@article{3077693,
    title = "Alcohol drinking and head and neck cancer risk: the joint effect of intensity and duration",
    author = "Di Credico, G. and Polesel, J. and Dal Maso, L. and Pauli, F. and Torelli, N. and Luce, D. and Radoï, L. and Matsuo, K. and Serraino, D. and Brennan, P. and Holcatova, I. and Ahrens, W. and Lagiou, P. and Canova, C. and Richiardi, L. and Healy, C.M. and Kjaerheim, K. and Conway, D.I. and Macfarlane, G.J. and Thomson, P. and Agudo, A. and Znaor, A. and Franceschi, S. and Herrero, R. and Toporcov, T.N. and Moyses, R.A. and Muscat, J. and Negri, E. and Vilensky, M. and Fernandez, L. and Curado, M.P. and Menezes, A. and Daudt, A.W. and Koifman, R. and Wunsch-Filho, V. and Olshan, A.F. and Zevallos, J.P. and Sturgis, E.M. and Li, G. and Levi, F. and Zhang, Z.-F. and Morgenstern, H. and Smith, E. and Lazarus, P. and La Vecchia, C. and Garavello, W. and Chen, C. and Schwartz, S.M. and Zheng, T. and Vaughan, T.L. and Kelsey, K. and McClean, M. and Benhamou, S. and Hayes, R.B. and Purdue, M.P. and Gillison, M. and Schantz, S. and Yu, G.-P. and Chuang, S.-C. and Boffetta, P. and Hashibe, M. and Yuan-Chin, A.L. and Edefonti, V.",
    journal = "British Journal of Cancer",
    year = "2020",
    volume = "123",
    number = "9",
    pages = "1456-1463",
    publisher = "Springer Nature BV",
    issn = "0007-0920, 1532-1827",
    doi = "10.1038/s41416-020-01031-z",
    keywords = "adult;  alcohol consumption;  Article;  cancer risk;  case control study;  controlled study;  current drinker;  drinking behavior;  female;  head and neck cancer;  human;  hypopharynx cancer;  larynx cancer;  male;  mouth cancer;  oropharynx cancer;  priority journal;  risk factor;  smoking;  adolescent;  adverse event;  aged;  drinking behavior;  head and neck tumor;  larynx tumor;  middle aged;  mouth tumor;  oropharynx tumor;  pathology;  severity of illness index;  time factor;  very elderly;  young adult, Adolescent;  Adult;  Aged;  Aged, 80 and over;  Alcohol Drinking;  Case-Control Studies;  Female;  Head and Neck Neoplasms;  Humans;  Laryngeal Neoplasms;  Male;  Middle Aged;  Mouth Neoplasms;  Oropharyngeal Neoplasms;  Risk Factors;  Severity of Illness Index;  Smoking;  Time Factors;  Young Adult",
    abstract = "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. © 2020, The Author(s), under exclusive licence to Cancer Research UK."
}