Tobacco smoking, alcohol consumption, and risk of oral cancer: a case-control study in Beijing, People's Republic of China

Risk factors and incidence of oral tumors: Findings from a longitudinal population-based study

OBJECTIVE

This study investigated risk factors contributed to benign and malignant oral tumors using longitudinal cohort big data.

MATERIALS AND METHODS

We included individuals aged ≥40 years who participated in the National Health Examination in South Korea between 2003 and 2004. National Health Insurance claims data after 16 years were used to determine the incidence of oral tumors and the related risk factors. Hazard ratios were calculated using the Cox proportional hazard regression.

RESULTS

A total of 5,992,671 participants were included. The incidence of oral cancer was significantly higher in men and increased with age, whereas that of benign tumors was unaffected by sex and decreased with age. Periodontal disease was associated with the incidence of oral cancer but not benign tumors. Soft tissue diseases were associated with both benign and malignant tumors. Various systemic diseases influence the development of oral tumors. Light alcohol consumption reduced the incidence of oral tumors, whereas heavy alcohol consumption increased the incidence of malignant tumors only. Smoking increased the incidence of benign but not malignant tumors.

CONCLUSION

Recognized risk factors such as sex, age, comorbidities, and dental diseases were associated with oral tumors. Alcohol consumption and smoking were not significantly associated with malignant tumors.

Reduction of head and neck cancer risk following smoking cessation: a systematic review and meta-analysis

OBJECTIVE

Head and neck (HN) cancer comprises the neoplasms originating from the oral cavity, pharynx and larynx. We aimed at reviewing the available literature on the effect of smoking cessation on HN cancer risk.

METHOD

We conducted a systematic search in Medline, PubMed and Embase to June 2022. We abstracted or calculated relative risks (RR) and 95% CIs of HN cancer after cessation of tobacco smoking (both former smoking status and duration of quitting) and combined them using random effects meta-analyses. Papers included were case-control or cohort studies available in the English language. Studies investigating smoking cessation after cancer diagnosis, case reports, intervention studies or animal studies were excluded. Quality and susceptibility to bias of each included study were evaluated using the Newcastle-Ottawa Scale. Publication bias was assessed using funnel plot and Egger's test.

RESULTS

A total of 65 studies were included in the review, including 5 cohort and 60 case-control studies. The RR of HN cancer for former smokers compared with current smokers was 0.40 (95% CI 0.35 to 0.46). In an analysis by cancer site, the RR of oral cancer was 0.44 (95% CI 0.35 to 0.55), that of pharyngeal cancer 0.44 (95% CI 0.32 to 0.60) and that of laryngeal cancer 0.38 (95% CI 0.29 to 0.50). The dose-response meta-analysis was based on 37 studies. The RR per 10-year increase in smoking cessation was 0.47 (95% CI 0.43 to 0.52).

CONCLUSIONS

The risk of HN cancer declines within the first 5 years of quitting smoking. Quitting smoking is an essential element of HN cancer prevention.

TRIAL REGISTRATION NUMBER

The protocol has been deposited in the PROSPERO repository (CRD42022338262).

Adverse childhood experiences and smoking status in children: A systematic review and meta‐analysis

Adverse childhood experiences are a factor that can have a broad impact on different dimensions of health in different eras. This research aimed to investigate the relationship between adverse childhood experiences and smoking in children through a systematic review and meta‐analysis. Three databases, including PubMed, Web of Science and Scopus, were selected for manuscript searches. These three databases were searched until July 2022. This search was limited to English. For this study, the odds ratio or risk ratio and 95% confidence interval were extracted. The odds ratio pool was performed using the random‐effects method reported. An analysis was done based on the types of adverse childhood experiences and an analysis based on sex. The year of publication of the earliest and last publication included in this analysis was, respectively, 2003 and 2022. After screening the manuscripts, finally, 39 studies remained for this study. Adverse childhood experiences are associated with an increased risk of smoking in children [odds ratio 1.69; CI = 1.55–1.85; z = 11.80; p < 0.001; I2 = 92.6%]. Components of adverse childhood experiences, including emotional abuse, emotional neglect, physical abuse, physical maltreatment and physical neglect, were associated with increased smoking. The present study showed that adverse childhood experiences provide a context that increases the possibility of smoking in children. It is necessary to pay attention to the dimensions of health and behaviour in this group.

Prevalence of tobacco and areca-nut use among patients attending dental teaching hospital in the central province of Sri Lanka and its association with oral mucosal lesions; a cross sectional study

Introduction

Tobacco and areca-nut are risk factors for oral cancer and potentially malignant disorders. Oral cancer is ranked as the commonest among males in Sri Lanka (18.4 %). This research aims to determine the prevalence of tobacco and areca-nut use and its association with oral lesions.

Method

It is a cross-sectional study using 368 patients attending the Dental Diagnostic Clinic. Details of tobacco and areca-nut use were collected and participants were examined for mucosal lesions.

Results

It revealed that 23.9 % had tobacco use. Out of these, 41.1 %, 22.2 % and 36.7 % had smokeless-tobacco use, smoking and both, respectively. Similarly, 25.3 % had areca-nut/betel-quid use and majority (72.8 %) added tobacco to it. Tobacco (93.2 %) and areca-nut (79.6 %) use was higher among males (p < 0.05). Significant associations of areca-nut use with age (p = 0.001) and education level (p = 0.025) were noted. Oral lesions like de-pigmentation, white patches, ulcers, growths and oral sub-mucous fibrosis (OSF) had prevalences of 2.4 % each. Prevalence of pigmentation, lobulated tongue and erosive lesions was 10.6 %, 4.6 % and 1.4 %, respectively. 32.6 % had abnormalities like linea-alba, periodontal problems, pericoronitis and hairy tongue. The study revealed that >90 % of those who used tobacco and areca-nut had oral lesions (p < 0.05).

Conclusion

The prevalence of tobacco and areca-nut use is high among patients attending the Dental Teaching Hospital, and its association with mucosal lesions is significant. Hence regular awareness programs on the adverse effects of tobacco and areca-nut use should be carried out at the Diagnostic clinic as a preventive measure.

