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

Julien Berthiller, Kurt Straif, Antonio Agudo, Wolfgang Ahrens, Alexandre Bezerra dos Santos, Stefania Boccia, Gabriella Cadoni, Cristina Canova, Xavier Castellsague, Chu Chen, David Conway, Maria Paula Curado, Lugino Dal Maso, Alexander W. Daudt, Eleonora Fabianova, Leticia Fernandez, Silvia Franceschi, Erica E. Fukuyama, Richard B. Hayes, Claire HealyRolando 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 Wunsch-Filho, Zuo-Feng Zhang, Ariana Znaor, Gilles Ferro, Paul Brennan, Paolo Boffetta, Mia Hashibe, Yuan-Chin Amy Lee

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Abstract

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 (IPD) from 23 independent casecontrol 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, 4 093 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 (OR=1.52, 95% 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.
Original languageEnglish
Pages (from-to)835-845
Number of pages11
JournalInternational Journal of Epidemiology
Volume45
Issue number3
Early online date30 Jul 2015
DOIs
Publication statusPublished - Jun 2016

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Head and Neck Neoplasms
Smoking
Tobacco Products
Laryngeal Neoplasms
Public Health
Alcohols
Population
Neoplasms

Keywords

  • head and neck cancer
  • low frequency cigarette smoking
  • risk factors
  • pooled analysis

Cite this

Berthiller, J., Straif, K., Agudo, A., Ahrens, W., dos Santos, A. B., Boccia, S., ... Lee, Y-C. A. (2016). Low frequency of cigarette smoking and the risk of head and neck cancer in the INHANCE consortium pooled analysis. International Journal of Epidemiology, 45(3), 835-845. https://doi.org/10.1093/ije/dyv146

Low frequency of cigarette smoking and the risk of head and neck cancer in the INHANCE consortium pooled analysis. / Berthiller, Julien; Straif, Kurt; Agudo, Antonio; Ahrens, Wolfgang; dos Santos, Alexandre Bezerra; Boccia, Stefania; Cadoni, Gabriella; Canova, Cristina; Castellsague, Xavier; Chen, Chu; Conway, David; Curado, Maria Paula; Dal Maso, Lugino; Daudt, Alexander W.; Fabianova, Eleonora; Fernandez, Leticia; Franceschi, Silvia; Fukuyama, Erica E.; Hayes, Richard B.; Healy, Claire; Herrero, Rolando; Holcatova, Ivana; Kelsey, Karl; Kjaerheim, Kristina; Koifman, Sergio; Lagiou, Pagona; La Vecchia, Carlo; Lazarus, Philip; Levi, Fabio; Lissowska, Jolanta; MacFarlane, Tatiana; Mates, Dana; McClean, Michael; Menezes, Ana; Merletti, Franco; Morgenstern, Hal; Muscat, Joshua; Olshan, Andrew F.; Purdue, Mark; Ramroth, Heribert; Rudnai, Peter; Schwartz, Stephen M.; Serraino, Diego; Shangina, Oxana; Smith, Elaine; Sturgis, Erich M.; Szeszenia-Dabrowska, Neonila; Thomson, Peter; Vaughan, Thomas L.; Vilensky, Marta; Wei, Qingyi; Winn, Deborah M.; Wunsch-Filho, Victor; Zhang, Zuo-Feng; Znaor, Ariana; Ferro, Gilles; Brennan, Paul; Boffetta, Paolo; Hashibe, Mia; Lee, Yuan-Chin Amy.

In: International Journal of Epidemiology, Vol. 45, No. 3, 06.2016, p. 835-845.

