Joint effect of tobacco, alcohol, and oral HPV infection on head and neck cancer risk in the French West Indies.

Aviane Auguste,Jacqueline Deloumeaux,Stanie Gaete,Clarisse Joachim,Cécile Herrmann‐Storck,Danièle Luce,Leah Michineau,Suzy Duflo

doi:10.1002/cam4.3327

Abstract

We investigated the role of tobacco and alcohol consumption on the occurrence of head and neck squamous cell carcinomas (HNSCC), and the joint effects of these factors with oral human papillomavirus (HPV) infection in the French West Indies, in the Caribbean. We conducted a population‐based case‐control study (145 cases and 405 controls). We used logistic regression models to estimate adjusted odds ratios (OR) and their 95% confidence intervals (CI). Two‐way interactions were assessed on both multiplicative and additive scales. Current smoking (OR = 11.6, 95% CI = 6.7‐20.1), drinking more than five glasses of alcohol per day (OR = 2.7, 95% CI = 1.2‐4.7), and oral infection with High‐risk HPV (OR = 2.4, 95% CI = 1.1‐5.0) were significantly associated with HNSCC. The combined exposure to tobacco and alcohol produced a significant synergistic effect on the incidence of HNSCC. Oral infection with High‐risk HPV increased the risk of HNSCC in never smokers and nondrinkers. The effects of tobacco, alcohol, and of the combined exposure of tobacco and alcohol were substantially lower in HPV‐positive than in HPV‐negative HNSCC. This is the first case‐control study to investigate the role of tobacco smoking, alcohol drinking and oral HPV infection in an Afro‐Caribbean population. Although each of these risk factors has a significant effect, our findings indicate that tobacco and alcohol play a less important role in Hr‐HPV‐positive HNSCC. Further investigations are warranted notably on the interaction of these three risk factors by cancer site.

Highlights

IntroductionMore than 700 000 cases of head and neck cancer (including cancers of the oral cavity, pharynx, and larynx) are diagnosed each year.[1] Tobacco smoking and alcohol drinking are the major risk factors for these cancers, their joint effect being at least multiplicative.[2,3] Human papillomavirus (HPV) is a recognized cause of a subset of head and neck
Worldwide, more than 700 000 cases of head and neck cancer are diagnosed each year.[1]
The joint effect of alcohol and Hr-Human papillomavirus (HPV) on head and neck squamous cell carcinomas (HNSCC) risk was less than additive (RERI = −3.30, 95% confidence intervals (CI) = −8.01 to 1.42) and significantly less than multiplicative (Ψ = 0.24, 95% CI = 0.06-0.99)

Summary

Introduction

More than 700 000 cases of head and neck cancer (including cancers of the oral cavity, pharynx, and larynx) are diagnosed each year.[1] Tobacco smoking and alcohol drinking are the major risk factors for these cancers, their joint effect being at least multiplicative.[2,3] Human papillomavirus (HPV) is a recognized cause of a subset of head and neck. | 6854 wileyonlinelibrary.com/jou rnal/cam[4]. Squamous cell carcinomas (HNSCC).[4,5] While the causal role of HPV16 in oropharyngeal cancer is well established, the role of other HPV genotypes or the association between HPV and other subsites of HNSCC is still debated.[6] The manner in which tobacco, alcohol, and HPV interact on HNSCC risk remains unclear, with conflicting results. Some studies demonstrated a lack of association with tobacco and alcohol in HPV16-positive HNSCC.[5,7,8] Other more recent studies have shown that tobacco smoking and alcohol drinking have rather an independent role in the etiology of HPV16-positive oropharyngeal cancer.[9,10,11]

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Conclusion