Association of age at menarche with gestational hypertension and preeclampsia: A large prospective cohort in China

This study explored the potential association between age at menarche and the risks of gestational hypertension and preeclampsia in Chinese women. Data were sourced from the China-US Collaborative Project for Neural Tube Defects Prevention, a large population-based cohort study. Our study consisted of 209 411 women pre-registered for pregnancy in two provinces in South China. Trained healthcare workers measured blood pressure at registration and recorded other pertinent health information. Using logistic regression, we assessed the correlations between age at menarche and the likelihood of developing gestational hypertension and preeclampsia, considering confounders such as maternal age, body mass index, ethnicity, parity, folic acid supplementation, education level, and occupation. The observed incidences for gestational hypertension and preeclampsia were 9.65% and 2.54%, respectively. The adjusted odds ratios (ORs) for gestational hypertension, based on age at menarche, were as follows: ≤13 years, 1.18 (95% confidence interval: 1.11-1.26); 14 years, 1.09 (1.04-1.15); 15 years, 1.11 (1.06-1.16); 16 years, 1.06 (1.01-1.12); and ≥17 years, 1.00 (reference; P for trend < .001). The correlation between age at menarche and preeclampsia varied across age groups, with the following respective ORs: 1.35 (1.20-1.52), 1.21 (1.09-1.34), 1.27 (1.15-1.39), 1.14 (1.03-1.26), and 1.00 (reference; P for trend < .001). This association appeared to be more pronounced in women with no folic acid supplementation and those with a lower education level. In conclusion, an earlier age at menarche seems to be linked to increased risks of gestational hypertension and preeclampsia.

Modifiable risk factors for oral cavity cancer in non-smokers: A systematic review and meta-analysis

BACKGROUND

Oral cavity cancer (OCC) is traditionally associated with smoking, but there is an increasing prevalence of the disease among non-smokers. This review investigates possible modifiable risk factors in the development of OCC in non-smokers (OCCNS).

METHODS

PubMed, EMBASE, Web of Science, and Scopus were searched for publications prior to June 2021. Comparative studies investigating modifiable OCCNS risk factors were identified following PRISMA guidelines. Publication date, population size, and results were indexed. Study quality was assessed using MINORS (Methodological Index for Non-Randomized Studies). Factors examined by multiple studies were analyzed using random-effect meta-analysis framework.

RESULTS

Literature search resulted in 1,625 unique publications. 52 records met inclusion criterion, investigating alcohol (n = 22), chewing products (n = 18), diet (n = 7), dental health (n = 11), and medical comorbidities (n = 6).

CONCLUSION

This review demonstrates the paucity of large studies investigating OCCNS risk factors. Further investigation is warranted to help clinicians risk-stratify patients without traditional risk factors.

Role of Toothbrushes as Gene Expression Profiling Tool for Oral Cancer Screening in Tobacco and Alcohol Users

AIM

The use of toothbrushes was investigated as a potential RNA source and gene expression profiling tool for oral cancer screening in tobacco and alcohol users.

METHODOLOGY

A total of 20 subjects were selected on the basis of inclusion and exclusion criteria. They were divided into two groups: group I-healthy controls (n = 6); group II-individuals who consume tobacco and alcohol (n = 14). After the volunteers brushed their teeth using a soft-bristle toothbrush with ~0.5 gm of toothpaste, the toothbrushes were collected, and the gene expression of BAX, BCL2, CDK4, CKDN2A, GNB3, and TCF7L2 was assessed.

RESULTS

The gene expression of BAX decreased significantly in alcoholics and smokers (0.13867 ± 0.12014), while the gene expression of BCL2 increased in alcoholics and smokers (1.91001 ± 0.90425) in comparison with healthy controls (p = 0.0054 and p = 0.0055). Although there was increased expression of CDK4, CKDN2A, and TCF7L2 and decreased expression of GNB3 in smokers and alcoholics, the results were not significant.

CONCLUSIONS

A toothbrush is a good source of RNA, and gene expression analysis can be performed using the genetic material retrieved from toothbrushes, which can aid in the early diagnosis of oral squamous cell carcinoma among tobacco and alcohol users. Further studies with a larger sample size and different durations of toothbrush use should be conducted to explore the role of toothbrushes as a noninvasive tool for disease diagnosis.

Epigenetic Analyses of Alcohol Consumption in Combustible and Non-Combustible Nicotine Product Users

Alcohol and tobacco use are highly comorbid and exacerbate the associated morbidity and mortality of either substance alone. However, the relationship of alcohol consumption to the various forms of nicotine-containing products is not well understood. To improve this understanding, we examined the relationship of alcohol consumption to nicotine product use using self-report, cotinine, and two epigenetic biomarkers specific for smoking (cg05575921) and drinking (Alcohol T Scores (ATS)) in n = 424 subjects. Cigarette users had significantly higher ATS values than the other groups (p < 2.2 × 10⁻¹⁶). Using the objective biomarkers, the intensity of nicotine and alcohol consumption was correlated in both the cigarette and smokeless users (R = −0.66, p = 3.1 × 10⁻¹⁴; R² = 0.61, p = 1.97 × 10⁻⁴). Building upon this idea, we used the objective nicotine biomarkers and age to build and test a Balanced Random Forest classification model for heavy alcohol consumption (ATS > 2.35). The model performed well with an AUC of 0.962, 89.3% sensitivity, and 85% specificity. We conclude that those who use non-combustible nicotine products drink significantly less than smokers, and cigarette and smokeless users drink more with heavier nicotine use. These findings further highlight the lack of informativeness of self-reported alcohol consumption and suggest given the public and private health burden of alcoholism, further research into whether using non-combustible nicotine products as a mode of treatment for dual users should be considered.

Binge drinking: Prevalence, correlates, and expectancies of alcohol use among individuals with first-episode psychosis

AIM

This study examines the prevalence and correlates of binge drinking and its association with expectancies of alcohol use, within a sample of patients with first-episode psychosis enrolled in the Early Psychosis Intervention Programme (EPIP) in Singapore's Institute of Mental Health.

METHODS

A total of 280 patients from the EPIP were recruited for an on-going longitudinal study examining cigarette smoking and alcohol habits. Only baseline data were used, pertaining to socio-demographics, alcohol use, clinical symptomology, quality of life, and expectancies of alcohol use.

RESULTS

Overall 23.9% (N = 67) reported ever binge drinking in their lifetime, and 11.4% (N = 32) had binged in the past 2 weeks. Controlling for all other socio-demographic and clinical factors, binge drinking was significantly associated with higher education levels, having children, current or past history of cigarette smoking, and lower negative symptom scores. Binge drinkers were also more likely to endorse statements relating to the themes of enhancement seeking (ie, using alcohol to alter or enhance experiences in a pleasurable way), coping with distress, and socializing-related expectancies of alcohol use.

CONCLUSION

Similar to past studies, the prevalence of binge drinking among our first-episode sample was relatively high. Our findings suggest certain lifestyle and social factors associated with risky drinking behaviour that future prevention efforts may address. Additionally, the three motivations of enhancement seeking, coping, and socializing also suggest psychological processes and coping styles that could be targeted for interventions.