Research output: Contribution to journalArticle

Berthiller, J, Straif, K, Agudo, A, Ahrens, W, dos Santos, AB, Boccia, S, Cadoni, G, Canova, C, Castellsague, X, Chen, C, Conway, D, Curado, MP, Dal Maso, L, Daudt, AW, Fabianova, E, Fernandez, L, Franceschi, S, Fukuyama, EE, Hayes, RB, Healy, C, Herrero, R, Holcatova, I, Kelsey, K, Kjaerheim, K, Koifman, S, Lagiou, P, La Vecchia, C, Lazarus, P, Levi, F, Lissowska, J, MacFarlane, T, Mates, D, McClean, M, Menezes, A, Merletti, F, Morgenstern, H, Muscat, J, Olshan, AF, Purdue, M, Ramroth, H, Rudnai, P, Schwartz, SM, Serraino, D, Shangina, O, Smith, E, Sturgis, EM, Szeszenia-Dabrowska, N, Thomson, P, Vaughan, TL, Vilensky, M, Wei, Q, Winn, DM, Wunsch-Filho, V, Zhang, Z-F, Znaor, A, Ferro, G, Brennan, P, Boffetta, P, Hashibe, M & Lee, Y-CA 2016, 'Low frequency of cigarette smoking and the risk of head and neck cancer in the INHANCE consortium pooled analysis', International Journal of Epidemiology, vol. 45, no. 3, pp. 835-845. https://doi.org/10.1093/ije/dyv146
Berthiller, Julien ; Straif, Kurt ; Agudo, Antonio ; Ahrens, Wolfgang ; dos Santos, Alexandre Bezerra ; Boccia, Stefania ; Cadoni, Gabriella ; Canova, Cristina ; Castellsague, Xavier ; Chen, Chu ; Conway, David ; Curado, Maria Paula ; Dal Maso, Lugino ; Daudt, Alexander W. ; Fabianova, Eleonora ; Fernandez, Leticia ; Franceschi, Silvia ; Fukuyama, Erica E. ; Hayes, Richard B. ; Healy, Claire ; Herrero, Rolando ; Holcatova, Ivana ; Kelsey, Karl ; Kjaerheim, Kristina ; Koifman, Sergio ; Lagiou, Pagona ; La Vecchia, Carlo ; Lazarus, Philip ; Levi, Fabio ; Lissowska, Jolanta ; MacFarlane, Tatiana ; Mates, Dana ; McClean, Michael ; Menezes, Ana ; Merletti, Franco ; Morgenstern, Hal ; Muscat, Joshua ; Olshan, Andrew F. ; Purdue, Mark ; Ramroth, Heribert ; Rudnai, Peter ; Schwartz, Stephen M. ; Serraino, Diego ; Shangina, Oxana ; Smith, Elaine ; Sturgis, Erich M. ; Szeszenia-Dabrowska, Neonila ; Thomson, Peter ; Vaughan, Thomas L. ; Vilensky, Marta ; Wei, Qingyi ; Winn, Deborah M. ; Wunsch-Filho, Victor ; Zhang, Zuo-Feng ; Znaor, Ariana ; Ferro, Gilles ; Brennan, Paul ; Boffetta, Paolo ; Hashibe, Mia ; Lee, Yuan-Chin Amy. / Low frequency of cigarette smoking and the risk of head and neck cancer in the INHANCE consortium pooled analysis. In: International Journal of Epidemiology. 2016 ; Vol. 45, No. 3. pp. 835-845.
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title = "Low frequency of cigarette smoking and the risk of head and neck cancer in the INHANCE consortium pooled analysis",
abstract = "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 (IPD) from 23 independent casecontrol 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, 4 093 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 (OR=1.52, 95{\%} 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.",
keywords = "head and neck cancer, low frequency cigarette smoking, risk factors, pooled analysis",
author = "Julien Berthiller and Kurt Straif and Antonio Agudo and Wolfgang Ahrens and {dos Santos}, {Alexandre Bezerra} and Stefania Boccia and Gabriella Cadoni and Cristina Canova and Xavier Castellsague and Chu Chen and David Conway and Curado, {Maria Paula} and {Dal Maso}, Lugino and Daudt, {Alexander W.} and Eleonora Fabianova and Leticia Fernandez and Silvia Franceschi and Fukuyama, {Erica E.} and Hayes, {Richard B.} and Claire Healy and Rolando Herrero and Ivana Holcatova and Karl Kelsey and Kristina Kjaerheim and Sergio Koifman and Pagona Lagiou and {La Vecchia}, Carlo and Philip Lazarus and Fabio Levi and Jolanta Lissowska and Tatiana MacFarlane and Dana Mates and Michael McClean and Ana Menezes and Franco Merletti and Hal Morgenstern and Joshua Muscat and Olshan, {Andrew F.} and Mark Purdue and Heribert Ramroth and Peter Rudnai and Schwartz, {Stephen M.} and Diego Serraino and Oxana Shangina and Elaine Smith and Sturgis, {Erich M.} and Neonila Szeszenia-Dabrowska and Peter Thomson and Vaughan, {Thomas L.} and Marta Vilensky and Qingyi Wei and Winn, {Deborah M.} and Victor Wunsch-Filho and Zuo-Feng Zhang and Ariana Znaor and Gilles Ferro and Paul Brennan and Paolo Boffetta and Mia Hashibe and Lee, {Yuan-Chin Amy}",
