CORRESPONDENCE

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

Xavier Castellsagué, Nubia Muñoz

Affiliations of authors: X. Castellsagué, Servei d'Epidemiologia i Registre del Càncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Nubia Muñoz, Unit of Field and Intervention Studies, International Agency for Research on Cancer (IARC), Lyon, France.

Correspondence to:Xavier Castellsagué, Servei d'Epidemiologia i Registre del Càncer, Institut Català d'Oncologia, Gran Via s/n, km 2.7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain (e-mail: xcastellsague{at}ico.scs.es).

In their recent brief communication, Talamini et al. (1) reported on the risk of developing cancer of the oral cavity and pharynx in nonsmokers who drink alcohol and in nondrinkers of alcohol who smoke tobacco. Although the data were quite sparse (60 never-smoking and 32 never-drinking case subjects), the authors concluded that there was a statistically significant increased risk of cancer in these sites associated with heavy alcohol intake in nonsmokers and with heavy tobacco smoking in nondrinkers. In this letter, we present solid evidence that the same conclusion holds true for esophageal cancer. The results shown in Table 1Go were gathered from a pooled analysis of five hospital-based case-control studies of squamous cell carcinoma of the esophagus conducted from 1986 through 1992 in the following four countries in South America: Brazil (2), Uruguay (3), Argentina (4), and Paraguay (5). These studies were coordinated by the International Agency for Research on Cancer (Lyon, France), and they were carried out with the same research protocol and data collection procedures, thus making the studies suitable for a pooled analysis. Overall, the pooled data included a total of 830 incident case subjects with esophageal cancer and 1779 control subjects. Control subjects were individually matched to the case subjects with respect to the admitting hospital, age (± 5 years), and sex.


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Table 1. Odds ratios and 95% confidence intervals of squamous cell carcinoma of the esophagus for alcohol drinking in nonsmokers and cigarette smoking in nondrinkers participating in five case-control studies in South America (1986-1992)

 
There were 144 case subjects and 630 control subjects who described themselves as being life-long nonsmokers and 179 case subjects and 776 control subjects who reported themselves as being life-long nondrinkers of alcohol. Table 1Go shows the estimated odds ratios (ORs) and 95% confidence intervals (CIs) of esophageal cancer linked to alcohol intake among nonsmokers and linked to cigarette smoking among nondrinkers. All logistic regression models were adjusted by age group, sex, admitting hospital, and years of schooling.

Consistent with the brief communication by Talamini et al. (1), for nonsmokers who drank alcohol, the OR was not markedly increased for a consumption of pure ethanol that was less than 150 mL per day, but it increased almost sixfold for amounts exceeding 150 mL or more of ethanol per day. The trend in risk was highly statistically significant (P = .002). It is interesting that this effect was much stronger among males than it was among females. Among males, the ORs (95% CIs) were 1.78 (0.42-7.54), 3.27 (0.57-18.78), 5.49 (1.82-16.57), and 12.62 (3.37-47.16) for 1-24 mL, 25-49 mL, 50-140 mL, and 150 mL or more of pure ethanol per day, respectively (P for trend <.001). For females, the association with alcohol intake was weak and not statistically significant.

For nondrinkers who smoked cigarettes, the OR was increased almost threefold for smoking as few as eight to 14 cigarettes per day, 3.4-fold for smoking 15-24 cigarettes per day, and 2.5-fold for smoking 25 cigarettes or more per day, also with a highly statistically significant trend in risk (P <.001). As with alcohol, this association was stronger among males in whom the corresponding ORs (95% CIs) were 1.22 (0.39-3.80), 3.75 (1.44-9.79), 5.03 (2.05-12.31), and 3.73 (1.39-10.02) (P for trend <.001). Among females, the association with cigarette smoking was weak, and the trend did not reach statistical significance.

These results add precision to the estimates by Talamini et al. (1) and further indicate that, in nondrinkers, even moderate exposure to tobacco smoking significantly increases the risk of esophageal cancer. These findings complete the epidemiologic picture of the independent etiologic role of alcohol drinking and tobacco smoking in the development of cancers of the upper aerodigestive tract.

NOTES

Supported by funds provided by the International Agency for Research on Cancer (IARC) Lyon, France. The Pooled Project was funded by the IARC and the Fondo de Investigaciones Sanitarias (FIS) of the Spanish Government, FIS 97/0662.

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 Victora CG, Munoz N, Day NE, Barcelos LB, Peccin DA, Braga NM. Hot beverages and oesophageal cancer in southern Brazil: a casecontrol study. Int J Cancer 1987;39:710-6.[Medline]

3 De Stefani E, Munoz N, Esteve J, Vasallo A, Victora CG, Teuchmann S. Mate drinking, alcohol, tobacco, diet, and esophageal cancer in Uruguay. Cancer Res 1990;50:426-31.[Abstract]

4 Castelletto R, Castellsague X, Munoz N, Iscovich J, Chopita N, Jmelnitsky A. Alcohol, tobacco, diet, mate drinking and esophageal cancer in Argentina. Cancer Epidemiol Biomarkers Prev 1994;3:557-64.[Abstract]

5 Rolon PA, Castellsague X, Benz M, Munoz N. Hot and cold mate drinking and esophageal cancer in Paraguay. Cancer Epidemiol Biomarkers Prev 1995;4:595-605.[Abstract]



             
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