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 & 12 others 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

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)616-625
Number of pages10
JournalOral Oncology
Volume50
Issue number6
Early online date27 Mar 2014
DOIs
Publication statusPublished - Jun 2014

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Mouthwashes
Dental Care
Oral Health
Odds Ratio
Confidence Intervals
Delivery of Health Care
Neoplasms
Alcohols
Logistic Models
Hypopharynx
Oropharynx
Mouth Neoplasms
Larynx
Occupations
Alcohol Drinking
Esophagus
Mouth
Ethanol
Smoking
Alleles

Keywords

  • head and neck neoplasms
  • oral health
  • oral hygiene
  • genetic polymorphisms

Cite this

Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe : the ARCAGE study. / Ahrens, Wolfgang; Pohlabeln, Hermann; Foraita, Ronja; Nelis, Mari; Lagiou, Pagona; Lagiou, Areti; Bouchardy, Christine; Slamova, Alena; Schejbalova, Miriam; Merletti, Franco; Richiardi, Lorenzo; Kjaerheim, Kristina; Agudo, Antonio; Castellsague, Xavier; MacFarlane, Tatiana; Macfarlane, Gary J; Lee, Yuan-Chin Amy; Talamini, Renato; Barzan, Luigi; Canova, Cristina; Simonato, Lorenzo; Thomson, Peter; McKinney, Patricia A; McMahon, Alex D; Znaor, Ariana; Healy, Claire M; McCartan, Bernad E; Metspalu, Andres; Marron, Manuela; Hashibe, Mia; Conway, David I; Brennan, Paul.

In: Oral Oncology, Vol. 50, No. 6, 06.2014, p. 616-625.

Research output: Contribution to journalArticle

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
Ahrens, Wolfgang ; Pohlabeln, Hermann ; Foraita, Ronja ; Nelis, Mari ; Lagiou, Pagona ; Lagiou, Areti ; Bouchardy, Christine ; Slamova, Alena ; Schejbalova, Miriam ; Merletti, Franco ; Richiardi, Lorenzo ; Kjaerheim, Kristina ; Agudo, Antonio ; Castellsague, Xavier ; MacFarlane, Tatiana ; Macfarlane, Gary J ; Lee, Yuan-Chin Amy ; Talamini, Renato ; Barzan, Luigi ; Canova, Cristina ; Simonato, Lorenzo ; Thomson, Peter ; McKinney, Patricia A ; McMahon, Alex D ; Znaor, Ariana ; Healy, Claire M ; McCartan, Bernad E ; Metspalu, Andres ; Marron, Manuela ; Hashibe, Mia ; Conway, David I ; Brennan, Paul. / Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe : the ARCAGE study. In: Oral Oncology. 2014 ; Vol. 50, No. 6. pp. 616-625.
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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.",
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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",
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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

N1 - Copyright © 2014 Elsevier Ltd. All rights reserved.

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

VL - 50

SP - 616

EP - 625

JO - Oral Oncology

JF - Oral Oncology

SN - 1368-8375

IS - 6

ER -