note = "Funding • The pooled data coordination team (PBoffetta, MH, YCAL) were supported by National Cancer Institute grant R03CA113157 and by National Institute of Dental and Craniofacial Research grant R03DE016611 • The Milan study (CLV) was supported by the Italian Association for Research on Cancer (Grant no. 10068). • The Aviano study (LDM) was supported by a grant from the Italian Association for Research on Cancer (AIRC), Italian League Against Cancer and Italian Ministry of Research • The Italy Multicenter study (DS) was supported by the Italian Association for Research on Cancer (AIRC), Italian League Against Cancer and Italian Ministry of Research. • The Study from Switzerland (FL) was supported by the Swiss League against Cancer and the Swiss Research against Cancer/Oncosuisse [KFS-700, OCS-1633]. • The central Europe study (PBoffetta, PBrenan, EF, JL, DM, PR, OS, NS-D) was supported by the World Cancer Research Fund and the European Commission INCO-COPERNICUS Program [Contract No. IC15- CT98-0332] • The New York multicentre study (JM) was supported by a grant from National Institute of Health [P01CA068384 K07CA104231]. • The study from the Fred Hutchison Cancer Research Center from Seattle (CC, SMS) was supported by a National Institute of Health grant [R01CA048996, R01DE012609]. • The Iowa study (ES) was supported by National Institute of Health [NIDCR R01DE011979, NIDCR R01DE013110, FIRCA TW001500] and Veterans Affairs Merit Review Funds. • The North Carolina studies (AFO) were supported by National Institute of Health [R01CA061188], and in part by a grant from the National Institute of Environmental Health Sciences [P30ES010126]. • The Tampa study (PLazarus, JM) was supported by National Institute of Health grants [P01CA068384, K07CA104231, R01DE013158] • The Los Angeles study (Z-F Z, HM) was supported by grants from National Institute of Health [P50CA090388, R01DA011386, R03CA077954, T32CA009142, U01CA096134, R21ES011667] and the Alper Research Program for Environmental Genomics of the UCLA Jonsson Comprehensive Cancer Center. • The Houston study (EMS, GL) was supported by a grant from National Institute of Health [R01ES011740, R01CA100264]. • The Puerto Rico study (RBH, MPP) was supported by a grant from National Institutes of Health (NCI) US and NIDCR intramural programs. • The Latin America study (PBoffetta, PBrenan, MV, LF, MPC, AM, AWD, SK, VW-F) was supported by Fondo para la Investigacion Cientifica y Tecnologica (FONCYT) Argentina, IMIM (Barcelona), Fundaco de Amparo a‘ Pesquisa no Estado de Sao Paulo (FAPESP) [No 01/01768-2], and European Commission [IC18-CT97-0222] • The IARC multicentre study (SF, RH, XC) was supported by Fondo de Investigaciones Sanitarias (FIS) of the Spanish Government [FIS 97/ 0024, FIS 97/0662, BAE 01/5013], International Union Against Cancer (UICC), and Yamagiwa-Yoshida Memorial International Cancer Study Grant. • The Boston study (KKelsey, MMcC) was supported by a grant from National Institute of Health [R01CA078609, R01CA100679]. • The Rome study (SB, GC) was supported by AIRC (Italian Agency for Research on Cancer). • The US multicentre study (BW) was supported by The Intramural Program of the National Cancer Institute, National Institute of Health, United States. • The Sao Paolo study (V W-F) was supported by Fundacao de Ampara a Pesquisa no Estado de Sao Paulo (FAPESP No 10/51168-0) • The MSKCC study (SS, G-P Y) was supported by a grant from National Institute of Health [R01CA051845]. • The Seattle-Leo stud (FV) was supported by a grant from National Institute of Health [R01CA030022] • The western Europe Study (PBoffetta, IH, WA, PLagiou, DS, LS, FM, CH, KKjaerheim, DC, TMc, PT, AA, AZ) was supported by European Community (5th Frame work Programme) grant no QLK1-CT-2001- 00182. • The Germany Heidelberg study (HR) was supported by the grant No. 01GB9702/3 from the German Ministry of Education and Research.",
year = "2016",
month = "6",
doi = "10.1093/ije/dyv146",
language = "English",
volume = "45",
pages = "835--845",
journal = "International Journal of Epidemiology",
issn = "0300-5771",
publisher = "OXFORD UNIV PRESS",
number = "3",

