Evidence map›Paper›PMID 31178212›Full record

ArticleOral oncology2019

Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer: A bivariate spline model approach.

Gioia Di Credico, Valeria Edefonti, Jerry Polesel, Francesco Pauli, Nicola Torelli, Diego Serraino, Eva Negri, Daniele Luce, Isabelle Stucker, Keitaro Matsuo and 68 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Oral oncology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 2 pooled it
4.3field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 46 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Radiomics in laryngeal squamous cell carcinoma: state of the art.Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale · 2026
    Review
  6. The histopathological spectrum of laryngeal epithelial neoplasia.Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale · 2026
    Review
  7. Article
  8. Review
  9. A systematic review and network meta-analysis of therapies for locally advanced head and neck squamous cell carcinoma with different HPV status.Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale · 2025
    Review
  10. Review
  11. Review
  12. Article
  13. Smoking and alcohol consumption with the risk of 11 common otolaryngological diseases: a bidirectional Mendelian randomization.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2023
    Article
  14. Review
  15. Oncological outcome of vocal cord-only radiotherapy for cT1-T2 glottic laryngeal squamous cell carcinoma.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2023
    Article
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  18. Article
  19. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

78 authors at 20 institutions in 22 countries.

Gioia Di CredicoDepartment of Statistics, Padua University, Padua, Italy; Department of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy.
Valeria EdefontiBranch of Medical Statistics, Biometry and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy. Electronic address: valeria.edefonti@unimi.it.
Jerry PoleselCancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
Francesco PauliDepartment of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy.
Nicola TorelliDepartment of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy.
Diego SerrainoCancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
Eva NegriDepartment of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy.
Daniele LuceUniversité de Rennes, INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, Pointe-à-Pitre, France.
Isabelle StuckerInserm, Center for Research in Epidemiology and Population Health (CESP), Cancer and Environment team, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
Keitaro MatsuoAichi Cancer Center Research Institute, Nagoya, Japan.
Paul BrennanInternational Agency for Research on Cancer, Lyon, France.
Marta VilenskyInstitute of Oncology Angel H. Roffo, University of Buenos Aires, Argentina.
Leticia FernandezInstitute of Oncology and Radiobiology, Havana, Cuba.
Maria Paula CuradoEpidemiology, CIPE/ACCAMARGO, Sao Paulo, Brazil.
Ana MenezesUniversidade Federal de Pelotas, Pelotas, Brazil.
Alexander W DaudtHospital Moinhos de Vento, Porto Alegre, Brazil.
Rosalina KoifmanEscola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
Victor Wunsch-FilhoUniversity of São Paulo School of Public Health, São Paulo, Brazil.
Ivana HolcatovaInstitute of Hygiene & Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
Wolfgang AhrensLeibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany; University of Bremen, Faculty of Mathematics and Computer Science, Bremen, Germany.
Pagona LagiouDepartment of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Lorenzo SimonatoDepartment of Cardiovascular and Thoracic Sciences and Public Health, University of Padova, Padova, Italy.
Lorenzo RichiardiDepartment of Medical Sciences, University of Turin, Turin, Italy.
Claire HealyTrinity College School of Dental Science, Dublin, Ireland.
Kristina KjaerheimCancer Registry of Norway, Oslo, Norway.
David I ConwaySchool of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK.
Tatiana V MacfarlaneSchool of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK and School of Medicine, University of Dundee, Dundee, UK.
Peter ThomsonUniversity of Hong Kong, Hong Kong, China.
Antonio AgudoInstitut Catala Oncologia, Barcelona, Spain.
Ariana ZnaorInternational Agency for Research on Cancer, Lyon, France.
Leonardo F Boaventura RiosUniversity of São Paulo School of Medicine, São Paulo, Brazil.
Tatiana N ToporcovUniversity of São Paulo School of Public Health, São Paulo, Brazil.
