ReviewA meta-analysis of alcohol drinking and oral and pharyngeal cancers. Part 2: Results by subsites
Introduction
Alcohol drinking increases the risk of oral and pharyngeal cancers. In a recent meta-analysis, including 45 studies for a total of 17,085 cases, we estimated relative risks (RR) of 1.29 for 10, 3.24 for 50, 8.61 for 100, and to 13.02 for 125 g of ethanol per day for oral cavity and pharynx combined.1
However, the anatomic sites most strongly associated with alcohol drinking have varied from study to study. Thus, in a case-control study from four areas of the United States2 the association was less strong for tongue than for other oral sites or pharynx, particularly in men. In another case-control study, based on US Veterans,3 patients with cancer at the floor of the mouth and oral tongue had higher RRs than those with cancer at other oral and pharyngeal sites. In a study from Italy and Switzerland,4 the RRs were appreciably higher for oral than for pharyngeal cancer. In a study from Puerto Rico5 there was no significant difference among tongue, other oral and pharynx in both sexes. However, no single study had adequate power to test the possible differences in alcohol-related risks across subsites, and the apparent differences may be due to chance alone. Human papillomavirus (HPV) is related to a subset of cancers of the oropharynx.6, 7 However, in a study comparing HPV-associated with HPV-independent cancers, no appreciable difference was observed for the alcohol-related RRs.6
In order to provide a detailed quantification of the association of alcohol consumption with oral and pharyngeal cancer separately, as well as with subsites of the oral cavity and of the pharynx, we conducted a meta-analysis of studies published up to September 2009.
Section snippets
Identification of studies and collection of data
The methodology of identification of studies and collection of data has been previously described.1 Briefly, using PubMed, we performed a literature search of all case-control and cohort studies published up to September 2009 and presenting data on the association between alcohol and risk of oral and/or pharyngeal cancer, following the meta-analysis of observational studies in epidemiology (MOOSE) guidelines.8 We did not consider cancer of the nasopharynx, as it shows an epidemiology and
Results
The main characteristics of the studies have already been described.1 Appendix 1 reports the characteristics of the five additional studies not included in the previous review.1 The present analyses are based on 303, 4, 9, 10, 11, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40 case-control and 117 cohort study. Some studies reported data for more than one anatomical site. Twenty-two reports3, 4, 11, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24,
Discussion
In this meta-analysis, we found higher risk estimates for alcohol intake for pharyngeal (oro- and hypopharynx) as compared to oral (including tongue) cancer. There was, however, significant heterogeneity among studies.
We conducted several sensitivity analyses, which confirmed the stronger association of alcohol with pharyngeal rather than oral cancer. In particular, we found that the different effect of alcohol on oral and pharyngeal carcinogenesis persists even when only studies reporting risk
Conflict of interest statement
None declared.
Acknowledgments
This work was conducted with the contribution of the Italian Association for Cancer Research (AIRC). Irene Tramacere was supported by a fellowship from the Italian Foundation for Cancer Research (FIRC). The authors thanks Ms. I. Garimoldi for editorial assistance.
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