}

TY - JOUR

T1 - Low frequency of cigarette smoking and the risk of head and neck cancer in the INHANCE consortium pooled analysis

AU - Berthiller, Julien

AU - Straif, Kurt

AU - Agudo, Antonio

AU - Ahrens, Wolfgang

AU - dos Santos, Alexandre Bezerra

AU - Boccia, Stefania

AU - Cadoni, Gabriella

AU - Canova, Cristina

AU - Castellsague, Xavier

AU - Chen, Chu

AU - Conway, David

AU - Curado, Maria Paula

AU - Dal Maso, Lugino

AU - Daudt, Alexander W.

AU - Fabianova, Eleonora

AU - Fernandez, Leticia

AU - Franceschi, Silvia

AU - Fukuyama, Erica E.

AU - Hayes, Richard B.

AU - Healy, Claire

AU - Herrero, Rolando

AU - Holcatova, Ivana

AU - Kelsey, Karl

AU - Kjaerheim, Kristina

AU - Koifman, Sergio

AU - Lagiou, Pagona

AU - La Vecchia, Carlo

AU - Lazarus, Philip

AU - Levi, Fabio

AU - Lissowska, Jolanta

AU - MacFarlane, Tatiana

AU - Mates, Dana

AU - McClean, Michael

AU - Menezes, Ana

AU - Merletti, Franco

AU - Morgenstern, Hal

AU - Muscat, Joshua

AU - Olshan, Andrew F.

AU - Purdue, Mark

AU - Ramroth, Heribert

AU - Rudnai, Peter

AU - Schwartz, Stephen M.

AU - Serraino, Diego

AU - Shangina, Oxana

AU - Smith, Elaine

AU - Sturgis, Erich M.

AU - Szeszenia-Dabrowska, Neonila

AU - Thomson, Peter

AU - Vaughan, Thomas L.

AU - Vilensky, Marta

AU - Wei, Qingyi

AU - Winn, Deborah M.