Tobacco smoking, alcohol drinking, betel quid chewing, and the risk of head and neck cancer in an East Asian population

BACKGROUND

The smoking prevalence among men in China is high, but the head and neck cancer incidence rates are low. This study's purpose was to investigate the impact of tobacco, betel quid, and alcohol on head and neck cancer risk in East Asia.

METHODS

A multicenter case-control study (921 patients with head and neck cancer and 806 controls) in East Asia was conducted. The odds ratio (OR) and 95% confidence interval (CI) were estimated using logistic regression.

RESULTS

Head and neck cancer risks were elevated for tobacco (OR = 1.58), betel quid (OR = 8.23), and alcohol (OR = 2.29). The total attributable risk of tobacco and/or alcohol was 47.2%. Tobacco/alcohol appeared to account for a small proportion of head and neck cancer among women (attributable risk of 2.2%). Betel quid chewing alone accounted for 28.7% of head and neck cancer.

CONCLUSIONS

Betel quid chewing is the strongest risk factor for oral cavity cancer in this Chinese population. Alcohol may play a larger role for head and neck cancer in this population than in European or U.S.

POPULATIONS

Tobacco and alcohol use disorders: Evaluating multimorbidity

There is growing interest in applying the multimorbidity model for mental health disorders - i.e. the interactive effects of co-occurring diagnoses. Alcohol use disorder (AUD) and tobacco use disorder (TUD) often occur together, but distinctive correlates of their co-occurrence have not been studied. Veterans treated by the Veterans Health Administration (VHA) nationally in FY 2012 with diagnoses of both AUD and TUD were compared to those with only AUD or only TUD on socio-environmental factors, medical and psychiatric diagnoses, and service use. Multimorbid effects were defined as those in which patients with both AUD and TUD had more serious problems greater likelihood of specific co-occurring conditions than those with either AUD alone or TUD alone. Veterans with concurrent AUD and TUD (N=153,397), as compared to those with AUD only (N=191,900) or with TUD only (N=643,377), had significantly higher rates of homelessness [odd ratios (ORs)=1.24, 1.68], hepatic disease (ORs=1.11, 2.18), substance use disorders (ORs=1.42, 3.14), receipt of a VA disability pension (ORs=1.26, 1.30) and use of substance and mental health outpatient services (ORs=1.04, 1.12). Veterans with AUD and TUD appear to have more severe problems in some, but not all, socio-environmental, medical, psychiatric, and service use domains than veterans with either of these diagnoses alone. The combination of AUD and TUD yield generally more adverse effects in diverse areas and thus reflect an emergent phenomenon that may a require a distinctive treatment approach.

Psychopharmacology of Tobacco and Alcohol Comorbidity: a Review of Current Evidence

Purpose of the Review

Comorbidity of alcohol and tobacco use is highly prevalent and may exacerbate the health effects of either substance alone. However, the mechanisms underlying this comorbidity are not well understood. This review will examine the evidence for shared neurobiological mechanisms of alcohol and nicotine comorbidity and experimental studies of the behavioural consequences of these interactions.

Recent Findings

Studies examining the shared neurobiology of alcohol and nicotine have identified two main mechanisms of comorbidity: (1) cross-reinforcement via the mesolimbic dopamine pathway and (2) cross-tolerance via shared genetic and nAChR interaction. Animal and human psychopharmacological studies demonstrate support for these two mechanisms of comorbidity.

Summary

Human behavioural studies indicate that (1) alcohol and tobacco potentiate each other’s rewarding effects and (2) nicotine reduces the sedative and intoxication effects of alcohol. Together, these findings provide a strong evidence base to support the role of the cross-reinforcement and cross-tolerance as mechanisms underlying the comorbidity of alcohol and tobacco use. Methodological concerns in the literature and recommendations for future studies are discussed alongside implications for treatment of comorbid alcohol and tobacco use.

Cutaneous Effects of Smoking

Background:

Cigarette smoking is the single biggest preventable cause of death and disability in developed countries and is a significant public health concern. While known to be strongly associated with a number of cardiovascular and pulmonary diseases and cancers, smoking also leads to a variety of cutaneous manifestations.

Objective:

This article reviews the effects of cigarette smoking on the skin and its appendages.

Methods:

A literature review was based on a MEDLINE search (1966–2004) for English-language articles using the MeSH terms cutaneous, dermatology, tobacco, skin, and smoking. An additional search was subsequently undertaken for articles related to smoking and associated mucocutanous diseases, with the focus on pathogenesis and epidemiologic data. Articles presenting the highest level of evidence and latest reports were preferentially selected.

Results:

Smoking is strongly associated with numerous dermatologic conditions including poor wound healing, wrinkling and premature skin aging, squamous cell carcinoma, psoriasis, hidradenitis suppurativa, hair loss, oral cancers, and other oral conditions. In addition, it has an impact on the skin lesions observed in diabetes, lupus, and AIDS. The evidence linking smoking and melanoma, eczema, and acne is inconclusive. Anecdotal data exist on the possible protective effects of smoking in oral/genital aphthosis of Behçet's disease, herpes labialis, pyoderma gangrenosum, acral melanoma, and Kaposi's sarcoma in AIDS patients.

Conclusions:

An appreciation of the adverse cutaneous consequences of smoking is important. Dermatologists can play an integral role in promoting smoking cessation by providing expert opinion and educating the public on the deleterious effects of smoking on the skin.

Long-Term Alcohol Consumption and Breast, Upper Aero-Digestive Tract and Colorectal Cancer Risk: A Systematic Review and Meta-Analysis

AIMS

Cancers of female breast, upper aero-digestive tract (UADT) (oral cavity, pharynx, larynx, oesophagus) and colorectum are causally related to alcohol consumption. Although alcohol consumption is likely to vary during life, the few studies that have explicitly measured lifetime consumption or intake over time have not been summarised. We therefore conducted a systematic review and meta-analysis.

METHODS

Studies were identified by searching the Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Scopus databases through January 2015 using broad search criteria. Studies reporting relative risks (RR) for quantitatively defined categories of alcohol consumption over time for breast, UADT or colorectal cancer were eligible. A two-stage random-effects meta-analysis was used to estimate a dose-response relationship between alcohol intake and each cancer site. RRs were also calculated for the highest relative to the lowest intake category.

