Age at start of using tobacco and drinking alcohol and the risk of head and neck cancer - a pooled analysis in the International Head and Neck Cancer Consortium (INHANCE)

論文發表人: 張慎之(加州大學洛杉磯分校流行病學研究所博士班)

 

MailScanner has detected a possible fraud attempt from "inhance.uarc.fr" claiming to be http://inhance.iarc.fr

 

吸煙與飲酒是頭頸癌的兩大主要危險因子, 而頭頸癌的危險性會隨著吸煙的頻率和長度以及喝酒的頻率而增加。但是開始吸煙與喝酒的年齡是否與頭頸癌的危險性有關還有待研究調查。之前的文獻一方面樣本量少,另一方面沒有考慮到相關的干擾因子, 為了進一步了解吸煙與喝酒的年齡對頭頸癌的影響, 我們利用國際頭頸癌協會(INHANCE)的資料做大型的匯整分析(pooled analysis)。

研究方法: 關於吸煙年齡的分析我們一共收集了17個病例對照研究(11,897個頭頸癌病例以及 16,852個對照)。關於飲酒年齡的分析我們一共收集了13個病例對照研究(9,167個頭頸癌病例以及12,593個對照)。我們運用非條件性邏輯迴歸分析估計勝算比(odds ratio)以及95%信賴區間, 並且對頭頸癌不同部位進行分層分析。結果: 在控制了吸煙的包裝年(pack-year)之後, 開始吸煙的年齡被發現與咽癌的危險性呈負相關(p<0.01)。十歲之前就開始抽煙的人的咽癌發生率是三十歲之後才開始抽煙的人的兩倍。吸煙年齡與口腔癌以及喉癌的危險性並沒有顯著相關。開始喝酒的年齡對頭頸癌的發生率也沒有被發現有顯著的影響。

 

BACKGROUND: Tobacco and alcohol use are two well-established major risk factors for head and neck cancer.  Whether early age of exposure to tobacco and alcohol is associated with head and neck carcinogenesis is of special interest.  Previous studies either had small sample sizes or did not properly control for possible confounding factors.  We analyzed the pooled data in the International Head and Neck Cancer Epidemiology Consortium (INHANCE) to investigate the association between age at start of using tobacco and alcohol products and the risk of head and neck cancer.  METHODS: Individual-level data from 17 case-control studies were pooled, included 11,897 head and neck cancer case subjects and 16,852 control subjects for the analysis on age at start of using tobacco products.  The analysis for age at start of drinking alcoholic beverages included 13 studies with 9,167 head and neck cancer case subjects and 12,593 control subjects.  Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models.  All statistical tests were two-sided.  RESULTS: Age at start of smoking tobacco was observed to be inversely associated with the risk of laryngeal cancer (p for trend < 0.01 for cigarettes/cigars/pipes smokers and p for trend = 0.02 for cigarette smokers), after adjustment for tobacco-year.  Similar trends were not found with the risk of oral cavity and pharyngeal cancer.  We did not observe dose response relations for head and neck cancer and younger age at start of using tobacco among cigar-only smokers, pipe-only smokers, or oral snuff-only tobacco users.  For chewing tobacco, we observed a higher head and neck cancer risk for subjects who began to chew at age younger than eighteen (OR = 96.07, 95% CI, 28.99, 318.40, p for trend = 0.07), after adjustment for the years of chewing tobacco.  We did not detect any dose-response relations for the risk of head and neck cancer subsites and age at start of drinking overall or drinking specific types of alcoholic beverages.  CONCLUSION: Our results suggest that young age at starting smoking may be more harmful for the risk of laryngeal cancer than starting at a later age.  Besides the carcinogenicity with increased intensity and duration of tobacco smoking, young individuals should be fully aware of their additional increased risk of developing laryngeal cancer.