Risk factors for head and neck cancer in more and less developed countries: Analysis from the INHANCE consortium

Neerav Goyal*, Max Hennessy, Erik Lehman, Wenxue Lin, Antonio Agudo, Wolfgang Ahrens, Stefania Boccia, Paul Brennan, Hermann Brenner, Gabriella Cadoni, Cristina Canova, Chu Chen, David Conway, Maria Paula Curado, Luigino Dal Maso, Alexander W. Daudt, Valeria Edefonti, Eleonora Fabianova, Leticia Fernandez, Silvia FranceschiWerner Garavello, Maura Gillison, Richard B. Hayes, Claire Healy, Rolando Herrero, Ivana Holcatova, Jossy L. Kanda, Karl Kelsey, Bo T. Hansen, Rosalina Koifman, Pagona Lagiou, Carlo La Vecchia, Fabio Levi, Guojun Li, Jolanta Lissowska, Rossana Mendoza Lopez, Daniele Luce, Gary Macfarlane, Dana Mates, Keitaro Matsuo, Michael McClean, Ana Menezes, Gwenn Menvielle, Hal Morgenstern, Kirsten Moysich, Eva Negri, Andrew F. Olshan, Tamas Pandics, Jerry Polesel, Mark Purdue, Loredana Radoi, Heribert Ramroth, Lorenzo Richiardi, Stimson Schantz, Stephen M. Schwartz, Diego Serraino, Oxana Shangina, Elaine Smith, Erich M. Sturgis, Beata Swiatkowska, Peter Thomson, Thomas L. Vaughan, Marta Vilensky, Deborah M. Winn, Victor Wunsch-Filho, Guo-Pei Yu, Jose P. Zevallos, Zuo-Feng Zhang, Tongzhang Zheng, Ariana Znaor, Paolo Boffetta, Mia Hashibe, Yuan-Chin A. Lee, Joshua E. Muscat

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)



We analyzed the pooled case-control data from the International Head and Neck Cancer Epidemiology (INHANCE) consortium to compare cigarette smoking and alcohol consumption risk factors for head and neck cancer between less developed and more developed countries.

Subjects and Methods

The location of each study was categorized as either a less developed or more developed country. We compared the risk of overall head and neck cancer and cancer of specific anatomic subsites associated with cigarette smoking and alcohol consumption. Additionally, age and sex distribution between categories was compared.


The odds ratios for head and neck cancer sites associated with smoking duration differed between less developed and more developed countries. Smoking greater than 20 years conferred a higher risk for oral cavity and laryngeal cancer in more developed countries, whereas the risk was greater for oropharynx and hypopharynx cancer in less developed countries. Alcohol consumed for more than 20 years conferred a higher risk for oropharynx, hypopharynx, and larynx cancer in less developed countries. The proportion of cases that were young (<45 years) or female differed by country type for some HNC subsites.


These findings suggest the degree of industrialization and economic development affects the relationship between smoking and alcohol with head and neck cancer.

Original languageEnglish
Pages (from-to)1565-1578
Number of pages14
JournalOral Diseases
Issue number4
Early online date8 Apr 2022
Publication statusPublished - May 2023

Bibliographical note

Xavier Castellsague, Catalan Institute of Oncology. Barcelona, Spain.

Funding information
This work was supported by the European Community (5th Framework Programme) grant no QLK1-CT-2001-00182, INHANCE Pooled Data Project: NCI R03CA113157NIDCR R03DE016611 and the Intramural Program of the NCI, NIH, United States. Individual studies were supported by: Aviano study: Italian Association for Research on Cancer (AIRC), Italian League Against Cancer and Italian Ministry of Research; Baltimore study: NIH [DE016631]; Boston study: NIH [R01CA078609, R01CA100679], Central Europe study: World Cancer Research Fund and the European Commission INCO-COPERNICUS Program [Contract No. IC15- CT98-0332]; France 2001–2007 (ICARE): French National Research Agency (ANR); French National Cancer Institute (INCA); French Agency for Food, Environmental and Occupational Health and Safety (ANSES); French Institute for Public Health Surveillance (InVS); Fondation pour la Recherche Médicale (FRM); Fondation de France; Fondation ARC pour la Recherche sur le Cancer; French Ministry of Labour (Direction Générale du Travail); French Ministry of Health (Direction Générale de la Santé); Germany-Heidelberg study: grant No. 01GB9702/3 from the German Ministry of Education and Research; IARC Multicenter study: Fondo de Investigaciones Sanitarias (FIS) of the Spanish Government [FIS 97/0024, FIS 97/0662, BAE 01/5013], International Union Against Cancer (UICC), and Yamagiwa-Yoshida Memorial International Cancer Study Grant; Iowa study: NIH [NIDCR R01DE011979, NIDCR R01DE013110, NIH FIRCA TW001500] and Veterans Affairs Merit Review Funds; Italy multicenter study: Italian Association for Research on Cancer (AIRC), Italian League Against Cancer and Italian Ministry of Research; Japan study (2001–2005): Scientific Research grant from the Ministry of Education, Science, Sports, Culture and Technology of Japan (17015052) and grant for the Third-Term Comprehensive 10-Year Strategy for Cancer Control from the Ministry of Health, Labor and Welfare of Japan (H20-002); Latin America study: Fondo para la Investigacion Cientifica y Tecnologica (FONCYT) Argentina, IMIM (Barcelona), Fundaco de Amparo a` Pesquisa no Estado de Sao Paulo (FAPESP) [No 01/01768-2, 04/12054-9, 10/51168-0], and European Commission [IC18-CT97-0222]; Los Angeles Study: NIH [P50CA090388, R01DA011386, R03CA077954, T32CA009142, U01CA096134, R21ES011667] and the Alper Research Program for Environmental Genomics of the UCLA Jonsson Comprehensive Cancer Center; MSKCC study: NIH [R01CA051845]; Northeast US study: NIH R01DE013158; North Carolina Study: NIH [R01CA061188], & NIEHS [P30ES010126]; NY multicenter study: NIH [P01CA068384 K07CA104231]; Milan study: Italian Association for Research on Cancer (AIRC); Puerto Rico study: jointly funded by National Institutes of Health (NCI) US and NIDCR intramural programs; Rome study: AIRC (Italian Agency for Research on Cancer); Saarland study: Ministry of Science, Research and Arts Baden-Wurttemberg; Seattle study: NIH [R01CA048996, R01DE012609]; Seattle-LEO study: NIH [R01CA030022.

Data Availability Statement

Descriptions of the studies included in the INHANCE Consortium can be found on the database website (http://www.inhance.utah.edu, accessed April 1, 2021).

The peer review history for this article is available at https://publons.com/publon/10.1111/odi.14196.


  • alcohol use
  • head and neck cancer
  • smoking
  • socioeconomic status


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