RESULTS

Sixteen articles for breast, 16 for UADT and 7 for colorectal cancer met the eligibility criteria. We observed a weak non-linear dose-response relationship for breast cancer and positive linear dose-response relationships for UADT and colorectal cancer. The pooled RRs were 1.28 (95% confidence interval, CI: 1.07, 1.52) for breast, 2.83 (95% CI: 1.73, 4.62) for UADT, 4.84 (95% CI: 2.51, 9.32) for oral cavity and pharynx, 2.25 (95% CI: 1.49, 3.42) for larynx, 6.71 (95% CI: 4.21, 10.70) for oesophageal and 1.49 (95% CI: 1.27, 1.74) for colorectal cancer.

CONCLUSION

Our findings confirm dose-dependent associations between long-term alcohol intake and breast, UADT and colorectal cancer.

High Prevalence of Tobacco Use and Associated Oral Mucosal Lesion Among Interstate Male Migrant Workers in Urban Kerala, India

Background:

Kerala is a highly urbanized state in India and interstate migrant laborers working there forms a marginalized community. It was generally perceived that use of tobacco and alcohol was high among the workers, but there are no epidemiological studies assessing the actual burden.

Objectives:

To estimate the prevalence of use of tobacco and also the prevalence of oral mucosal lesions associated with such use consumption among the adult male interstate migrant workers in North Kerala.

Materials and Methods:

A cross sectional study was carried out among male migrant workers above 18 years working in different factories in urban parts of Kannur district. Total of 244 participants attending routine health check-up camp were assessed for the use of tobacco/alcohol, type, frequency and duration of their use by a questionnaire. The trained dental interns conducted oral cavity examination for detecting oral mucosal lesions associated with tobacco use.

Results:

The prevalence of current use of smoked tobacco, smokeless tobacco and alcohol use were 41.8%, 71.7% and 56.6%, respectively among migrants. Oral mucosal lesions (OML) were seen in 36.3% of participants. Among smokeless tobacco users, 44.6% had lesions. Adjusted odds ratio for OML was 4.5 (CI: 1.9 - 19.84) among smokeless tobacco users.

Conclusions:

The current use of smokeless tobacco and oral mucosal lesions are highly prevalent among migrant workers.

Oral lesions, chronic diseases and the risk of head and neck cancer

OBJECTIVES

The aim of our study is to explore the role of the history of oral lesions and chronic diseases on the risk of head and neck cancer in a Chinese population.

MATERIALS AND METHODS

Our case-control study included 921 head and neck cancer cases and 806 controls. We obtained medical history information by administering questionnaires to both cases and controls. We used unconditional logistic regression to estimate odds ratios for oral lesions and chronic conditions.

RESULTS

Oral submucous fibrosis (OR=24.24, 95% CI=7.39-79.52), oral leukoplakia (OR=4.05, 95% CI=2.44-6.71) and repetitive dental ulcers (OR=5.12, 95% CI=3.17-8.28) increased the risk of HNC. Depression was associated with HNC risk when adjusted for several covariates (OR=2.10, 95% CI=1.06-4.15), but the association was not statistically significant after adjusting for smoking and alcohol drinking (OR=1.53, 95% CI=0.72-3.25). Also, the crude OR suggested an association between diabetes and HNC risk (OR=1.51, 95% CI=1.09-2.11), but it was not significant after adjusting for confounders.

CONCLUSION

Our study reported on strong associations between HNC risk and oral leukoplakia, oral submucous fibrosis, which is consistent with prior research. We also observed repetitive dental ulcer to be associated with HNC risk. Future studies may focus on studying the association between depression and HNC, using medical records or psychological evaluation results to get more accurate information about depression, with careful assessment of tobacco and alcohol history.

Different levels in alcohol and tobacco consumption in head and neck cancer patients from 1957 to 2013

Objective

To provide a precise quantification of the association between alcohol and tobacco consumption trends in head and neck cancer patients over the past 45 years.

Methods

We combined findings from all studies published until March 2014 and evaluated the association between different levels in alcohol and tobacco consumption and head and neck cancers through a meta-analytic approach.

Results

We included 28 studies involving 13830 patients with head and neck cancer. In patients with alcohol consumption, the pooled odds ratio (OR) and 95% confidence interval (CI) were 1.29(1.06-1.57), 2.67(2.05-3.48) and 6.63(5.02-8.74) for light drinkers, moderate drinkers and heavy drinkers, respectively. In patients with tobacco consumption, the pooled OR and 95% CI were 2.33(1.84-2.95), 4.97(3.67-6.71) and 6.77(4.81-9.53) for light smokers, moderate smokers and heavy smokers, respectively.

Conclusion

The increased alcohol and tobacco consumption trends increased the risk of head and neck cancer over the past 45 years. Tobacco consumption was found to be a stronger risk factor for head and neck cancer than alcohol consumption. Thus, the control should be considered to limit the intake of alcohol and tobacco.

Interaction of alcohol use and specific types of smoking on the development of oral cancer

BACKGROUND

Oral cancer is one of the most common life threatening diseases all over the world, in particular in Asian countries, and tobacco and alcohol are considered to be the most potent risk factors for oral cancer.

OBJECTIVES

The aim of this study was to examine the combined effect of smoking types and alcohol consumption on the development of oral cancer.

PATIENTS AND METHODS

A case-control study of 350 cases and 350 controls over a period of 19 months in the time period between February 2005 and September 2006 was carried out in Pune, India. The self-reported information about their consumption of alcohol and smoking behaviors was collected by structured questionnaires. The data was analyzed by SPSS software package. Risk analysis was performed using conditional logistic regression, which provides results in the form of crude odd ratios.

RESULTS

The smoking as well as alcohol drinking rates in the subjects of the case group were significantly higher than the controls. Of smoking types, bidi (a hand rolled cigarette) (OR = 4.1, 95% CI = 2.4-6.9), and among alcohol types, hard liquor (OR = 2.6, 95% CI = 1. 4-6.4), country liquor (OR = 2.5, 95% CI = 1.3-3.6) and beer (OR = 2.2, 95% CI = 1.2-5.0), showed a strong association with oral cancer. A significant interaction effect was found between alcohol consumption and bidi smoking (OR = 19.6, 95% CI = 4.6-83.5) followed by alcohol and non-filtered cigarette (OR = 4.2, 95% CI = 1.8-12.0) as well as filtered-cigarette (OR = 2.3, 95% CI = 1.1-5.0).

CONCLUSIONS

We conclude that oral cancer is etiologically related to the interaction between smoking and drinking.

