Regular Article

British Journal of Cancer (2001) 85, 678–682. doi:10.1054/bjoc.2001.1986 www.bjcancer.com
Published online 28 August 2001

Risk of cancers of the lung, head and neck in patients hospitalized for alcoholism in Sweden

P Boffetta1,2, W Ye2, H-O Adami2,3, L A Mucci3 and O Nyrén2

  1. 1Unit of Environmental Cancer Epidemiology, International Agency for Research on Cancer, 150 cours Albert-Thomas, Lyon, F-69008, France
  2. 2Department of Medical Epidemiology, Karolinska Institute, Box 281, Stockholm, S-17177, Sweden
  3. 3Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

Received 27 March 2001; Revised 8 June 2001; Accepted 8 June 2001.

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Abstract

Alcoholic patients are at increased risk of cancers of the head and neck but little information is available on the magnitude of the risk for specific sites and for different histological types. We followed 182 667 patients with a hospital discharge diagnosis of alcoholism during 1965–1994, for an average of 10.2 years. We compared their incidence of site- and histological type-specific cancers of the oral cavity, pharynx, larynx and lung with that of the national population. The standardized incidence ratio (SIR) of cancer of the oral cavity and pharynx was 5.33 (95% confidence interval [CI] 5.04–5.64, based on 1207 cases). The SIRs of laryngeal and lung cancer were 4.21 (95% Cl 3.78–4.68, 347 cases) and 2.40 (2.29–2.51, 1880 cases), respectively. The SIR was highest for cancers of the hypopharynx, floor of the mouth, mesopharynx and base of the tongue. The relative excess of lung cancer was similar for squamous cell carcinoma and adenocarcinoma. Low age at first hospitalization was associated with higher SIRs for all sites under study. 25 years after first hospitalization for alcoholism, the cumulative probability of developing a lung cancer was in the order of 5%, for oral and pharyngeal cancer it was 2.5%, and for oesophageal or laryngeal cancer 1% each. Our study shows that the risk of head and neck cancer among heavy drinkers is highest for sites in direct contact with alcohol. The high risk of head and neck neoplasms may justify specific medical attention. © 2001 Cancer Research Campaign www.bjcancer.com

Keywords:

