Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: the ARCAGE study

Wolfgang Ahrens; Hermann Pohlabeln; Ronja Foraita; Mari Nelis; Pagona Lagiou; Areti Lagiou; Christine Bouchardy; Alena Slamova; Miriam Schejbalova; Franco Merletti; Lorenzo Richiardi; Kristina Kjaerheim; Antonio Agudo; Xavier Castellsague; Tatiana MacFarlane; Gary J Macfarlane; Yuan-Chin Amy Lee; Renato Talamini; Luigi Barzan; Cristina Canova; Lorenzo Simonato; Peter Thomson; Patricia A McKinney; Alex D McMahon; Ariana Znaor; Claire M Healy; Bernad E McCartan; Andres Metspalu; Manuela Marron; Mia Hashibe; David I Conway; Paul Brennan

doi:10.1016/j.oraloncology.2014.03.001

Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: the ARCAGE study

Wolfgang Ahrens, Hermann Pohlabeln, Ronja Foraita, Mari Nelis, Pagona Lagiou, Areti Lagiou, Christine Bouchardy, Alena Slamova, Miriam Schejbalova, Franco Merletti, Lorenzo Richiardi, Kristina Kjaerheim, Antonio Agudo, Xavier Castellsague, Tatiana MacFarlane, Gary J Macfarlane, Yuan-Chin Amy Lee, Renato Talamini, Luigi Barzan, Cristina CanovaLorenzo Simonato, Peter Thomson, Patricia A McKinney, Alex D McMahon, Ariana Znaor, Claire M Healy, Bernad E McCartan, Andres Metspalu, Manuela Marron, Mia Hashibe, David I Conway, Paul Brennan

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Abstract

OBJECTIVE: We aimed to assess the association of oral health (OH), dental care (DC) and mouthwash with upper-aerodigestive tract (UADT) cancer risk, and to examine the extent that enzymes involved in the metabolism of alcohol modify the effect of mouthwash.

MATERIALS AND METHODS: The study included 1963 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or esophagus and 1993 controls. Subjects were interviewed about their oral health and dental care behaviors (which were converted to scores of OH and DC respectively), as well as smoking, alcohol drinking, diet, occupations, medical conditions and socio-economic status. Blood samples were taken for genetic analyses. Mouthwash use was analyzed in relation to the presence of polymorphisms of alcohol-metabolizing genes known to be associated with UADT. Adjusted odds ratios (ORs) and 95%-confidence intervals [CI] were estimated with multiple logistic regression models adjusting for multiple confounders.

RESULTS: Fully adjusted ORs of low versus high scores of DC and OH were 2.36[CI=1.51-3.67] and 2.22[CI=1.45-3.41], respectively, for all UADT sites combined. The OR for frequent use of mouthwash use (3 or more times/day) was 3.23[CI=1.68-6.19]. The OR for the rare variant ADH7 (coding for fast ethanol metabolism) was lower in mouthwash-users (OR=0.53[CI=0.35-0.81]) as compared to never-users (OR=0.97[CI=0.73-1.29]) indicating effect modification (pheterogeneity=0.065) while no relevant differences were observed between users and non-users for the variant alleles of ADH1B, ADH1C or ALDH2.

CONCLUSIONS: Poor OH and DC seem to be independent risk factors for UADT because corresponding risk estimates remain substantially elevated after detailed adjustment for multiple confounders. Whether mouthwash use may entail some risk through the alcohol content in most formulations on the market remains to be fully clarified.

Original language	English
Pages (from-to)	616-625
Number of pages	10
Journal	Oral Oncology
Volume	50
Issue number	6
Early online date	27 Mar 2014
DOIs	https://doi.org/10.1016/j.oraloncology.2014.03.001
Publication status	Published - Jun 2014

Keywords

head and neck neoplasms
oral health
oral hygiene
genetic polymorphisms

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.oraloncology.2014.03.001

OO-S-13-00510_Submitted_20130626_PDF_Coauthors
NOTICE: this is the author’s version of a work that was accepted for publication in Oral Oncology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in ORAL ONCOLOGY, VOL 50, ISSUE 6,(2014)DOI: 10.1016/j.oraloncology.2014.03.001
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Ahrens, W., Pohlabeln, H., Foraita, R., Nelis, M., Lagiou, P., Lagiou, A., Bouchardy, C., Slamova, A., Schejbalova, M., Merletti, F., Richiardi, L., Kjaerheim, K., Agudo, A., Castellsague, X., MacFarlane, T., Macfarlane, G. J., Lee, Y-C. A., Talamini, R., Barzan, L., ... Brennan, P. (2014). Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: the ARCAGE study. Oral Oncology, 50(6), 616-625. https://doi.org/10.1016/j.oraloncology.2014.03.001

