ArticleJournal of the National Cancer Institute2025
Alcohol consumption and upper aerodigestive tract squamous cell carcinoma: evidence from 28 prospective cohorts.
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70 authors.
Elmira EbrahimiGenomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.ORCID 0000-0003-0910-3447
Sabine NaudinNutrition and Metabolism Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.ORCID 0000-0003-1049-6225
Niki DimouNutrition and Metabolism Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.ORCID 0000-0003-1678-9328
Ana-Lucia MayénNutrition and Metabolism Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.ORCID 0000-0001-9635-0416
Molin WangDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Christian C AbnetDivision of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.ORCID 0000-0002-3008-7843
Agneta ÅkessonInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0001-9594-4140
Matthew J BarnettDivision of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States.ORCID 0000-0002-1028-1091
Rino BelloccoDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0002-2538-0287
Amy Berrington de GonzalezDivision of Genetics and Epidemiology, Institute of Cancer Research, London, MD, United Kingdom.ORCID 0000-0002-7332-8387
Stephanie E BonnDivision of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0002-2219-7970
Chu ChenDivision of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States.ORCID 0000-0003-2267-8050
David C ChristianiDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.ORCID 0000-0002-0301-0242
Tracy E CraneMedical Oncology, Miller School of Medicine, University of Miami, Miami, FL, United States.ORCID 0000-0002-4288-134X
A Heather EliassenDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.ORCID 0000-0002-3961-6609
Jo L FreudenheimDepartment of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States.ORCID 0000-0002-9301-0499
Yu-Tang GaoDepartment of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Montse Garcia-ClosasDivision of Genetics and Epidemiology, Institute of Cancer Research, London, MD, United Kingdom.ORCID 0000-0003-1033-2650
Gretchen GierachDivision of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.ORCID 0000-0002-0165-5522
Edward L GiovannucciDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.ORCID 0000-0002-6123-0219
Inger T GramFaculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.ORCID 0000-0002-0031-4152
Niclas HåkanssonInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0001-7673-5554
Mayo HirabayashiDivision of Prevention, Institute for Cancer Control, National Cancer Center, Tokyo, Japan.ORCID 0000-0002-6765-6499
Tao HouDepartment of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Brian Z HuangDepartment of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.ORCID 0000-0001-8645-5142
José-Maria HuertaDepartment of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain.ORCID 0000-0002-9637-3869
Harindra JayasekaraCancer Epidemiology Division, Cancer Council Victoria, East Melbourne, VIC, Australia.ORCID 0000-0002-2453-0183
Woon-Puay KohHealthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.ORCID 0000-0002-5674-6341
James V LaceyBeckman Research Institute, City of Hope, Duarte, CA, United States.ORCID 0000-0002-4560-8592
Ylva Trolle LagerrosDepartment of Medicine (Huddinge), Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0001-6816-7577
Erikka LoftfieldDivision of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.ORCID 0000-0002-3573-8748
Robert J MacInnisCancer Epidemiology Division, Cancer Council Victoria, East Melbourne, VIC, Australia.
Satu MannistoDepartment of Public Health, Finnish Institute for Health and Welfare, Helsinki, Finland.
Maria Elena MartinezDepartment of Family Medicine and Public Health, University of California, San Diego, CA, United States.ORCID 0000-0002-6728-1834
Marjorie L McCulloughDepartment of Population Science, American Cancer Society, Atlanta, GA, United States.ORCID 0000-0003-3025-6341
Roger L MilneCancer Epidemiology Division, Cancer Council Victoria, East Melbourne, VIC, Australia.ORCID 0000-0001-5764-7268
Steven C MooreDivision of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.ORCID 0000-0002-8169-1661
Lorelei A MucciDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.ORCID 0000-0002-2551-4927
Marian L NeuhouserDivision of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States.
Elizabeth A PlatzDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.ORCID 0000-0003-3676-8954
Jenny N PoynterDepartment of Pediatrics, University of Minnesota, Minneapolis, MN, United States.ORCID 0000-0002-8460-3938
Anna E PrizmentDepartment of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, United States.ORCID 0000-0003-1932-6548
Samantha ReesDepartment of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States.ORCID 0000-0003-1466-9357
Kim RobienDepartment of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, United States.ORCID 0000-0002-2120-2280
Thomas E RohanDepartment of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, United States.
