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      Cancer Risk Associated with Alcohol and Tobacco Use: Focus on Upper Aero-digestive Tract and Liver

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          Alcohol and tobacco, alone or in combination, are associated with an increased risk of various cancers, including those of the upper aero-digestive tract and liver. Both alcohol and tobacco use can increase the risk of cancer of the oral cavity and throat (pharynx), and their combined use has a multiplicative effect on risk. Moreover, those regions of the mouth and pharynx that are more directly exposed to alcohol or tobacco are more likely to be affected by cancer than other regions. A similar effect was found with respect to cancer of the voice box (larynx). For squamous cell carcinoma of the esophagus, alcohol and tobacco also appear to increase risk synergistically. With liver cancer, in contrast, alcohol consumption and tobacco use appear to be independent risk factors.

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          Most cited references 26

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          Global cancer statistics, 2002.

           D Parkin,  F Bray,  J Ferlay (2005)
          Estimates of the worldwide incidence, mortality and prevalence of 26 cancers in the year 2002 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. The results are presented here in summary form, including the geographic variation between 20 large "areas" of the world. Overall, there were 10.9 million new cases, 6.7 million deaths, and 24.6 million persons alive with cancer (within three years of diagnosis). The most commonly diagnosed cancers are lung (1.35 million), breast (1.15 million), and colorectal (1 million); the most common causes of cancer death are lung cancer (1.18 million deaths), stomach cancer (700,000 deaths), and liver cancer (598,000 deaths). The most prevalent cancer in the world is breast cancer (4.4 million survivors up to 5 years following diagnosis). There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors related to lifestyle or environment, and provides a clear challenge to prevention.
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            Esophageal cancer.

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              Smoking and drinking in relation to oral and pharyngeal cancer.

              A case-control study of oral and pharyngeal cancer conducted in four areas of the United States provided information on the tobacco and alcohol use of 1114 patients and 1268 population-based controls. Because of the large study size, it could be shown that the risks of these cancers among nondrinkers increased with amount smoked, and conversely that the risks among nonsmokers increased with the level of alcohol intake. Among consumers of both products, risks of oropharyngeal cancer tended to combine more in a multiplicative than additive fashion and were increased more than 35-fold among those who consumed two or more packs of cigarettes and more than four alcoholic drinks/day. Cigarette, cigar, and pipe smoking were separately implicated, although it was shown for the first time that risk was not as high among male lifelong filter cigarette smokers. Cessation of smoking was associated with a sharply reduced risk of this cancer, with no excess detected among those having quit for 10 or more years, suggesting that smoking affects primarily a late stage in the process of oropharyngeal carcinogenesis. The risks varied by type of alcoholic beverage, being higher among those consuming hard liquor or beer than wine. The relative risk patterns were generally similar among whites and blacks, and among males and females, and showed little difference when oral and pharyngeal cancers were analyzed separately. From calculations of attributable risk, we estimate that tobacco smoking and alcohol drinking combine to account for approximately three-fourths of all oral and pharyngeal cancers in the United States.

                Author and article information

                Alcohol Res Health
                Alcohol Res Health
                Alcohol Research & Health
                National Institute on Alcohol Abuse and Alcoholism
                : 29
                : 3
                : 193-198
                Claudio Pelucchi, Sc.D., is a researcher; Silvano Gallus, Sc.D., is a senior researcher; and Cristina Bosetti, Sc.D., is head of the Unit of Cancer Epidemiology; all are at the Istituto di Ricerche Farmacologiche “Mario Negri” in Milan, Italy. Werner Garavello, M.D., is a researcher at the Istituto di Ricerche Farmacologiche “Mario Negri” in Milan, Italy, and a researcher at the Clinica Otorinolaringoiatrica, Dipartimento di Neuroscienze e Tecnologie Biomediche, Università Milano-Bicocca in Monza, Italy. Carlo La Vecchia, M.D., is head of the Laboratory of General Epidemiology at the Istituto di Ricerche Farmacologiche “Mario Negri” and an associate professor in epidemiology at the Istituto di Statistica Medica e Biometria at the Università degli Studi di Milano, both in Milan, Italy

                Unless otherwise noted in the text, all material appearing in this journal is in the public domain and may be reproduced without permission. Citation of the source is appreciated.

                Health Risks


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