Smokers report greater demand for alcohol on a behavioral economic purchase task

OBJECTIVE

Cigarette smokers have higher levels of alcohol consumption than nonsmokers and poorer response to alcohol treatment. It is possible that the greater severity of alcohol problems observed in smokers reflects a greater susceptibility to alcohol-related reinforcement. The present study used a behavioral economic purchase task to investigate whether heavy drinking smokers would have greater demand for alcohol than heavy drinking nonsmokers.

METHOD

Participants were 207 college students who reported at least one heavy drinking episode in the past month. Of the 207 participants, 33.2% (n = 67) reported smoking cigarettes at least 1 day in the past month. Participants completed the hypothetical alcohol purchase task, a simulation task that asked them to report how many drinks they would purchase at varying price increments.

RESULTS

After the participants' reported alcohol consumption, gender, alcohol problems, and depression were controlled for, analyses of covariance revealed that heavy drinking smokers had significantly greater reported maximum alcohol expenditures (Omax), greater maximum inelastic price (Pmax), and higher breakpoint values (first price suppressing consumption to zero).

CONCLUSIONS

College student heavy drinkers who also smoke cigarettes exhibit increased demand for alcohol. Smokers in this high-risk developmental stage may thus be less sensitive to price and other contingencies that would otherwise serve to modulate drinking and may require more intensive intervention approaches.

Tobacco smoking, alcohol drinking and risk of oral cavity cancer by subsite: results of a French population-based case-control study, the ICARE study

The objective was to examine the role of tobacco smoking and alcohol drinking in the incidence of oral cavity cancer by subsite in France, a high-incidence area. We analysed detailed data on lifelong tobacco smoking and alcohol drinking from 772 oral cavity cancer cases and 3555 controls included in a population-based case-control study, the ICARE study. Tobacco smoking increased the risk of oral cavity cancer even for the smaller quantities and durations, whereas alcohol drinking increased this risk only in heavy drinkers who were also ever smokers. The combined effect of smoking and drinking was greater than multiplicative. The floor of the mouth was the subsite that was the most affected by the harmful effects of tobacco and alcohol, whereas the gums were less susceptible. The risk associated with tobacco and alcohol consumption did not differ between intraoral cavity and subsites usually included in the oropharynx (soft palate and base of the tongue). Population-attributable risks for oral cavity cancer were 78.6% for tobacco smoking, 7.3% for alcohol drinking and 80.7% for tobacco and/or alcohol consumption. These results indicate that regular oral check-ups should be targeted at smokers and heavy drinkers, and that prevention efforts should be focused on smoking cessation.

Lentiviral vector-based therapy in head and neck cancer (Review)

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common neoplasm worldwide. Despite advances in multimodality treatments involving surgery, radiation and chemotherapy, the five-year survival rate has remained at ~50% for the past 35 years. Therefore, the early detection of recurrent or persistent disease is extremely important. Replication-incompetent HIV-1-based lentiviral vectors have emerged as powerful and safe tools for gene delivery. Commonly, HNSCC is a locoregional disease that presents at or close to the body surface. Thus, HNSCC is amendable to intratumoral injections of gene therapy vectors aimed at correcting defects associated with tumor suppressor genes to induce the direct cytotoxicity of cancer cells or immune modulation to promote antitumor immunity. Current investigations analyzing HNSCC gene mutations and stem cell markers and the cancer immunoediting concept are creating exciting therapeutic opportunities for lentiviral and other gene transfer vectors. The present review reports specific examples of the current applications of lentiviral vectors in HNSCC.

Cigarette, cigar, and pipe smoking and the risk of head and neck cancers: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium

Cigar and pipe smoking are considered risk factors for head and neck cancers, but the magnitude of effect estimates for these products has been imprecisely estimated. By using pooled data from the International Head and Neck Cancer Epidemiology (INHANCE) Consortium (comprising 13,935 cases and 18,691 controls in 19 studies from 1981 to 2007), we applied hierarchical logistic regression to more precisely estimate odds ratios and 95% confidence intervals for cigarette, cigar, and pipe smoking separately, compared with reference groups of those who had never smoked each single product. Odds ratios for cigar and pipe smoking were stratified by ever cigarette smoking. We also considered effect estimates of smoking a single product exclusively versus never having smoked any product (reference group). Among never cigarette smokers, the odds ratio for ever cigar smoking was 2.54 (95% confidence interval (CI): 1.93, 3.34), and the odds ratio for ever pipe smoking was 2.08 (95% CI: 1.55, 2.81). These odds ratios increased with increasing frequency and duration of smoking (Ptrend ≤ 0.0001). Odds ratios for cigar and pipe smoking were not elevated among ever cigarette smokers. Head and neck cancer risk was elevated for those who reported exclusive cigar smoking (odds ratio = 3.49, 95% CI: 2.58, 4.73) or exclusive pipe smoking (odds ratio = 3.71, 95% CI: 2.59, 5.33). These results suggest that cigar and pipe smoking are independently associated with increased risk of head and neck cancers.

Role of GRB2-associated binder 1 in epidermal growth factor receptor-induced signaling in head and neck squamous cell carcinoma

The epidermal growth factor receptor (EGFR) plays an important role in the pathogenesis of head and neck squamous cell carcinoma (HNSCC). Despite the high expression of EGFR in HNSCC, EGFR inhibitors have only limited success as monotherapy. The Grb2-associated binder (GAB) family of adaptor proteins acts as docking/scaffolding molecules downstream of tyrosine kinase receptors. We hypothesized that GAB1 may amplify EGFR-induced signaling in HNSCCs and therefore could play a role in the reduced sensitivity of HNSCC to EGFR inhibitors. We used representative human HNSCC cell lines overexpressing wild type EGFR, and expressing GAB1 but not GAB2. We demonstrated that baseline Akt and MAPK signaling were reduced in HNSCC cells in which GAB1 expression was reduced. Furthermore, the maximal EGF-induced activation of the Akt and MAPK pathway was reduced and delayed, and the duration of the EGF-induced activation of these pathways was reduced in cells with GAB1 knock-down. In agreement with this, HNSCC cells in which GAB1 levels were reduced showed an increased sensitivity to the EGFR inhibitor gefitinib. Our work demonstrates that GAB1 plays an important role as part of the mechanism of by which EGFR induces induced activation of the MAPK and AKT pathway. Our results identify GAB1 as an amplifier of the EGFR-initiated signaling, which may also interfere with EGFR degradation. These findings support the emerging notion that reducing GAB1 function may sensitize HNSCC to EGFR inhibitors, hence representing a new therapeutic target HNSCC treatment in combination with EGFR targeting agents.