Ahrens, W, Pohlabeln, H, Foraita, R, Nelis, M, Lagiou, P, Lagiou, A, Bouchardy, C, Slamova, A, Schejbalova, M, Merletti, F, Richiardi, L, Kjaerheim, K, Agudo, A, Castellsague, X, MacFarlane, T , Macfarlane, GJ, Lee, Y-CA, Talamini, R, Barzan, L, Canova, C, Simonato, L, Thomson, P, McKinney, PA, McMahon, AD, Znaor, A, Healy, CM, McCartan, BE, Metspalu, A, Marron, M, Hashibe, M, Conway, DI & Brennan, P 2014, 'Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: the ARCAGE study', Oral Oncology, vol. 50, no. 6, pp. 616-625. https://doi.org/10.1016/j.oraloncology.2014.03.001

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title = "Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: the ARCAGE study",

abstract = "OBJECTIVE: We aimed to assess the association of oral health (OH), dental care (DC) and mouthwash with upper-aerodigestive tract (UADT) cancer risk, and to examine the extent that enzymes involved in the metabolism of alcohol modify the effect of mouthwash.MATERIALS AND METHODS: The study included 1963 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or esophagus and 1993 controls. Subjects were interviewed about their oral health and dental care behaviors (which were converted to scores of OH and DC respectively), as well as smoking, alcohol drinking, diet, occupations, medical conditions and socio-economic status. Blood samples were taken for genetic analyses. Mouthwash use was analyzed in relation to the presence of polymorphisms of alcohol-metabolizing genes known to be associated with UADT. Adjusted odds ratios (ORs) and 95%-confidence intervals [CI] were estimated with multiple logistic regression models adjusting for multiple confounders.RESULTS: Fully adjusted ORs of low versus high scores of DC and OH were 2.36[CI=1.51-3.67] and 2.22[CI=1.45-3.41], respectively, for all UADT sites combined. The OR for frequent use of mouthwash use (3 or more times/day) was 3.23[CI=1.68-6.19]. The OR for the rare variant ADH7 (coding for fast ethanol metabolism) was lower in mouthwash-users (OR=0.53[CI=0.35-0.81]) as compared to never-users (OR=0.97[CI=0.73-1.29]) indicating effect modification (pheterogeneity=0.065) while no relevant differences were observed between users and non-users for the variant alleles of ADH1B, ADH1C or ALDH2.CONCLUSIONS: Poor OH and DC seem to be independent risk factors for UADT because corresponding risk estimates remain substantially elevated after detailed adjustment for multiple confounders. Whether mouthwash use may entail some risk through the alcohol content in most formulations on the market remains to be fully clarified.",

keywords = "head and neck neoplasms, oral health, oral hygiene, genetic polymorphisms",

author = "Wolfgang Ahrens and Hermann Pohlabeln and Ronja Foraita and Mari Nelis and Pagona Lagiou and Areti Lagiou and Christine Bouchardy and Alena Slamova and Miriam Schejbalova and Franco Merletti and Lorenzo Richiardi and Kristina Kjaerheim and Antonio Agudo and Xavier Castellsague and Tatiana MacFarlane and Macfarlane, {Gary J} and Lee, {Yuan-Chin Amy} and Renato Talamini and Luigi Barzan and Cristina Canova and Lorenzo Simonato and Peter Thomson and McKinney, {Patricia A} and McMahon, {Alex D} and Ariana Znaor and Healy, {Claire M} and McCartan, {Bernad E} and Andres Metspalu and Manuela Marron and Mia Hashibe and Conway, {David I} and Paul Brennan",

