Smoking, ‘heavy’ drinking linked to elevated risk for head and neck cancer
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Key takeaways:
- Smoking associated with an increased risk for head and neck cancer, specifically at sites close to the lungs.
- Eating whole grains and whole fruit conferred a slight reduction in risk for head and neck cancer.
Smokers and heavy drinkers had increased risk for head and neck cancer, whereas healthy eating slightly decreased risk, according to study data published in JAMA Otolaryngology-Head & Neck Surgery.
The consumption of whole fruits and whole grains appeared to be most beneficial in reducing potential risk, according to researchers.
“These findings emphasize the importance of smoking cessation, drinking in moderation, and healthy eating for the prevention of head and neck cancer,” Daniel P. Lander, MD, MSCI, of Washington University School of Medicine in St. Louis, and colleagues wrote. “They also demonstrate the need for further large-scale studies to evaluate the risk [for] head and neck cancer associated with smoking, drinking, HPV infection, and dietary habits, ideally with the goal of creating a robust risk assessment tool for head and neck cancer.”
Background and methodology
Researchers conducted a nested cohort survival study to determine potential associations between smoking, drinking and dietary habits with risk for head and neck cancer. The analysis included trial participants from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial (n = 139,926; 51% women; mean age, 62.6 years).
Participants joined the trial from 10 centers across the United States between November 1993 and July 2001, with patients who developed head and neck cancer being matched with controls based on demographics and family history of head and neck cancer for analysis of smoking habits. o
Additionally, for the analysis of drinking and dietary habits, researchers matched patients who developed head and neck cancer based on smoking status and duration, in addition to demographics and family history of head and neck cancer.
Diagnosis of head and neck cancer served as the study’s main outcome measurement.
Results, next steps
At a median follow-up of 12.1 years (range, 10.3-13.6), researchers reported 571 cases of head and neck cancer from a study population of 139,926 patients.
Risk for developing a head or neck cancer associated with smoking increased with the closer the proximity of the head and neck subsite to the lungs, with the largest risk associated with smoking observed for laryngeal cancer (current smoker HR = 9.36; 95% CI, 5.78-15.15 compared with nonsmoker).
Of 94,466 participants included for analysis of drinking and dietary habits, at median follow-up of 12.2 years (range, 10.5-13.), 264 developed head and neck cancer.
Risk for head and neck cancer increaseed with heavy drinking (HR = 1.85; 95% CI, 1.44-2.38), but decreased with consumption of whole grains (HR = 0.78; 95% CI, 0.64-0.94/oz per day), whole fruits (HR = 0.9; 95% CI, 0.82-0.98/cup per day) and overall healthy eating according to the Healthy Eating Index 2015 (HR = 0.87; 95% CI, 0.78-0.98/10 points).
Potential study limitation — as recognized by the researchers — included selection bias in the Dietary History Questionnaire study population as shown by the “difference between the crude incidence rate of head and neck cancer in the [baseline questionnaire] and [dietary history questionnaire],” a lack of racial and ethnic diversity in the study population and lack of data on HPV status for many of the participants.
“Our study observed an increased risk [for] head and neck cancer with heavy drinking, predominantly driven by heavy consumption of beer and liquor rather than heavy consumption of wine,” researchers wrote. “Interestingly, increased risk [for] head and neck cancer was not observed with light or moderate drinking, and an interaction effect was not observed between smoking and drinking. This is contrary to prior studies, which suggested a dose-response trend with an increasing risk [for] head and neck cancer as alcohol consumption increased.”
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