Norie SawadaDivision of Prevention, Institute for Cancer Control, National Cancer Center, Tokyo, Japan.ORCID 0000-0002-9936-1476
V Wendy SetiawanDepartment of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.ORCID 0000-0001-9239-5692
Marissa M Shams-WhiteDepartment of Population Science, American Cancer Society, Atlanta, GA, United States.ORCID 0000-0002-7824-4545
Xiao-Ou ShuDivision of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States.ORCID 0000-0002-0711-8314
Rashmi SinhaDivision of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.ORCID 0000-0002-2466-7462
Meir J StampferDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.ORCID 0000-0001-8865-935X
Rachael Z Stolzenberg-SolomonDivision of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.ORCID 0000-0003-3698-7006
Cynthia A ThomsonMel & Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ, United States.ORCID 0000-0003-3645-7048
Caroline Y UmDepartment of Population Science, American Cancer Society, Atlanta, GA, United States.ORCID 0000-0001-5449-6230
Piet A van den BrandtDepartment of Epidemiology, Maastricht University, Maastricht, The Netherlands.ORCID 0000-0001-8781-8099
Kala VisvanathanDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.ORCID 0000-0002-0582-8005
Renwei WangCancer Epidemiology and Prevention Program, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, United States.
Sophia S WangBeckman Research Institute, City of Hope, Duarte, CA, United States.
Emily WhiteFred Hutchinson Cancer Research Center, Seattle, WA, United States.ORCID 0000-0002-8177-0829
Kami K WhitePopulation Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, United States.ORCID 0000-0002-8024-0770
Walter C WilletDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Alicja WolkInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0001-7387-6845
Yukiko YanoDivision of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.ORCID 0000-0001-9816-0384
Shiaw-Shyuan YaunDepartment of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.ORCID 0000-0003-1114-5080
Jian-Min YuanDepartment of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.ORCID 0000-0002-4620-3108
Wei ZhengDivision of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States.ORCID 0000-0003-1226-070X
Elio RiboliDepartment of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.ORCID 0000-0001-6795-6080
Stephanie A Smith-WarnerDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.ORCID 0000-0003-3462-8608
Paul BrennanGenomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.ORCID 0000-0002-0518-8714
Pietro FerrariNutrition and Metabolism Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.ORCID 0000-0001-9358-7338
Funding
THE CAROTENE AND RETINOL EFFICACY TRIAL (CARET)U01CA063673 · NCI · FRED HUTCHINSON CANCER RESEARCH CENTER · PI GOODMAN, GARY E · 1994 to 2006
$13.0MThe Boston Lung Cancer Survival CohortU01CA209414 · NCI · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI David C Christiani · 2017 to 2026
$12.2MProspective studies of cancer etiology and prevention in Shanghai and SingaporeR01CA144034 · NCI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI YUAN, JIAN-MIN · 2010 to 2014
$7.0MDIETARY FACTORS IN THE ETIOLOGY OF CANCER IN SHANGHAIR01CA043092 · NCI · UNIVERSITY OF SOUTHERN CALIFORNIA · PI YUAN, JIAN-MIN · 1987 to 2006
$5.8MTHE SINGAPORE COHORT STUDY OF DIET AND CANCERR01CA080205 · NCI · UNIVERSITY OF SOUTHERN CALIFORNIA · PI YUAN, JIAN-MIN · 1999 to 2009
$5.3MCancer epidemiology cohorts in Shanghai and Singapore UM1CA182876 · NCI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI YUAN, JIAN-MIN · 2014 to 2018
$4.3MCLUE STUDIES--EVALUATING BIOMARKERS OF CARCINOGENESISU01CA086308 · NCI · JOHNS HOPKINS UNIVERSITY · PI HELZLSOUER, KATHY J · 2000 to 2004
$4.2MInfrastructure Support and Pilot Tissue Collection for the CARET BiorepositoryU01CA167462 · NCI · FRED HUTCHINSON CANCER RESEARCH CENTER · PI NEUHOUSER, MARIAN L · 2018 to 2022
