Population attributable risk of tobacco and alcohol for upper aerodigestive tract cancer

Devasena Anantharaman, Manuela Marron, Pagona Lagiou, Evangelia Samoli, Wolfgang Ahrens, Hermann Pohlabeln, Alena Slamova, Miriam Schejbalova, Franco Merletti, Lorenzo Richiardi, Kristina Kjaerheim, Xavier Castellsague, Antonio Agudo, Renato Talamini, Luigi Barzan, Tatiana MacFarlane, Martin Tickle, Lorenzo Simonato, Cristina Canova, David I ConwayPatricia A McKinney, Peter Thomson, Ariana Znaor, Claire M Healy, Bernard E McCartan, Mia Hashibe, Paul Brennan, Gary J Macfarlane

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130 Citations (Scopus)


Tobacco and alcohol are major risk factors for upper aerodigestive tract (UADT) cancer and significant variation is observed in UADT cancer rates across Europe. We have estimated the proportion of UADT cancer burden explained by tobacco and alcohol and how this varies with the incidence rates across Europe, cancer sub-site, gender and age. This should help estimate the minimum residual burden of other risk factors to UADT cancer, including human papillomavirus. We analysed 1981 UADT cancer cases and 1993 controls from the ARCAGE multicentre study. We estimated the population attributable risk (PAR) of tobacco alone, alcohol alone and their joint effect. Tobacco and alcohol together explained 73% of UADT cancer burden of which nearly 29% was explained by smoking alone, less than 1% due to alcohol on its own and 44% by the joint effect of tobacco and alcohol. Tobacco and alcohol together explained a larger proportion of hypopharyngeal/laryngeal cancer (PAR=85%) than oropharyngeal (PAR=74%), esophageal (PAR=67%) and oral cancer (PAR=61%). Tobacco and alcohol together explain only about half of the total UADT cancer burden among women. Geographically, tobacco and alcohol explained a larger proportion of UADT cancer in central (PAR=84%) than southern (PAR=72%) and western Europe (PAR=67%). While the majority of the UADT cancers in Europe are due to tobacco or the joint effect of tobacco and alcohol, our results support a significant role for other risk factors in particular, for oral and oropharyngeal cancers and also for UADT cancers in southern and western Europe.

Original languageEnglish
Pages (from-to)725-731
Number of pages7
JournalOral Oncology
Issue number8
Early online date20 Jun 2011
Publication statusPublished - Aug 2011

Bibliographical note

Copyright © 2011 Elsevier Ltd. All rights reserved.


  • adult
  • alcohol drinking
  • case-control studies
  • esophageal neoplasms
  • Europe
  • female
  • humans
  • incidence
  • male
  • middle aged
  • mouth neoplasms
  • otorhinolaryngologic neoplasms
  • risk factors
  • smoking
  • upper aerodigestive tract cancer
  • ARCAGE study
  • population attributable risk
  • tobacco
  • alcohol


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