Low frequency of cigarette smoking and the risk of head and neck cancer in the INHANCE consortium pooled analysis.

Stefania Boccia, Gabriella Cadoni, Giorgia Ferro, Paolo Boffetta, Julien Berthiller, Kurt Straif, Antonio Agudo, Wolfgang Ahrens, Alexandre Bezerra Dos Santos, Cristina Canova, Xavier Castellsague, Chu Chen, David Conway, Maria Paula Curado, Luigino Dal Maso, Alexander W Daudt, Eleonora Fabianova, Leticia Fernandez, Silvia Franceschi, Erica E FukuyamaRichard B Hayes, Claire Healy, Rolando Herrero, Ivana Holcatova, Karl Kelsey, Kristina Kjaerheim, Sergio Koifman, Pagona Lagiou, Carlo La Vecchia, Philip Lazarus, Fabio Levi, Jolanta Lissowska, Tatiana Macfarlane, Dana Mates, Michael Mcclean, Ana Menezes, Franco Merletti, Hal Morgenstern, Joshua Muscat, Andrew F Olshan, Mark Purdue, Heribert Ramroth, Peter Rudnai, Stephen M Schwartz, Diego Serraino, Oxana Shangina, Elaine Smith, Erich M Sturgis, Neonila Szeszenia-Dabrowska, Peter Thomson, Thomas L Vaughan, Marta Vilensky, Qingyi Wei, Deborah M Winn, Victor Wünsch-Filho, Zuo-Feng Zhang, Ariana Znaor, Gilles Ferro, Paul Brennan, Mia Hashibe, Yuan-Chin Amy Lee

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BACKGROUND: Cigarette smoking is a major risk factor for head and neck cancer (HNC). To our knowledge, low cigarette smoking (<10 cigarettes per day) has not been extensively investigated in fine categories or among never alcohol drinkers. METHODS: We conducted a pooled analysis of individual participant data from 23 independent case-control studies including 19 660 HNC cases and 25 566 controls. After exclusion of subjects using other tobacco products including cigars, pipes, snuffed or chewed tobacco and straw cigarettes (tobacco product used in Brazil), as well as subjects smoking more than 10 cigarettes per day, 4093 HNC cases and 13 416 controls were included in the analysis. The lifetime average frequency of cigarette consumption was categorized as follows: never cigarette users, >0-3, >3-5, >5-10 cigarettes per day. RESULTS: Smoking >0-3 cigarettes per day was associated with a 50% increased risk of HNC in the study population [odds ratio (OR) = 1.52, 95% confidence interval (CI): (1.21, 1.90). Smoking >3-5 cigarettes per day was associated in each subgroup from OR = 2.01 (95% CI: 1.22, 3.31) among never alcohol drinkers to OR = 2.74 (95% CI: 2.01, 3.74) among women and in each cancer site, particularly laryngeal cancer (OR = 3.48, 95% CI: 2.40, 5.05). However, the observed increased risk of HNC for low smoking frequency was not found among smokers with smoking duration shorter than 20 years. CONCLUSION: Our results suggest a public health message that low frequency of cigarette consumption contributes to the development of HNC. However, smoking duration seems to play at least an equal or a stronger role in the development of HNC. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association. KEYWORDS: Head and neck cancer; low frequency cigarette smoking; pooled analysis; risk factors
Original languageEnglish
Pages (from-to)835-845
Number of pages11
JournalInternational Journal of Epidemiology
Publication statusPublished - 2016


  • head and neck cancer


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