Silvia FranceschiCancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
Rolando HerreroInternational Agency for Research on Cancer, Lyon, France.
Joshua MuscatPenn State College of Medicine, Hershey, PA, USA.
Andrew F OlshanUniversity of North Carolina School of Public Health, Chapel Hill, NC, USA.
Jose P ZevallosDivision of Head and Neck Surgical Oncology in the Department of Otolaryngology/Head and Neck Surgery at Washington University School of Medicine, USA.
Carlo La VecchiaBranch of Medical Statistics, Biometry and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
Deborah M WinnDivision of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Erich M SturgisUT - M.D. Anderson Cancer Center, Houston, TX, USA.
Guojun LiUT - M.D. Anderson Cancer Center, Houston, TX, USA.
Eleonora FabianovaRegional Authority of Public Health in Banska Bystrica, Slovakia.
Jolanda LissowskaThe M. Skasodowska-Curie Memorial Cancer Center and Institute of Oncology, Dept. of Cancer Epidemiology and Prevention, Warsaw, Poland.
Dana MatesNational Institute of Public Health, Bucharest, Romania.
Peter RudnaiNational Institute of Environmental Health to National Public Health Institute, Budapest, Hungary.
Oxana ShanginaCancer Research Centre, Moscow, Russia.
Beata SwiatkowskaInstitute of Occupational Medicine, Lodz, Poland.
Kirsten MoysichRoswell Park Cancer Institute, Buffalo, NY, USA.
Zuo-Feng ZhangUCLA School of Public Health, Los Angeles, CA, USA.
Hal MorgensternDepartments of Epidemiology and Environmental Health Sciences, School of Public Health and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA.
Fabio LeviInstitut Universitaire de Medecine Sociale et Preventive (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Elaine SmithCollege of Public Health, University of Iowa, Iowa City, IA, USA.
Philip LazarusWashington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA.
Cristina BosettiDepartment of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
Werner GaravelloDepartment of Otorhinolaryngology, School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.
Karl KelseyBrown University, Providence, RI, USA.
Michael McCleanBoston University School of Public Health, Boston, MA, USA.
Heribert RamrothUniversity of Heidelberg, Germany.
Chu ChenProgram in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Stephen M SchwartzProgram in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Thomas L VaughanProgram in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Tongzhang ZhengDepartment of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Gwenn MenvielleSorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of Social Epidemiology, F75012 Paris, France.
Stefania BocciaDepartment of Woman and Child Health and Public Health, Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy.
Gabriella CadoniDipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Istituto di Clinica Otorinolaringoiatrica, Università Cattolica del Sacro Cuore, Roma, Italy.
Richard B HayesDivision of Epidemiology, New York University School Of Medicine, New York, NY, USA.
Mark PurdueDivision of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
Maura Gillison"Thoracic/Head and Neck Medical Oncology", The University of Texas MD Anderson Cancer Center, TX, USA.
Stimson SchantzNew York Eye and Ear Infirmary, New York, NY, USA.
Guo-Pei YuMedical Informatics Center, Peking University, China.
Hermann BrennerDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
Gypsyamber D'SouzaJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Neil D GrossDepartment of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Shu-Chun ChuangInstitute of Population Health Sciences, National Health Research Institutes, Taiwan.
Paolo BoffettaThe Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Mia HashibeDivision of Public Health, Department of Family & Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA.
Yuan-Chin Amy LeeDivision of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Luigino Dal MasoCancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
Centro di Riferimento Oncologico · ITThe University of Texas MD Anderson Cancer Center · USCentre international de recherche sur le cancer · FRFred Hutch Cancer Center · USUniversidade de São Paulo · BRUniversity of Milan · ITBrown University · USInserm · FRNational Cancer Institute · USUniversità Cattolica del Sacro Cuore · ITUniversity of Padua · ITUniversity of Trieste · ITUniversity of Utah · USAichi Cancer Center · JPBoston University · USCancer Registry of Norway · NOCharles University · CZEscola Nacional de Saúde Pública · BRGerman Cancer Research Center · DEHeidelberg University · DE

