Types of tobacco and alcoholic beverages use and head and neck cancer: A case-control study in state of São Paulo, Brazil, 1999–2015

Abstract

Introduction Risk factors for health problems change over time and space. With regard to head and neck cancer (HNC), associations with smoking and alcohol consumption are well-established. Literature data suggest that the most prevalent types of tobacco and alcohol in a population are associated with higher risks of cancer. In Brazil, few epidemiological studies have investigated the effect of different types of tobacco and alcohol on HNC. The aim of this study was to measure the probabilistic risks for HNC by tobacco and alcohol types in non-exclusive consumption (use of more than one type of tobacco or alcoholic beverage) and exclusive consumption (use of only one type of tobacco or alcoholic beverage). Types of tobacco analysed were industrialized cigarette, hand-rolled cigarettes, pipe and cigar. The analyzed alcoholic beverages were distilled, beer and wine. Methods The present study has origin from three multicentric projects: Latin American, conducted from 03/1999 to 12/2001; Clinical Genome of Cancer performed from 07/2000 to 08/2011; and the Thematic Markers of Aggression in Head and Neck Tumors (GENCAPO), conducted from 07/2011 to 06/2015. Thus, it is a case-control study with data from hospitals in the State of Sao Paulo. The cases were diagnosed with squamous cell carcinoma of the head and neck, histologically confirmed. The controls, patients with diseases other than cancer, were selected in some of the hospitals where the cases originated. Both cases and controls were interviewed through questionnaires with information on characteristics and habits, as well as data on education and occupational history. Associations between the variables tobacco type and type of alcoholic beverages with HNC were estimated by the odds ratio (OR) and respective 95% confidence interval (95% CI) through non-conditional logistic regression adjusted for confounding variables: sex (female, male), age ( 100 and ≤ 900 and > 900 kg, to adjust the effect of tobacco). Results The risks due to smoking were more significant for the hypopharynx, particularly, in the non-exclusive pattern and consumption ≥ 40 packs per year OR: 36.1 (95% CI: 11.1–117.6); for oropharynx, larynx and oral cavity, the risks were: OR: 16.1 (95% CI: 10.4–24.9); OR: 14.2 (95% CI: 9.6–21.0); OR: 7.4 (95% CI: 5.6–10.0). In the exclusive consumption condition, for the same category ≥ 40 packets per year for industrialized cigarettes, the risks were slightly less intense: OR: 31.9 (95% CI: 9.7–104.3); OR: 15.4 (95% CI: 9.9–24.0); OR: 13.1 (95% CI: 8.8–19.5); OR: 7.1 (95% CI: 5.3–9.6), respectively, for hypopharynx, oropharynx, larynx and oral cavity. In alcohol consumption, higher associations of HNC with distilled beverages were observed. In the exclusive consumption condition, consumption level of distilled ≥ 2000 kg induced OR: 39.1 (95% CI: 12.7–121.8) for oropharynx. Simultaneous use of tobacco and alcohol increased the risk of HNC: OR: 10.5 (95% CI: 8.5–13.0). Conclusions Among smokers with the non-exclusive pattern of consumption, the greatest risks were observed for the hypopharynx. Among the consumers of alcoholic beverages, the distilled conferred greater risks in the two patterns of consumption. In beer and wine consumption, differences in intensity of associations with HNC became evident only in the higher consumption categories.