A case-control study of oral cancer was conducted in Beijing, People's Republic of China (PRC). The study was hospital-based and controls were hospital in-patients matched for age and gender with the cases. The response rates for cases and controls were 100 percent and 404 case/control pairs were interviewed. Tobacco smoking and alcohol consumption emerged as independent risk factors for oral cancer. For tobacco smoking, the association was considerably stronger for smokers of pipes than for smokers of cigarettes. For all kinds of tobacco, expressed as cigarette equivalents, the odds ratio (OR) for total pack-years smoked, among males, rose from 1.0 in never-smokers to 3.7 (95 percent confidence interval, 1.8–7.4) in the highest quintile of exposure. Similar results were found for females. The association with tobacco consumption was strong for squamous cell carcinoma but there was no trend in risk associated with tobacco for adenocarcinomas and other histologic types. So few women reported consuming alcohol that this variable could be examined only in male. Risk in the highest category of total lifetime intake of alcohol relative to than in lifetime abstainers was 2.3 (1.1–4.8) with a significant trend in risk with increasing dose (P<0.002). The combined effects of tobacco and alcohol appear to be approximately multiplicative in males. The attributable risk of oral cancer for tobacco among tobacco smokers was estimated as 34 percent (45 percent among males and 21 percent among females); for alcohol consumption in males the estimate was 23 percent.
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References
Boyle P, Zheng T, Macfarlane GJ, et al. Btiology and epidemiology of head and neck cancer, Current Opinion in Oncology (in press).
Pindborg JJ, Zheng KH, Kong CR, et al. Pilot survey of oral mucosa in areca (betel) nut chewers on Hailand Island of the People's Republic of China, Community Dent Oral Epidemiol 1984; 12: 195–6.
Wong XZ. The results from a smoking prevalence survey in China. In: News for Tobacco Control. Beijing: Chinese Health Education Institute, 1988.
Li B. Atlas of Cancer Mortality in the People's Republic of China. Beijing: China Map Press, 1983.
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. JNCI 1959; 22: 719–48.
Breslow NE, Day NE. Statistical Methods in Cancer Research Vol. 1. The Analysis of Case-control Studies. Lyon: International Agency for Research on Cancer, 1980; IARC publication no. 32: 248–79.
Kahn HA. An Introduction to Epidemiological Methods. Oxford: Oxford University Press, 1983.
Wynder EL, Bross IJ., Feldman R. A study of the etiological factors in cancer of the mouth. Cancer 1957; 6: 1300–23.
Franco EL, Kowalski LP, Oliveira BV, et al. Risk factors for oral cancer in Brazil: a case-control study. Int J Cancer 1989: 43: 992–1000.
Merletti F, Bofetta P, Ciccone G, et al. Rote of tobacco and alcoholic beverages in the etiology of cancer of the oral cavity/oropharynx in Torino, Italy. Cancer Res 1989; 49: 4919–24.
Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Carces Res 1988; 8: 3282–7.
Marshall JR, Graham S, Haughey BP. Smoking, alcohol, dentition and diet in the epidemiology of oral cancer (submitted).
International Agency for Research on Cancer. Alcohol Drinking. Lyon: International Agency for Research on Cancer, 1988; IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 44: 71–93.
Mashberg A, Garfinkel L, Harris S. Alcohol as a primary risk factor in oral squamous carcinoma. CA 1981; 31: 146–56.
Sankaranarayanan R, Duffy SW, Day NE. A case-control investigation of cancer of the oral tongue and the floor of the mouth in southern India. Int J Cancer 1989; 44: 617–21.
Elwood JM, Pearson JCG, Skippen DH. Alcohol, smoking, social and occupational factors in the aetiology of cancer of the oral cavity, pharynx and larynx. Int J Cancer 1984; 34: 603–12.
Brugere J, Guenel P, Leclerc A, et al.. Differential effects of tobacco and alcohol in cancer of the layrnx, pharynx and mouth. Cancer 1986; 57: 391–5.
Kabat G, Wynder EL. Type of alcohol beverage and oral cancer. Int J Cancer 1989; 43: 190–4.
Rothman KJ, Cann CI, Fried MP. Carcinogenicity of dark liquor. Am J Public Health 1989; 79: 1516–90.
Rothman KJ, Keller A. The effect of joint exposure to alcohol and tobacco on risk of cancer of the mouth and pharynx. J. Chronic Dis 1972; 25: 711–6.
Graham S, Dayal H, Rohrer T. Dentition, diet, tobacco and alcohol in the epidemiology of oral cancer. JNCI 1977; 59: 1611–8.
Additional information
Drs Zheng, Hu, and Niu are from the Department of Epidemiology, National Institute for Enviromental Health and Engineering, Chinese Academy of Pieventive Medicine, Beijing, People's Republic of China. Dr Boyle is with the Unit of Analytical Epidemiology, Internationat Agency for Research on Cancer, Lyon, France, where Dr Zheng beld a fellowship. Dr Duan is with the Beijing Union Hospital. Dr Jian is with the Cancer Institute, Chinese Academy of Medical Sciences. Dr Ma is with the Beijing Medical University Stomatological Hospital, Dr Shui is with the Beijing Municipal Stomatological Hospital, Dr MacMabon is in the Department of Epidemiology, Harvard School of Public Health where Dr Zbeng was a graduate student. Address reprint requests to Dr Zheng at the Cancer Prevention Research Unit, Department of Epidemiology and Public Health, Yale University, School of Medicine, B.O. Box 3333, New Haven, CT 06310, USA, Dr Zbeng was supported, in part by a grant from the DuPont Company.
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Zheng, T., Boyle, P., Hu, H. et al. Tobacco smoking, alcohol consumption, and risk of oral cancer: a case-control study in Beijing, People's Republic of China. Cancer Causes Control 1, 173–179 (1990). https://doi.org/10.1007/BF00053170
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DOI: https://doi.org/10.1007/BF00053170