$2.9MINFRASRUCTURE SUPPORT AND DATA ENHANCEMENTS FOR THE CARET BIOREPOSITORYUM1CA167462 · NCI · FRED HUTCHINSON CANCER RESEARCH CENTER · PI GOODMAN, GARY E · 2013 to 2017
$2.8MGENE-ENVIRONMENT INTERACTIONS: THE ODYSSEY COHORTU01AG018033 · NIA · JOHNS HOPKINS UNIVERSITY · PI HOFFMAN, SANDRA · 1999 to 2003
$2.8MA pooling project on alcohol use and risk of cancers with inconsistent prior evidence, with an emphasis in non-smokers.R01AA024770 · NIAAA · INTERNATIONAL AGENCY FOR RES ON CANCER · PI FERRARI, PIETRO, SMITH-WARNER, STEPHANIE A · 2016 to 2019
$1.8MThe Singapore Chinese Health StudyU01CA182876 · NCI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI YUAN, JIAN-MIN · 2019 to 2019
$150kAlberta Heritage Fund for Cancer ResearchBeta-Carotene and Retinol Efficacy TrialCampaign Against Cancer and Heart DiseaseCanadian Cancer SocietyCanadian National Breast Screening StudyCDC HHSDepartment of National Health and WelfareHHSManitoba Health Services CommissionMaryland Cancer Registry, Center for Cancer Prevention and ControlMaryland Cigarette Restitution Fund NU58DP007114Maryland Department of HealthMedical Research Council of CanadaMinistry of Health and Social Services of QuébecNCI NIH HHS R01 CA043092NCI NIH HHS R01 CA080205NCI NIH HHS R01 CA144034NCI NIH HHS U01 CA063673NCI NIH HHS U01 CA086308NCI NIH HHS U01-CA-086308NCI NIH HHS U01 CA167462NCI NIH HHS U01 CA182876NCI NIH HHS U01 CA209414NCI NIH HHS UM1 CA167462NCI NIH HHS UM1 CA182876NIAAA NIH HHS R01 AA024770NIA NIH HHS U01 AG018033NIA NIH HHS U01-AG-18033NIHNIH HHSNIH HHS AAA R01NIH HHS GR-IARC-2015-05-05-01NIH HHS R01AA024770NIH HHS U01-CA063673NIH HHS U01-CA167462NIH HHS UM1-CA167462Nova Scotia Department of HealthOntario Ministry of HealthSwedish Cancer FoundationSwedish Infrastructure for Medical Population-based Life-course and Environmental ResearchSwedish Research Council 2017-00644Swedish Research Council 2021-00160The Alpha-Tocopherol Beta-Carotene Cancer PreventionThe Breast Cancer Detection DemonstrationWorld Health Organization 001
Abstract
backgroundThis study aimed to investigate the association between alcohol consumption and squamous cell cancers of the upper aerodigestive tract (UADT), using data from 28 cohorts within the Pooling Project of Prospective Studies of Diet and Cancer (DCPP).
methodsIndividual-level data from 2 365 437 participants were pooled. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models to quantify the association between alcohol consumption (g/day) and UADT cancer risk, adjusting for potential confounders. Analyses were conducted by sex, smoking status, geographic region, and alcoholic beverages.
resultsOver a median follow-up of 15.5 years, 6903 UADT cancer cases were identified. Alcohol consumption was positively associated with UADT cancer risk overall. Even at intakes as low as 5-<15 g/day, the HR estimate was 1.12 (95% CI = 1.03 to 1.21) compared with the reference group (0.1-<5 g/day). The HR10 g/day (95% CI) was 1.16 (1.14 to 1.18) for women and 1.12 (1.11 to 1.13) for men (Pheterogeneity < .0001). HR10 g/day estimates were 1.14 (1.13 to 1.15) in current, 1.10 (1.09 to 1.12) in former, and 1.15 (1.12 to 1.18) in never smokers. Consistent UADT HR10 g/day estimates were observed across all beverage types. HR10 g/day estimates varied across geographic regions, with HR10 g/day (95% CI) equal to 1.15 (1.14 to 1.17) in Europe-Australia, 1.13 (1.11 to 1.15) in Asia, and 1.11 (1.09 to 1.12) in North America (Pheterogeneity < .0001).
conclusionAlcohol consumption was associated with UADT cancer risk, irrespective of smoking status or beverage type. However, due to differential baseline risks, alcohol is expected to impact the UADT cancer burden more in smokers than never smokers. These findings support public health strategies to reduce alcohol consumption.
Indexed as
Alcohol DrinkingCarcinoma, Squamous CellHead and Neck NeoplasmsAdultAgedFemaleHumansMaleMiddle AgedProportional Hazards ModelsProspective StudiesRisk FactorsSmokingSquamous Cell Carcinoma of Head and Neck
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