AU - Wunsch-Filho, Victor

AU - Zhang, Zuo-Feng

AU - Znaor, Ariana

AU - Ferro, Gilles

AU - Brennan, Paul

AU - Boffetta, Paolo

AU - Hashibe, Mia

AU - Lee, Yuan-Chin Amy

N1 - Funding • The pooled data coordination team (PBoffetta, MH, YCAL) were supported by National Cancer Institute grant R03CA113157 and by National Institute of Dental and Craniofacial Research grant R03DE016611 • The Milan study (CLV) was supported by the Italian Association for Research on Cancer (Grant no. 10068). • The Aviano study (LDM) was supported by a grant from the Italian Association for Research on Cancer (AIRC), Italian League Against Cancer and Italian Ministry of Research • The Italy Multicenter study (DS) was supported by the Italian Association for Research on Cancer (AIRC), Italian League Against Cancer and Italian Ministry of Research. • The Study from Switzerland (FL) was supported by the Swiss League against Cancer and the Swiss Research against Cancer/Oncosuisse [KFS-700, OCS-1633]. • The central Europe study (PBoffetta, PBrenan, EF, JL, DM, PR, OS, NS-D) was supported by the World Cancer Research Fund and the European Commission INCO-COPERNICUS Program [Contract No. IC15- CT98-0332] • The New York multicentre study (JM) was supported by a grant from National Institute of Health [P01CA068384 K07CA104231]. • The study from the Fred Hutchison Cancer Research Center from Seattle (CC, SMS) was supported by a National Institute of Health grant [R01CA048996, R01DE012609]. • The Iowa study (ES) was supported by National Institute of Health [NIDCR R01DE011979, NIDCR R01DE013110, FIRCA TW001500] and Veterans Affairs Merit Review Funds. • The North Carolina studies (AFO) were supported by National Institute of Health [R01CA061188], and in part by a grant from the National Institute of Environmental Health Sciences [P30ES010126]. • The Tampa study (PLazarus, JM) was supported by National Institute of Health grants [P01CA068384, K07CA104231, R01DE013158] • The Los Angeles study (Z-F Z, HM) was supported by grants from National Institute of Health [P50CA090388, R01DA011386, R03CA077954, T32CA009142, U01CA096134, R21ES011667] and the Alper Research Program for Environmental Genomics of the UCLA Jonsson Comprehensive Cancer Center. • The Houston study (EMS, GL) was supported by a grant from National Institute of Health [R01ES011740, R01CA100264]. • The Puerto Rico study (RBH, MPP) was supported by a grant from National Institutes of Health (NCI) US and NIDCR intramural programs. • The Latin America study (PBoffetta, PBrenan, MV, LF, MPC, AM, AWD, SK, VW-F) was supported by Fondo para la Investigacion Cientifica y Tecnologica (FONCYT) Argentina, IMIM (Barcelona), Fundaco de Amparo a‘ Pesquisa no Estado de Sao Paulo (FAPESP) [No 01/01768-2], and European Commission [IC18-CT97-0222] • The IARC multicentre study (SF, RH, XC) was supported by Fondo de Investigaciones Sanitarias (FIS) of the Spanish Government [FIS 97/ 0024, FIS 97/0662, BAE 01/5013], International Union Against Cancer (UICC), and Yamagiwa-Yoshida Memorial International Cancer Study Grant. • The Boston study (KKelsey, MMcC) was supported by a grant from National Institute of Health [R01CA078609, R01CA100679]. • The Rome study (SB, GC) was supported by AIRC (Italian Agency for Research on Cancer). • The US multicentre study (BW) was supported by The Intramural Program of the National Cancer Institute, National Institute of Health, United States. • The Sao Paolo study (V W-F) was supported by Fundacao de Ampara a Pesquisa no Estado de Sao Paulo (FAPESP No 10/51168-0) • The MSKCC study (SS, G-P Y) was supported by a grant from National Institute of Health [R01CA051845]. • The Seattle-Leo stud (FV) was supported by a grant from National Institute of Health [R01CA030022] • The western Europe Study (PBoffetta, IH, WA, PLagiou, DS, LS, FM, CH, KKjaerheim, DC, TMc, PT, AA, AZ) was supported by European Community (5th Frame work Programme) grant no QLK1-CT-2001- 00182. • The Germany Heidelberg study (HR) was supported by the grant No. 01GB9702/3 from the German Ministry of Education and Research.

PY - 2016/6

Y1 - 2016/6

N2 - 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 (IPD) from 23 independent casecontrol 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, 4 093 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 (OR=1.52, 95% 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.

AB - 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 (IPD) from 23 independent casecontrol 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, 4 093 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 (OR=1.52, 95% 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.

KW - head and neck cancer

KW - low frequency cigarette smoking

KW - risk factors

KW - pooled analysis

U2 - 10.1093/ije/dyv146

DO - 10.1093/ije/dyv146

M3 - Article

VL - 45

SP - 835

EP - 845

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

SN - 0300-5771

IS - 3

ER -