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 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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
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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 Fagerstrom 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.

Original languageEnglish
Pages (from-to)2688-2695
Number of pages8
JournalInternational Journal of Cancer
Issue number11
Early online date21 Jun 2013
Publication statusPublished - 1 Dec 2013

Bibliographical note

Copyright © 2013 UICC.


  • adult
  • aged
  • alcohol drinking
  • carcinoma, squamous cell
  • case-control studies
  • Europe
  • female
  • head and neck neoplasms
  • humans
  • logistic models
  • male
  • middle aged
  • mouth neoplasms
  • questionnaires
  • risk factors
  • smoking
  • smoking addiction
  • Fagerstrom
  • upper-aerodigestive-tract cancer
  • nicotine dependence
  • Fagerstrom test
  • 1st cigarette
  • neck-cancer
  • alcohol
  • population
  • tobacco
  • time
  • head


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