alcohol, laryngeal neoplasms, lung neoplasms, oral cavity neoplasms

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References

  1. Adami, H-O, McLaughlin, JK, Hising, AW, Wolk, A, Ekbom, A, Holmberg, L & Persson, I (1992). Alcoholism and cancer risk: a population-based cohort study. Cancer Causes Control, 3, 419–425. | Article | PubMed | ISI | ChemPort |
  2. Blot, WJ & Fraumeni, JF Jr (1996). Cancers of the lung and pleura. Cancer Epidemiology and Prevention, Schottenfeld D, Fraumeni JF Jr (eds) 637–665, Oxford University Press: New York
  3. Boffetta, P, Mashberg, A, Winkelmann, R & Garfinkel, L (1992). Carcinogenic effect of tobacco smoking and alcohol drinking on anatomic sites of the oral cavity and oropharynx. Int J Cancer, 52, 530–533.
  4. Breslow, NE & Day, NE (1987). Statistical Methods in Cancer Research, Vol II, The Design and Analysis of Cohort Studies (IARC Sci Publ No 82), International Agency for Research on Cancer: Lyon
  5. Chen, C-J, Wang, Y-F & Shieh, T (1988). Multifactorial etiology of nasopharyngeal carcinoma: Epstein-Barr virus, familial tendency and environmental cofactors. Head and Neck Oncology Research, Wolf GT, Carey TE (eds) 469–476, Kugler Publications: Amsterdam-Berkeley
  6. Franceschi, S, Barra, S, La Vecchia, C, Bidoli, E, Negri, E & Talamini, R (1992). Risk factors for cancer of the tongue and the mouth: a case-control study from northern Italy. Cancer, 70, 2227–2233.
  7. Hakulinen, T, Lehtimäki, L, Lehtonen, M & Teppo, L (1974). Cancer morbidity among two male cohorts with increased alcohol consumption in Finland. J Natl Cancer Inst, 52, 1711–1714. | PubMed | ChemPort |
  8. Kalbfleisch, JD & Prentice, RL (1980). The Statistical Analysis of Failure Time Data, John Wiley & Sons, Inc: New York
  9. Kjaerheim, K, Gaard, M & Andersen, A (1998). The role of alcohol, tobacco, and dietary factors in upper aerogastric tract cancers: a prespective study of 10,900 Norwegian men. Cancer Causes Control, 9, 99–108. | Article | PubMed | ISI | ChemPort |
  10. Kühlorn, E (1991). Svensk Alkoholpolitik – Facta och Myter. Hurmycket tål Svensken?, Atterstam I (ed) Forskingsrådsnamnden: Stockholm
  11. Lagiou, P, Ye, W, Wedren, S, Ekborn, A, Nyren, O, Trichopoulos, D & Adami, HO (2001). Incidence of ovarian cancer among alcoholic women: a cohort study in Sweden. Int J Cancer, 91, 264–266.
  12. Mattson, B (1977). The Completeness of Registration in the Swedish Cancer Registry (Stat Rep HS No 15), Stockholm
  13. Monson, RR & Lyon, JL (1975). Proportional mortality among alcoholics. Cancer, 36, 1077–1079. | PubMed | ISI | ChemPort |
  14. Muscat, JE & Wynder, EL (1998). A case/control study of risk factors for major salivary gland cancer. Otolaryngol Head Neck Surg, 118, 195–198.
  15. Nam, J-M, McLaughlin, JK & Blot, WJ (1992). Cigarette smoking, alcohol, and nasopharyngeal carcinoma: a case-control study among U.S. whites. J Natl Cancer Inst, 84, 619–622.
  16. Pell, S & D'Alonzo, CA (1973). A five-year mortality study of alcoholics. J Occup Med, 15, 120–125.
  17. Prior, P (1988). Long-term cancer risk in alcoholism. Alcohol & Alcoholism, 23, 163–171.
  18. Robinette, CD, Hrubec, Z & Fraumeni, JF Jr (1979). Chronic alcoholism and subsequent mortality in World War II veterans. Am J Epidemiol, 109, 687–700. | PubMed | ISI | ChemPort |
  19. Sas Institute (1990). SAS Users Guide, Version 6, Sas Institute, Inc: Cary, NC
  20. Schmidt, W & Popham, RE (1981). The role of drinking and smoking in mortality from cancer and other causes in male alcoholics. Cancer, 47, 1031–1041. | PubMed | ISI | ChemPort |
  21. Seitz, HK, Poschl, G & Simanowski, UA (1998). Alcohol and cancer. Recent Dev Alcohol, 14, 67–95. | PubMed | ChemPort |
  22. Sigvardsson, S, Hardell, L, Przybeck, TR & Cloninger, R (1996). Increased cancer risk among Swedish female alcoholics. Epidemiology, 7, 140–143. | PubMed | ISI | ChemPort |
  23. Spitz, MR, Fueger, JJ, Goepfert, H & Newell, GR (1990). Salivary gland cancer: a case-control investigation of risk factors. Arch Otolaryngol Head Neck Surg, 116, 1163–1166.
  24. Sundby, P (1967). Alcoholism and Mortality (National Institute of Alcohol Research, Publication No, Universitets-forlaget: Oslo
  25. Tønnesen, H, Møller, H, Andersen, JR, Jensen, E & Juel, K (1994). Cancer morbidity in alcohol abusers. Br J Cancer, 69, 327–332. | PubMed | ISI | ChemPort |
  26. Tuyns, AJ, Esteve, J, Raymond, L, Berrino, F, Benhamou, E, Blanchet, F, Boffetta, P, Crosignani, P, Del Moral, A & Lehmann, W (1988). Cancer of the larynx/hypopharynx, tobacco and alcohol: IARC international case-control study in Turin and Varese (Italy), Zaragoza and Navarra (Spain), Geneva (Switzerland) and Calvados (France). Int J Cancer, 41, 483–491. | PubMed | ChemPort |
  27. Vaughan, TL, Shapiro, JA, Burt, RD, Swanson, GM, Berwick, M, Lynch, CF & Lyon, JL (1996). Nasopharyngeal cancer in a low-risk population: defining risk factors by histological type. Cancer Epidemiol Biomark Prev, 5, 587–593.
  28. WCRF/AICR (1997). Dietary constituents. Food, Nutrition and the Prevention of Cancer: a Global Perspective, 362–427, American Institute for Cancer Research: Washington
  29. WHO (1955). International Classification of Diseases, 7th rev, World Health Organization: Geneva
  30. WHO (1965). International Classification of Diseases, 8th rev, World Health Organization: Geneva
  31. WHO (1975). International Classification of Diseases, 9th rev, World Health Organization: Geneva
  32. WHO (1999). Global Status Report on Alcohol (WHO/HSC/SAB/99.11). World Health Organization: Geneva
  33. Yu, MC & Henderson, BE (1996). Nasopharyngeal cancer. Cancer Epidemiology and Prevention, Schottenfeld D, Fraumeni J F Jr (eds) 603–618, Oxford University Press: New York