© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 15, 1336-1337,
August 4, 1999
© 1999 Oxford University Press
CORRESPONDENCE |
Re: Cancer of the Oral Cavity and Pharynx in Nonsmokers Who Drink Alcohol and in Nondrinkers Who Smoke Tobacco
Affiliations of authors: X. Castellsagué, Servei d'Epidemiologia i Registre del Càncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Nubia Muñoz, Unit of Field and Intervention Studies, International Agency for Research on Cancer (IARC), Lyon, France.
Correspondence to:Xavier Castellsagué, Servei d'Epidemiologia i Registre del Càncer, Institut Català d'Oncologia, Gran Via s/n, km 2.7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain (e-mail: xcastellsague{at}ico.scs.es).
In their recent brief communication, Talamini et al. (1)
reported on the risk of developing cancer of the oral cavity and
pharynx in nonsmokers who drink alcohol and in nondrinkers of alcohol
who smoke tobacco. Although the data were quite sparse (60
never-smoking and 32 never-drinking case subjects), the authors
concluded that there was a statistically significant increased risk of
cancer in these sites associated with heavy alcohol intake in
nonsmokers and with heavy tobacco smoking in nondrinkers. In this
letter, we present solid evidence that the same conclusion holds true
for esophageal cancer. The results shown in Table 1
were gathered from a pooled analysis of five hospital-based
case-control studies of squamous cell carcinoma of the esophagus
conducted from 1986 through 1992 in the following four countries in
South America: Brazil (2), Uruguay (3),
Argentina
(4), and Paraguay (5). These studies were
coordinated
by the International Agency for Research on Cancer (Lyon, France), and
they were carried out with the same research protocol and data
collection procedures, thus making the studies suitable for a pooled
analysis. Overall, the pooled data included a total of 830 incident
case subjects with esophageal cancer and 1779 control subjects. Control
subjects were individually matched to the case subjects with respect to
the admitting hospital, age (± 5 years), and sex.
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There were 144 case subjects and 630 control subjects who described themselves as being life-long nonsmokers and 179 case subjects and 776 control subjects who reported themselves as being life-long nondrinkers of alcohol. Table 1
shows the estimated odds
ratios (ORs) and 95% confidence intervals (CIs) of esophageal cancer linked to alcohol
intake among nonsmokers and linked to cigarette smoking among nondrinkers. All logistic
regression models were adjusted by age group, sex, admitting hospital, and years of schooling. Consistent with the brief communication by Talamini et al. (1), for nonsmokers who drank alcohol, the OR was not markedly increased for a consumption of pure ethanol that was less than 150 mL per day, but it increased almost sixfold for amounts exceeding 150 mL or more of ethanol per day. The trend in risk was highly statistically significant (P = .002). It is interesting that this effect was much stronger among males than it was among females. Among males, the ORs (95% CIs) were 1.78 (0.42-7.54), 3.27 (0.57-18.78), 5.49 (1.82-16.57), and 12.62 (3.37-47.16) for 1-24 mL, 25-49 mL, 50-140 mL, and 150 mL or more of pure ethanol per day, respectively (P for trend <.001). For females, the association with alcohol intake was weak and not statistically significant.
For nondrinkers who smoked cigarettes, the OR was increased almost threefold for smoking as few as eight to 14 cigarettes per day, 3.4-fold for smoking 15-24 cigarettes per day, and 2.5-fold for smoking 25 cigarettes or more per day, also with a highly statistically significant trend in risk (P <.001). As with alcohol, this association was stronger among males in whom the corresponding ORs (95% CIs) were 1.22 (0.39-3.80), 3.75 (1.44-9.79), 5.03 (2.05-12.31), and 3.73 (1.39-10.02) (P for trend <.001). Among females, the association with cigarette smoking was weak, and the trend did not reach statistical significance.
These results add precision to the estimates by Talamini et al. (1) and further indicate that, in nondrinkers, even moderate exposure to tobacco smoking significantly increases the risk of esophageal cancer. These findings complete the epidemiologic picture of the independent etiologic role of alcohol drinking and tobacco smoking in the development of cancers of the upper aerodigestive tract.
NOTES
Supported by funds provided by the International Agency for Research on Cancer (IARC) Lyon, France. The Pooled Project was funded by the IARC and the Fondo de Investigaciones Sanitarias (FIS) of the Spanish Government, FIS 97/0662.
REFERENCES
1
Talamini R, La Vecchia C, Levi F, Conti E, Favero A, Franceschi
S. Cancer of the oral cavity and pharynx in nonsmokers who drink alcohol and in nondrinkers
who smoke tobacco. J Natl Cancer Inst 1998;90:1901-3.
2 Victora CG, Munoz N, Day NE, Barcelos LB, Peccin DA, Braga NM. Hot beverages and oesophageal cancer in southern Brazil: a casecontrol study. Int J Cancer 1987;39:710-6.[Web of Science][Medline]cancerlit;87220985
3
De Stefani E, Munoz N, Esteve J, Vasallo A, Victora CG,
Teuchmann S. Mate drinking, alcohol, tobacco, diet, and esophageal cancer in Uruguay. Cancer Res 1990;50:426-31.
4 Castelletto R, Castellsague X, Munoz N, Iscovich J, Chopita N, Jmelnitsky A. Alcohol, tobacco, diet, mate drinking and esophageal cancer in Argentina. Cancer Epidemiol Biomarkers Prev 1994;3:557-64.[Abstract]cancerlit;95128270
5 Rolon PA, Castellsague X, Benz M, Munoz N. Hot and cold mate drinking and esophageal cancer in Paraguay. Cancer Epidemiol Biomarkers Prev 1995;4:595-605.[Abstract]cancerlit;96070131
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