Funding

UNC-CH CENTER FOR ENVIRONMENTAL HEALTH &SUSCEPTIBILITYP30ES010126 · NIEHS · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Stephanie Engel · 2001 to 2026
$36.3M
UCLA SPORE IN LUNG CANCERP50CA090388 · NCI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI DUBINETT, STEVEN M. · 2001 to 2008
$13.0M
UDP GLUCURONOSYLTRANSFERASES, DETOXIFICATION OF NNKP01CA068384 · NCI · PENNSYLVANIA STATE UNIV HERSHEY MED CTR · PI LAZARUS, PHILIP · 1995 to 2005
$8.5M
UCLA CANCER EPIDEMIOLOGY TRAINING PROGRAMT32CA009142 · NCI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ZHANG, ZUO-FENG · 1986 to 2024
$6.3M
Molecular Epidemiology of Head and Neck CancerR01ES011740 · NIEHS · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI WEI, QINGYI · 2001 to 2012
$6.3M
The Boston Collaborative Oral Cancer StudyR01CA078609 · NCI · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI KELSEY, KARL TIMOTHY · 1999 to 2010
$5.3M
LUNG CANCER CHEMOPREVENTION WITH CELECOXIB IN EX-SMOKERSU01CA096134 · NCI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI MAO, JENNY T · 2002 to 2007
$5.1M
Gene Environment Interaction in Head and Neck CancerR01CA090731 · NCI · UNIVERSITY OF NORTH CAROLINA CHAPEL HILL · PI OLSHAN, ANDREW · 2001 to 2005
$4.6M
UDPGLUCURONOSYLTRANSFERASE GENOTYPE AND ORAL CANCER RISKR01DE013158 · NIDCR · UNIVERSITY OF SOUTH FLORIDA · PI LAZARUS, PHILIP · 2000 to 2011
$3.6M
Patterns of Somatic Gene Alterations in Oral CancerR01CA100679 · NCI · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI KELSEY, KARL TIMOTHY · 2004 to 2012
$2.6M
Oral HPV Infection in HIV-Infected Men and WomenR01DE016631 · NIDCR · OHIO STATE UNIVERSITY · PI GILLISON, MAURA L · 2005 to 2008
$2.5M
Seroepidemiologic Study of HPV and Oral CancerR01DE013110 · NIDCR · UNIVERSITY OF IOWA · PI SMITH, ELAINE M. · 1999 to 2003
$2.5M
FIC NIH HHS R03 TW001500NCI NIH HHS K07 CA104231NCI NIH HHS P01 CA068384NCI NIH HHS P50 CA090388NCI NIH HHS R01 CA030022NCI NIH HHS R01 CA048996NCI NIH HHS R01 CA078609NCI NIH HHS R01 CA090731NCI NIH HHS R01 CA100264NCI NIH HHS R01 CA100679NCI NIH HHS R03 CA077954NCI NIH HHS R03 CA113157NCI NIH HHS R13 CA210555NCI NIH HHS T32 CA009142NCI NIH HHS U01 CA096134NIDA NIH HHS R01 DA011386NIDA NIH HHS R01 DA011979NIDCR NIH HHS R01 DE013110NIDCR NIH HHS R01 DE013158NIDCR NIH HHS R01 DE016631NIDCR NIH HHS R03 DE016611NIEHS NIH HHS P30 ES010126NIEHS NIH HHS R01 ES011740NIEHS NIH HHS R21 ES011667World Health Organization 001
6 · The paper itself

Abstract

objectivesThis study aimed at re-evaluating the strength and shape of the dose-response relationship between the combined (or joint) effect of intensity and duration of cigarette smoking and the risk of head and neck cancer (HNC). We explored this issue considering bivariate spline models, where smoking intensity and duration were treated as interacting continuous exposures. MATERIALS AND

methodsWe pooled individual-level data from 33 case-control studies (18,260 HNC cases and 29,844 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. In bivariate regression spline models, exposures to cigarette smoking intensity and duration (compared with never smokers) were modeled as a linear piecewise function within a logistic regression also including potential confounders. We jointly estimated the optimal knot locations and regression parameters within the Bayesian framework.

resultsFor oral-cavity/pharyngeal (OCP) cancers, an odds ratio (OR) >5 was reached after 30 years in current smokers of ∼20 or more cigarettes/day. Patterns of OCP cancer risk in current smokers differed across strata of alcohol intensity. For laryngeal cancer, ORs >20 were found for current smokers of ≥20 cigarettes/day for ≥30  years. In former smokers who quit ≥10  years ago, the ORs were approximately halved for OCP cancers, and ∼1/3 for laryngeal cancer, as compared to the same levels of intensity and duration in current smokers.

conclusionReferring to bivariate spline models, this study better quantified the joint effect of intensity and duration of cigarette smoking on HNC risk, further stressing the need of smoking cessation policies.

Indexed as

AdultAgedAged, 80 and overCase-Control StudiesCigarette SmokingFemaleHead and Neck NeoplasmsHumansMaleMiddle AgedRisk FactorsBivariate spline modelsCigarette smoking durationCigarette smoking intensityHead and neck cancerINHANCELaryngeal cancerOral cavity and pharyngeal cancers

Identifiers

PMID31178212
PMCPMC7117823
OpenAlexW2946739169

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.