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Evid Based Dent. 2010;11(3):89-90. doi: 10.1038/sj.ebd.6400744.

" Everything in moderation...? ".

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Dental Public Health Unit, University of Glasgow Dental School, Scotland, UK.



Data are from the International Head and Neck Cancer Epidemiology (INHANCE) Consortium of case-control studies of head and neck cancer.


15 case-control studies with detailed information on cigarette smoking and alcohol consumption were included.


The authors pooled data from 15 case-control studies and modelled the excess odds ratio (EOR) to assess risk by total exposure (pack-years and drink-years) and its modification by exposure rate (cigarettes/day and drinks/day).


The smoking analysis included 1761 laryngeal, 2453 pharyngeal and 1990 oral cavity cancers, and the alcohol analysis included 2551 laryngeal, 3693 pharyngeal and 3116 oval cavity cancers, with over 8000 controls. Above 15 cigarettes/day, the EOR/pack-year decreased with increasing cigarettes/day, suggesting that more cigarettes/day for a shorter duration was less deleterious than fewer cigarettes/day for a longer duration. Estimates of EOR/pack-year were homogeneous across sites, while the effects of cigarettes/day varied, indicating that the greater laryngeal cancer risk derived from differential cigarettes/day effects and not pack-years. EOR/drink-year estimates increased through 10 drinks/day, suggesting that more drinks/day for a shorter duration was more deleterious than fewer drinks/day for a longer duration. Above 10 drinks/day, data were limited. EOR/drink-year estimates varied by site, while drinks/day effects were homogeneous, indicating that the greater pharyngeal/oral cavity cancer risk with alcohol consumption derived from the differential effects of drink-years and not drinks/day.


We observed an inverse exposure rate effect for cigarette smoking above 15 cigarettes/day, whereby the strength of the association between head and neck cancer and pack-years decreased with cigarettes/day, and a direct exposure rate effect for drinks/day ≤10 drinks/day, whereby the strength of the association between head and neck cancer and total drink-years increased with drinks/day. Smoking risks were greater for the larynx than for the pharynx and oral cavity, while alcohol risks were greater for the pharynx and oral cavity. We found suggestive evidence that greater smoking-related risk of laryngeal cancer was derived primarily from the differential effects of cigarettes/day, while the effect of pack-years was similar by site, and that the greater alcohol-related risk for pharyngeal and oral cavity cancers was derived from a greater effect of total drink-years, while the modification of drink-years-related risk by drinks/day was similar for each site.

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