A review of risk factors for oral cavity cancer: the importance of a standardized case definition

The aim of this work is to review the literature on risk factors of oral cavity cancer with a special attention to the definition of the cases, in order to highlight special features of these cancers and of their subsites. PubMed database was systematically searched to access relevant articles published between 1980 and 2010. Reference lists of selected papers were examined to identify further articles. One hundred and two studies met the inclusion criteria. Their results were difficult to compare because of the lack of uniformity in defining oral cavity. In addition, few studies examined risk factors other than alcohol and tobacco, and studies differentiating between subsites were rare. Despite these limitations, some characteristics of oral cavity cancers may be emphasized: smoked tobacco seems to be a stronger risk factor for oral cavity cancer than alcohol, and the floor of the mouth seems to be more sensitive to the harmful effects of alcohol and smoked tobacco. Studies limited strictly to oral cavity cancers and distinguishing between subsites are needed to better understand the aetiology of these cancers, and better define risk groups to target prevention efforts and screening.

The effect of tobacco and alcohol and their reduction/cessation on mortality in oral cancer patients: short communication

Background

The use of tobacco is known to increase the incidence of developing oral cancer by 6 times, while the additive effect of drinking alcohol further increases the risk leading to higher rate of morbidity and mortality. In this short communication, we prospectively assessed the effect of tobacco smoking and alcohol drinking in oral cancer patients on the overall mortality from the disease, as well as the effect of smoking and drinking reduction/cessation at time of diagnosis on mortality in the same group.

Materials and methods

A cohort, involved 67 male patients who were diagnosed with oral squamous cell carcinoma, was included in this study. The smoking and drinking habits of this group were recorded, in addition to reduction/cessation after diagnosis with the disease. Comparisons were made to disease mortality at 3 and 5 years.

Results

Follow-up resulted in a 3-year survival of 46.8% and a 5-year survival of 40.4%. Reduction of tobacco smoking and smoking cessation led to a significant reduction in mortality at 3 (P < 0.001) and 5 (P < 0.001) years. Reduction in drinking alcohol and drinking cessation led to a significant reduction in mortality at 3 (P < 0.001) and 5 (P < 0.001) years.

Conclusion

Chronic smoking and drinking does have an adverse effect on patients with oral cancer leading to increased mortality from cancer-related causes. Reduction/cessation of these habits tends to significantly reduce mortality in this group of patients. Smoking and drinking cessation counseling should be provided to all newly diagnosed oral cancer patients.

Tobacco smoking in China: prevalence, disease burden, challenges and future strategies

About one-third of the world's tobacco is produced and consumed in China. Despite existing tobacco control policies and activities, the prevalence of smoking in China remains high with 350 million smokers and 740 million passive smokers. Furthermore, smoking rates in the young population and in females are increasing. The number of deaths attributed to tobacco use has reached 1.2 million per year, whereas the death toll is expected to rise to 2 million annually by 2025. Sociocultural factors favouring smoking initiation, lack of awareness among the public about the hazards of smoking, weak support from the government and strong resistance from the tobacco industry are major reasons for the lack of effectiveness of current tobacco control measures. Effective intervention efforts are urgently required. Commitments from the government are crucial in tobacco control. Firm action should be taken on tobacco control issues at multiple levels including a reduction in tobacco supply, increased tobacco taxation, increased education, tobacco advertising limitations, decreased second-hand smoke exposure and smoking cessation support. The health-care community should also play a leading role in anti-tobacco campaigns and take a more active role in smoking cessation programmes.

Trends in oral, pharyngeal and oesophageal cancer mortality in Australia: the comparative importance of tobacco, alcohol and other risk factors

OBJECTIVE

The relationship of long-term population-level trends in oral, pharyngeal and oesophageal cancer mortality with major risk factors such as tobacco consumption have not been statistically analysed in Australia. We have demonstrated the long-term implications using historical data.

METHODS

Estimated age and sex-specific tobacco consumption back-extrapolated to 1887 were used together with alcohol and fruit and vegetable consumption data to examine their association with trends in oral, pharyngeal and oesophageal cancer mortality. Log-linear Poisson regression models were applied to specify the relationship with oesophageal and pharyngeal mortality data.

RESULTS

Oral cancer mortality for males decreased sharply in the first half of the 20th Century in contrast to steadily rising tobacco consumption. Female oral and pharyngeal cancer remained steady at low levels. Post-World War II male and female oesophageal and male pharyngeal cancer mortality rose, then either fell or stabilised, without a clear relationship with risk factors.

CONCLUSIONS

Tobacco and alcohol consumption have influenced post-World War II trends in oral, pharyngeal and oesophageal cancer mortality. However, the challenges in using historical population level data prevent precise interpretation of findings.

IMPLICATIONS

There is increased exposure to risk factors for these cancers in many low- and middle-income countries. In particular, smoking cessation programs are needed to prevent increases in mortality from these cancers in such countries.

Alcohol consumption and cancers of the oral cavity and pharynx from 1988 to 2009: an update

Evidence for the human carcinogenic effects of alcohol consumption on the risk of cancers of the oral cavity and pharynx has been considered sufficient in the International Agency for Research on Cancer Monograph 44 on alcohol and cancer in 1988. We evaluated human carcinogenic evidence related to the risk of oral and pharyngeal cancers based on cohort and case-control studies published from 1988 to 2009. A large body of evidence from epidemiological studies of different designs and conducted in different populations has consistently supported the fact that alcohol consumption is strongly associated with an increase in the risk of oral and pharyngeal cancers. The relative risks are 3.2-9.2 for more than 60 g/day (or more than four drinks/day) when adjusted for tobacco smoking and other potential confounders. A strong dose-response effect on the intensity of alcohol use is reported in most of the studies. However, no apparent association is observed for the duration of alcohol use. Compared with current alcoholics, a decreased risk of approximately 10 to 15 years is associated with alcohol cessation. Similar associations have been observed among nonsmokers in over 20 studies. In general, the dominant type of alcohol consumption in each population is associated with the greatest increase in risk. A large number of studies on joint exposure to alcohol and tobacco consumption show a greater than multiplicative synergistic effect.

Tobacco and the skin

Smoking negatively impacts the health of the skin as it does every organ system. This contribution reviews the effect of cigarette smoking on wound healing, wrinkling, and aging of the skin, skin cancer, psoriasis, and other inflammatory skin diseases, hidradenitis suppurativa, acne, alopecia, lupus erythematosus, polymorphous light eruption, and tobacco-associated oral lesions. Dermatologists need to encourage their patients to discontinue this deleterious habit.

