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Eur J Cancer Prev. 2016 Jul;25(4):344-8. doi: 10.1097/CEJ.0000000000000179.

Mouthwash use and cancer of the head and neck: a pooled analysis from the International Head and Neck Cancer Epidemiology Consortium.

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aThe Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai bDepartment of Population Health, Division of Epidemiology, New York University School of Medicine cNew York Eye and Ear Infirmary, New York, New York dDepartment of Family and Preventive Medicine, Division of Public Health, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah ePenn State College of Medicine, Hershey, Pennsylvania fUniversity of North Carolina School of Public Health, Chapel Hill, North Carolina gNational Cancer Institute, Bethesda hJohns Hopkins Medical Institute iJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland jUniversity of California at Los Angeles School of Public Health, Los Angeles, California kDepartment of Epidemiology and Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan lFred Hutchinson Cancer Research Center, Seattle, Washington mDana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA nCatalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat oConsortium of Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain pUniversity of Sao Paulo, Sao Paulo qNational School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro rFederal University of Pelotas, Pelotas sHospital de Clinicas de Porto Alegre, Porto Alegre, Brazil tInternational Prevention Research Institute, Lyon, France uInstitute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires, Argentina vInstitute of Oncology and Radiobiology, Havana, Cuba wMedical Informatics Center, Peking University, Beijing, China xDepartment of Clinical Sciences and Community Health, University of Milan, Milan, Italy.


Most mouthwashes contain alcohol, a known cause of head and neck cancer (oral cavity, pharynx, larynx), likely through the carcinogenic activity of acetaldehyde, formed in the oral cavity from alcohol. We carried out a pooled analysis of 8981 cases of head and neck cancer and 10‚ÄČ090 controls from 12 case-control studies with comparable information on mouthwash use in the International Head and Neck Cancer Epidemiology Consortium. Logistic regression was used to assess the association of mouthwash use with cancers of the oral cavity, oropharynx, hypopharynx, and larynx, adjusting for study, age, sex, pack-years of tobacco smoking, number of alcoholic drinks/day, and education. Compared with never users of mouthwash, the odds ratio (OR) of all head and neck cancers was 1.01 [95% confidence interval (CI): 0.94-1.08] for ever users, based on 12 studies. The corresponding ORs of cancer of the oral cavity and oropharynx were 1.11 (95% CI: 1.00-1.23) and 1.28 (95% CI: 1.06-1.56), respectively. OR for all head and neck cancer was 1.15 (95% CI: 1.01-1.30) for use for more than 35 years, based on seven studies (P for linear trend=0.01), and OR 1.31 (95% CI: 1.09-1.58) for use more than one per day, based on five studies (P for linear trend <0.001). Although limited by the retrospective nature of the study and the limited ability to assess risks of mouthwash use in nonusers of tobacco and alcohol, this large investigation shows potential risks for head and neck cancer subsites and in long-term and frequent users of mouthwash. This pooled analysis provides the most precise estimate of the association between mouthwash use and head and neck cancer.

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