefonti

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


BACKGROUND: Alcohol is a well-established risk factor for head and neck cancer (HNC). This study aims to explore the effect of alcohol intensity and duration, as joint continuous exposures, on HNC risk.

METHODS: Data from 26 case-control studies in the INHANCE Consortium were used, including never and current drinkers who drunk ≤10 drinks/day for ≤54 years (24234 controls, 4085 oral cavity, 3359 oropharyngeal, 983 hypopharyngeal and 3340 laryngeal cancers). The dose-response relationship between the risk and the joint exposure to drinking intensity and duration was investigated through bivariate regression spline models, adjusting for potential confounders, including tobacco smoking.

RESULTS: For all subsites, cancer risk steeply increased with increasing drinks/day, with no appreciable threshold effect at lower intensities. For each intensity level, the risk of oral cavity, hypopharyngeal and laryngeal cancers did not vary according to years of drinking, suggesting no effect of duration. For oropharyngeal cancer, the risk increased with durations up to 28 years, flattening thereafter. The risk peaked at the higher levels of intensity and duration for all subsites (odds ratio = 7.95 for oral cavity, 12.86 for oropharynx, 24.96 for hypopharynx and 6.60 for larynx).

CONCLUSIONS: Present results further encourage the reduction of alcohol intensity to mitigate HNC risk.

Original languageEnglish
Pages (from-to)1456-1463
Number of pages8
JournalBritish Journal of Cancer
Early online date24 Aug 2020
Publication statusPublished - 27 Oct 2020

Bibliographical note

We would like to thank Xavier Castellsague, who collected data in the IARC International Multicenter study and passed away in 2016. We thank Mrs Luigina Mei for editorial assistance

Note: This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).




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