CORRESPONDENCE

RESPONSE: Re: Cancer of the Oral Cavity and Pharynx in Nonsmokers Who Drink Alcohol and in Nondrinkers Who Smoke Tobacco

Carlo La Vecchia, Renato Talamini, Cristina Bosetti, Eva Negri, Silvia Franceschi

Affiliations of authors: C. La Vecchia, Istituto di Ricerche Farmacologiche "Mario Negri," and Istituto di Statistica Medica e Biometria, Università degli Studi, Milan, Italy; R. Talamini, S. Franceschi, Centro di Riferimento Oncologico, Servizio di Epidemiologia, Aviano, Italy; C. Bosetti, E. Negri, Istituto di Ricerche Farmacologiche "Mario Negri," Milan.

Correspondence to: Silvia Franceschi, M.D., Centro di Riferimento Oncologico, Servizio di Epidemiologia, Via Pedemontana Occidentale, 33081 Aviano (PN), Italy.

We thank Drs. Castellsagué and Muñoz for their interest in our work (1) and take this opportunity for reconsidering, as they have done, the risk of esophageal cancer in nonsmokers who drink alcohol and alcohol abstainers who smoke tobacco; we use the combined dataset of two case-control studies on esophageal cancer conducted in the greater Milan area (2-4) and the Pordenone province (5) of northern Italy.

Overall, the dataset included 410 case subjects (343 men and 67 women) with incident, histologically confirmed esophageal cancer who were admitted to major teaching and general hospitals of the study areas from 1984 through 1992. Control subjects were admitted to the same network of hospitals as case subjects for acute, non-neoplastic conditions. Diseases related to tobacco use or alcohol abuse were excluded as causes of hospital admission but not as comorbidities. Fifty-five case subjects (20 men and 35 women) and 275 control subjects (100 men and 175 women) described themselves as life-long never smokers, and 40 case subjects (22 men and 18 women, all from Milan) and 151 control subjects (79 men and 72 women) described themselves as alcohol abstainers. These subgroups are the subject of the present communication.

We used a validated (6) questionnaire, including information on smoking status, number of cigarettes and/or pipe and cigars habitually smoked per day, age at smoking initiation, duration of smoking, and time since smoking cessation for exsmokers. Total alcohol consumption was defined as the mean number of alcoholic beverages consumed per week. One drink corresponded to approximately 120 mL of wine, 330 mL of beer, and 30 mL of spirits (i.e., about 12 g of ethanol). Odds ratios (ORs) and corresponding 95% confidence intervals (CI) were computed by unconditional multiple logistic regression, including terms for study center, age, sex, and educational years.

For nonsmokers who drank alcohol, the OR increased significantly (P = .02) with the increase in alcohol consumption and was 5.5 (95% CI = 1.4-21.3) for 56 drinks or more per week compared with nondrinkers (Table 1).Go The risk increase seemed steeper for women (OR for >= 35 drinks/week = 5.5; 95% CI = 1.0-30.7) than for men (OR for >= 56 drinks/week = 1.7; 95% CI = 0.3-10.0), but consumption ranges varied substantially and the risk estimates were not statistically heterogeneous between sexes (data not shown).


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Table 1. Odds ratios of esophageal cancer and corresponding 95% confidence intervals for alcohol-drinking nonsmokers and tobacco-smoking nondrinkers in Italy, 1984-1992*

 
For never drinkers who were current smokers of fewer than 20 cigarettes per day, the OR was 1.3 (95% CI = 0.4-4.2); however, for never drinkers who were heavy tobacco smokers, the OR rose to 7.5 (95% CI = 2.7-20.4) (Table 1)Go. ORs for smokers of 20 cigarettes per day or more were similar for the two sexes (i.e., OR = 8.1 [95% CI = 1.8-7.0] for men and OR = 6.3 [95% CI = 1.4-29.0] for women [data not shown]).

Our present findings thus confirm and further quantify the observation that, in developed countries, alcohol is the most important risk factor for esophageal cancer in nonsmokers, and tobacco is most important in alcohol abstainers (7).

REFERENCES

1 Talamini R, La Vecchia C, Levi F, Conti E, Favero A, Franceschi S. Cancer of the oral cavity and pharynx in nonsmokers who drink alcohol and in nondrinkers who smoke tobacco. J Natl Cancer Inst 1998;90: 1901-3.[Free Full Text]

2 La Vecchia C, Negri E. The role of alcohol in oesophageal cancer in non-smokers, and of tobacco in non-drinkers. Int J Cancer 1989;43:784-5.[Medline]

3 Tavani A, Negri E, Franceschi S, La Vecchia C. Risk factors for esophageal cancer in lifelong nonsmokers. Cancer Epidemiol Biomarkers Prev 1994;3:387-92.[Abstract]

4 Tavani A, Negri E, Franceschi S, La Vecchia C. Tobacco and other risk factors for oesophageal cancer in alcohol non-drinkers. Eur J Cancer Prev 1996;5:313-8.[Medline]

5 Franceschi S, Talamini R, Barra S, Baron AE, Negri E, Bidoli E, et al. Smoking and drinking in relation to cancers of the oral cavity, pharynx, larynx, and esophagus in northern Italy. Cancer Res 1990;50:6502-7.[Abstract]

6 D'Avanzo B, La Vecchia C, Katsouyanni K, Negri E, Trichopoulos D. Reliability of information on cigarette smoking and beverage consumption provided by hos-pital controls. Epidemiology 1996;7:312-5.[Medline]

7 Doll R, Forman D, La Vecchia C, Woutersen R. Alcoholic beverages and cancers of the digestive tract and larynx. In: Verschuren PM, editor. Health issues related to alcohol consumption. Washington (DC): ILSI Press;1993. p. 125-66.



             
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