year = "2014",

month = jun,

doi = "10.1016/j.oraloncology.2014.03.001",

language = "English",

volume = "50",

pages = "616--625",

journal = "Oral Oncology",

issn = "1368-8375",

publisher = "Elsevier Limited",

number = "6",

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TY - JOUR

T1 - Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe

T2 - the ARCAGE study

AU - Ahrens, Wolfgang

AU - Pohlabeln, Hermann

AU - Foraita, Ronja

AU - Nelis, Mari

AU - Lagiou, Pagona

AU - Lagiou, Areti

AU - Bouchardy, Christine

AU - Slamova, Alena

AU - Schejbalova, Miriam

AU - Merletti, Franco

AU - Richiardi, Lorenzo

AU - Kjaerheim, Kristina

AU - Agudo, Antonio

AU - Castellsague, Xavier

AU - MacFarlane, Tatiana

AU - Macfarlane, Gary J

AU - Lee, Yuan-Chin Amy

AU - Talamini, Renato

AU - Barzan, Luigi

AU - Canova, Cristina

AU - Simonato, Lorenzo

AU - Thomson, Peter

AU - McKinney, Patricia A

AU - McMahon, Alex D

AU - Znaor, Ariana

AU - Healy, Claire M

AU - McCartan, Bernad E

AU - Metspalu, Andres

AU - Marron, Manuela

AU - Hashibe, Mia

AU - Conway, David I

AU - Brennan, Paul

PY - 2014/6

Y1 - 2014/6

N2 - OBJECTIVE: We aimed to assess the association of oral health (OH), dental care (DC) and mouthwash with upper-aerodigestive tract (UADT) cancer risk, and to examine the extent that enzymes involved in the metabolism of alcohol modify the effect of mouthwash.MATERIALS AND METHODS: The study included 1963 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or esophagus and 1993 controls. Subjects were interviewed about their oral health and dental care behaviors (which were converted to scores of OH and DC respectively), as well as smoking, alcohol drinking, diet, occupations, medical conditions and socio-economic status. Blood samples were taken for genetic analyses. Mouthwash use was analyzed in relation to the presence of polymorphisms of alcohol-metabolizing genes known to be associated with UADT. Adjusted odds ratios (ORs) and 95%-confidence intervals [CI] were estimated with multiple logistic regression models adjusting for multiple confounders.RESULTS: Fully adjusted ORs of low versus high scores of DC and OH were 2.36[CI=1.51-3.67] and 2.22[CI=1.45-3.41], respectively, for all UADT sites combined. The OR for frequent use of mouthwash use (3 or more times/day) was 3.23[CI=1.68-6.19]. The OR for the rare variant ADH7 (coding for fast ethanol metabolism) was lower in mouthwash-users (OR=0.53[CI=0.35-0.81]) as compared to never-users (OR=0.97[CI=0.73-1.29]) indicating effect modification (pheterogeneity=0.065) while no relevant differences were observed between users and non-users for the variant alleles of ADH1B, ADH1C or ALDH2.CONCLUSIONS: Poor OH and DC seem to be independent risk factors for UADT because corresponding risk estimates remain substantially elevated after detailed adjustment for multiple confounders. Whether mouthwash use may entail some risk through the alcohol content in most formulations on the market remains to be fully clarified.

AB - OBJECTIVE: We aimed to assess the association of oral health (OH), dental care (DC) and mouthwash with upper-aerodigestive tract (UADT) cancer risk, and to examine the extent that enzymes involved in the metabolism of alcohol modify the effect of mouthwash.MATERIALS AND METHODS: The study included 1963 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or esophagus and 1993 controls. Subjects were interviewed about their oral health and dental care behaviors (which were converted to scores of OH and DC respectively), as well as smoking, alcohol drinking, diet, occupations, medical conditions and socio-economic status. Blood samples were taken for genetic analyses. Mouthwash use was analyzed in relation to the presence of polymorphisms of alcohol-metabolizing genes known to be associated with UADT. Adjusted odds ratios (ORs) and 95%-confidence intervals [CI] were estimated with multiple logistic regression models adjusting for multiple confounders.RESULTS: Fully adjusted ORs of low versus high scores of DC and OH were 2.36[CI=1.51-3.67] and 2.22[CI=1.45-3.41], respectively, for all UADT sites combined. The OR for frequent use of mouthwash use (3 or more times/day) was 3.23[CI=1.68-6.19]. The OR for the rare variant ADH7 (coding for fast ethanol metabolism) was lower in mouthwash-users (OR=0.53[CI=0.35-0.81]) as compared to never-users (OR=0.97[CI=0.73-1.29]) indicating effect modification (pheterogeneity=0.065) while no relevant differences were observed between users and non-users for the variant alleles of ADH1B, ADH1C or ALDH2.CONCLUSIONS: Poor OH and DC seem to be independent risk factors for UADT because corresponding risk estimates remain substantially elevated after detailed adjustment for multiple confounders. Whether mouthwash use may entail some risk through the alcohol content in most formulations on the market remains to be fully clarified.

KW - head and neck neoplasms

KW - oral health

KW - oral hygiene

KW - genetic polymorphisms

U2 - 10.1016/j.oraloncology.2014.03.001

DO - 10.1016/j.oraloncology.2014.03.001

M3 - Article

C2 - 24680035

VL - 50

SP - 616

EP - 625

JO - Oral Oncology

JF - Oral Oncology

SN - 1368-8375

IS - 6

ER -

Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: the ARCAGE study

Abstract

Keywords

UN SDGs

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