Relationship between Selected Socio-Demographic Factors and Cancer of Oral Cavity - A Case Control Study

The aim of this study was to recognize factors associated with cancer of oral cavity considering socio-demographic characteristics. The cases were 350 with squamous-cell carcinoma of oral cavity diagnosed between 2005 and 2006 in Morbai, Narandia, Budharani Cancer Institute, Pune, India. Similar number of controls match for age and sex selected from the background population. Cases and controls were interviewed for tobacco related habits and general characteristics; age, gender, education and possible socio-demographic factors. Chi-square test in uni-variate analysis and estimate for risk showed that education, occupation and monthly household income were significantly different between cases and controls (P < 0.001). Irrespective to gender, relative risk, here odds ratio, (OR) of low level of education (OR = 5.3, CI 3.7-7.6), working in field as a farmer (OR = 2.5, CI 1.7-3.7), and monthly household income less than 5000 Indian Rupees currency (OR = 1.7, CI 1.2-2.3) were significant risk factors for oral cancer. While, there was no significant relationship between religious and or marital status either in males or females.

The risk of upper aero digestive tract cancer associated with smoking, with and without concurrent alcohol consumption

BACKGROUND

Smoking and alcohol are major causal factors for upper aerodigestive tract cancer, but reliable quantification of the combined impact of smoking and alcohol on this cancer and its major subtypes has not been performed.

METHODS

A meta-analysis of studies that had published quantitative estimates of smoking and upper aerodigestive tract cancer by January 2007 was performed. Pooled estimates of relative risks were obtained. Publication bias was investigated through funnel plots and corrected if found to be present.

RESULTS

Overall, 85 studies with information on 53,940 individuals with upper aerodigestive tract cancer were included. The pooled estimate for the association between smoking and the risk of this cancer was 3.47 (95% confidence interval, 3.06-3.92). The risk remained elevated for a decade after smoking cessation but declined thereafter. Individuals who both smoked and consumed alcohol had double the risk of upper aerodigestive tract cancer in comparison with those who only smoked: the relative risk was 6.93 (95% confidence interval, 4.99-9.62) for the former and 2.56 (95% confidence interval, 2.20-2.97) for the latter (P < 0.001).

CONCLUSIONS

Public health interventions that simultaneously discourage smoking and heavy drinking would have greater benefits than would be expected from those that target only one of these risk factors.

Characterization of initial clinical symptoms and risk factors for sinonasal adenocarcinomas: results of a case-control study

PURPOSE

Sinonasal adenocarcinoma is a rare cancer, frequently associated with occupational exposure to inhalable wood dust. Among the EU member States, Germany was reported to have the highest number of exposed workers. Location and long latency make early diagnosis difficult. This case-control study was aimed at assessing potential risk factors and at characterizing initial clinical symptoms, both serving as matrix to identify persons at increased risk and to improve management of this cancer.

METHODS

Of 58 patients, 31 diagnosed with sinonasal adenocarcinoma (cases) between 1973 and 2007 were identified and underwent standardized interview on clinical data. A total of 85 patients diagnosed over the same period with carcinoma of the oral cavity served as controls.

RESULTS

The ethmoid was confirmed as the predominant site of adenocarcinoma associated with wood dust exposure, whereas the nasal cavity was most commonly affected in patients denying any exposure to wood dust. Cases were significantly engaged in mainly woodworking occupations compared to controls. The main initial clinical symptoms were nasal obstruction 6 months (71%) and epistaxis 4 years (41.9%) prior to diagnosis. Hardwood dust from beech and oak proved to be the most common occupational exposure, with a mean exposure period of 32.3 years and a latency of 43.5 (34-58) years.

CONCLUSIONS

Our investigation confirms the importance of regular screenings for persons exposed to wood dust even years after the end of occupational or private exposure. Banal clinical symptoms such as epistaxis and nasal obstruction might be predictive, requiring early and thorough investigation.

Alcohol intake and oral cavity cancer risk among men in a prospective study in Kerala, India

OBJECTIVE

The aim of the study was to evaluate the role of alcohol drinking and patterns of consumption in oral cancer incidence and mortality in a cohort study using data from the Trivandrum Oral Cancer Screening Study, India.

METHODS

At baseline, the study participants completed a lifestyle questionnaire including items on frequency and duration of alcohol consumption. They were followed up for oral cancer incidence and mortality. Data from 32 347 subjects, of whom 134 eventually developed oral cancer, were analysed to estimate risk of oral cancer incidence and mortality according to drinking patterns, using a Cox regression model adjusted for age, religion, education, occupation, body mass index (BMI), standard of living index, chewing habits, smoking habits, and vegetable and fruit intake.

RESULTS

Current and past drinkers were each associated with significantly increased risk of developing oral cancer. The hazard ratio increased significantly by 49% (95% CI = 1-121%) among current drinkers and 90% (95% CI = 13-218%) among past drinkers. A significant dose-response relationship between intake frequency, duration and oral cancer risk (incidence and mortality) was observed.

CONCLUSIONS

As with other lifestyle factors, alcohol intake plays an important role in oral carcinogenesis in this population, and understanding this role is relevant to developing public health policies targeting at-risk population.

Clinical analysis of head and neck cancer cases in south-west China 1953 - 2002

The occurrence of head and neck cancers varies worldwide. This study retrospectively analysed the incidence and types of 8646 cases of head and neck cancers in south-west China that were treated at the West China Stomatology Hospital of Sichuan University between 1953 and 2002. Overall mean patient age was 50.3 years and the overall male:female ratio was 2.38:1; mean age increased and the male:female ratio decreased over the study period. Peak incidence occurred between the ages of 40 and 60 years. Primary tumours most frequently developed in the tongue, followed by the bucca and gingiva. Histologically, squamous cell carcinomas were most frequently recorded. The parotid gland and palate were the most common locations for salivary gland tumours. Over the study period the incidence of head and neck cancers increased with time and the rate of increase was greater in females than males. The frequency of histological types and topography were similar to previous reports.

The additive effect of ethanol and extract of cigarette smoke on rabbit esophagus epithelium

AIM

The combination of alcohol and smoking takes a place in the epidemiology and pathogenesis of gastroesophageal reflux disease and squamous cancers of the esophagus. Therefore, a study was designed to assess the impact of these agents alone or in combination on the structure and function of squamous epithelium of rabbit esophagus.

METHODS

Rabbit esophageal epithelium was mounted in Ussing Chambers, exposed luminally for ethanol (1-10%), extract of cigarette smoke (EOCS) and combinations or sequential application of these agents. An in-vivo model was also used to mimic conditions more representative of human alcohol consumption.

