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Carcinogenesis. 2017 Dec 7;38(12):1188-1195. doi: 10.1093/carcin/bgx106.

Aetiological heterogeneity of head and neck squamous cell carcinomas: the role of human papillomavirus infections, smoking and alcohol.

Author information

1
Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Saudi Arabia.
2
Division of Oral Health and Society, Faculty of Dentistry, McGill University, Canada.
3
Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Canada.
4
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, USA.
5
Department of Oncology, Division of Cancer Epidemiology, McGill University, Canada.
6
Department of Radiation Oncology, Hôpital Notre-Dame du Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada.
7
Department of Hemato-Oncology, Hôpital Notre-Dame du Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada.
8
Department of Microbiology and Infectious Diseases, Hôpital Notre-Dame du Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada.
9
Faculty of Medicine, McGill University, Department of Otolaryngology-Head and Neck Surgery, Canada.

Abstract

Tobacco and alcohol consumption are the main risk factors for head and neck squamous cell carcinoma (HNSCC). In addition, human papillomavirus (HPV) infection plays a causal role in oropharyngeal cancer (OPC), a subset of HNSCC. We assessed the independent effects of tobacco, alcohol and HPV infection on OPC risk in the head and neck cancer (HeNCe) Life study, a hospital-based case-control study of HNSCC with frequency-matched controls by age and sex from four Montreal hospitals. Interviewers collected information on socio-demographic and behavioural factors. We tested exfoliated oral cells for HPV DNA by polymerase chain reaction (PCR). We included only OPC cases (n = 188) and controls (n = 427) without missing values for HPV, smoking or alcohol. We examined associations by estimating odds ratios (ORs) and corresponding 95% confidence intervals (CI) using unconditional logistic regression. Smoking (OR = 1.90, 95% CI: 1.04-3.45) and alcohol (OR = 2.74, 95% CI: 1.45-5.15) were associated with an increased risk of OPC independent of HPV status. Positivity for HPV 16 among heavy smokers and heavy alcohol users was associated with a 30.4-fold (95% CI: 8.94-103.26) and 18.6-fold (95% CI: 5.75-60.13) elevation in risk of OPC relative to participants who were HPV negative, respectively. Moreover, the combined effect of heavy smoking and alcohol comsumption with HPV 16 infection substantially increased OPC risk (OR = 48.76, 95% CI: 15.83-150.17) and (OR = 50.60, 95% CI: 15.96-160.40), respectively. Our results support the independent roles of smoking, alcohol and HPV infection in OPC risk and a possible combined effect. Efforts should be made to tackle these major risk factors simultaneously.

PMID:
29029021
DOI:
10.1093/carcin/bgx106
[Indexed for MEDLINE]

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