RESULTS

Ethanol (1-10%) dose dependently decreased tissue resistance. Extract of cigarette smoke caused a reduction on transepithelial potential difference (PD), short circuit current. Combinations of EOCS, ethanol (5-10% EtOH and EOCS 1-2) showed a more pronounced decrease than agents alone, mainly the result of EOCS. In vivo studies showed that EOCS administration dropped PD dose dependently. In-vivo 10% EtOH, EOCS-2 dropped PD (55%) similar to in-vitro 5% EtOH, EOCS-1. The effect was clearly additive; boluses of 10% ethanol (36%) and EOCS-2 (17%) decreased PD and combination of agents resulted in a 55% drop on PD which is a very similar decrease compared to the sum of the separate effects of agents (53%).

CONCLUSION

Ethanol affected the barrier and cigarette smoke altered ion transport on rabbit esophageal epithelium under conditions reflecting human consumption. Results were consistent with in vivo and in vitro conditions except higher concentrations were needed in vivo. When applied, these agents showed an additive effect. Ethanol predisposed the tissue to the effect of EOCS.

Incidence of cancers of the oral cavity and pharynx among American Indians and Alaska Natives, 1999-2004

BACKGROUND

Previous studies identified disparities in incidence rates of cancers of the oral cavity and pharynx between American Indians/Alaska Natives (AI/AN) and non-Hispanic whites (NHW) and differences between various AI/AN populations. Reporting among AI/AN has been hampered by: 1) heterogeneity among various anatomic sites of oral cavity and pharyngeal cancers obscuring unique patterns of individual anatomic sites; 2) race misclassification and underreporting of AI/AN; and 3) sparseness of data needed to identify regional variations.

METHODS

To improve race classification of AI/AN, data from US central cancer registries were linked with Indian Health Service (IHS) records. AI/AN incidence data from 1999 to 2004 were stratified by sex, age, stage at diagnosis, and anatomic subsite for 6 IHS geographic regions and compared with NHW populations.

RESULTS

For all oral cavity and pharynx cancers combined, among residents of Contract Health Service Delivery Area counties, AI/AN overall had significantly lower incidence rates than NHW (8.5 vs 11.0). However, AI/AN rates were significantly higher in the Northern Plains (13.9 vs 10.5) and Alaska (16.3 vs 10.6), significantly lower in the Pacific Coast (7.7 vs 11.6) and Southwest (3.3 vs 10.4), and similar in the Southern Plains (11.4). Overall AI/AN males had higher incidence rates than AI/AN women. Nasopharyngeal cancer was more frequent (1.1AI/AN vs 0.4 NHW), and tongue cancer less frequent (1.6 AI/AN vs 2.9 NHW) in AI/AN than NHW populations; however, rates varied by region. Stage distribution was modestly less favorable for AI/AN compared with NHW populations.

CONCLUSIONS

Variation by region, anatomic site, and sex indicates a need for research into etiologic factors and attention to regional risk factor profiles when planning cancer control programs.

Alcohol and tobacco use, and cancer risk for upper aerodigestive tract and liver

This study reviews the association between alcohol, tobacco, and the risk of cancers of the upper digestive and respiratory tract (i.e. oral cavity and pharynx, larynx, and esophagus) and liver. Alcohol drinking and tobacco smoking are the major risk factors for upper aerodigestive tract cancers, accounting for a large proportion (i.e. about three-quarters) of cases in developed countries. Consumption amount is the strongest alcohol-related determinant of risk, whereas the pattern of alcohol-related risk with duration is inconsistent. Both dose and duration of smoking have important effects on the risk of upper aerodigestive tract cancers. The combined exposure to alcohol and tobacco has a multiplicative effect on carcinogenesis of this tract. Alcohol and tobacco consumption are also causally related to liver cancer, although the associations are moderate and a lower fraction of neoplasms is attributable to these factors as compared with cancers of the upper aerodigestive tract. An interaction between alcohol drinking and tobacco smoking has been reported, but the issue is not adequately assessed.

Teeth loss and risk of cancer at 14 common sites in Japanese

BACKGROUND

Tooth loss has been associated with a higher risk of several types of cancer. To clarify the significance of tooth loss to the risk of 14 common cancers, we conducted a large-scale, case-control study based on the Hospital-based Epidemiologic Research Program at Aichi Cancer Center.

METHODS

A total of 5,240 cancer subjects and 10,480 age- and sex-matched noncancer controls were recruited. Patients with 14 types of cancer newly diagnosed from 2000 to 2005 were eligible as case subjects, and new outpatients without cancer in the same time period were eligible as controls. Tooth loss was categorized into four groups: group 1, number of remaining teeth, >or=21; group 2, 9 to 20; group 3, 1 to 8; and group 4, 0. The effect of tooth loss was assessed as odds ratios (OR) with 95% confidence intervals (95% CI) calculated with conditional logistic regression models, with adjustment for potential confounders.

RESULTS

A decreased number of remaining teeth was associated with increased OR of head and neck (OR, 1.68; 95% CI, 0.88-1.93; P trend = 0.055), esophageal (OR, 2.36; 95% CI, 1.17-4.75; P trend = 0.002), and lung (OR, 1.54; 95% CI, 1.05-2.27; P trend = 0.027) cancers.

CONCLUSIONS

We showed a significant positive association between tooth loss and the risk of head and neck, esophageal, and lung cancers after adjustment for potential confounding factors. The findings indicate that preventive efforts aimed at the preservation of teeth may decrease the risk of these cancers.

Pipe smoking and cancers of the upper digestive tract

Pipe smoking has been related to the risk of cancers of the upper digestive and respiratory tract, but quantification of the risk for exclusive pipe smokers is still limited. To analyse the association between exclusive pipe smoking and cancers of the upper digestive tract, we used data from a series of case-control studies conducted in Italy and Switzerland between 1984 and 1999. After excluding cigarette and cigar smokers, 41 male oral and pharyngeal cancer cases, 52 male oesophageal cancer cases and 1,032 male controls were included in the present analysis. Odds ratios (OR) of cancers were estimated by the mean of unconditional multivariate logistic regression, including terms for age, study centre, education, body mass index, and alcohol drinking. Compared to never smokers, exclusive pipe smokers had an OR of 8.7 [95% confidence intervals (CI): 4.0-18.9] of all upper digestive tract cancers. The OR was 12.6 for oral and pharyngeal and 7.2 for oesophageal cancer. Pipe smokers who were also heavy alcohol drinkers had an OR of 38.8 (95% CI: 13.6-110.9) as compared to never smokers and light drinkers. Thus, pipe smoking and heavy alcohol drinking appears to interact at least on a multiplicative model.