Radoï Loredana, Menvielle Gwenn, Cyr Diane, Lapôtre-Ledoux Bénédicte, Stücker Isabelle, Luce Danièle
INSERM UMRS 1018, Environmental Epidemiology of Cancer, Centre for research in Epidemiology and Population Health, 16 Avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France.
Oral Medicine and Oral Surgery Department, Paris Descartes University, Montrouge, France.
BMC Cancer. 2015 Oct 31;15:827. doi: 10.1186/s12885-015-1841-5.
Population attributable risks (PARs) are useful tool to estimate the burden of risk factors in cancer incidence. Few studies estimated the PARs of oral cavity cancer to tobacco smoking alone, alcohol drinking alone and their joint consumption but none performed analysis stratified by subsite, gender or age. Among the suspected risk factors of oral cavity cancer, only PAR to a family history of head and neck cancer was reported in two studies. The purpose of this study was to estimate in France the PARs of oral cavity cancer to several recognized and suspected risk factors, overall and by subsite, gender and age.
We analysed data from 689 oral cavity cancer cases and 3481 controls included in a population-based case-control study, the ICARE study. Unconditional logistic regression models were used to estimate odds ratios (ORs), PARs and 95% confidence intervals (95% CI).
The PARs were 0.3% (95% CI -3.9%; +3.9%) for alcohol alone, 12.7% (6.9%-18.0%) for tobacco alone and 69.9% (64.4%-74.7%) for their joint consumption. PAR to combined alcohol and tobacco consumption was 74% (66.5%-79.9%) in men and 45.4% (32.7%-55.6%) in women. Among suspected risk factors, body mass index 2 years before the interview <25 kg.m(-2), never tea drinking and family history of head and neck cancer explained 35.3% (25.7%-43.6%), 30.3% (14.4%-43.3%) and 5.8% (0.6%-10.8%) of cancer burden, respectively. About 93% (88.3%-95.6%) of oral cavity cancers were explained by all risk factors, 94.3% (88.4%-97.2%) in men and only 74.1% (47.0%-87.3%) in women.
Our study emphasizes the role of combined tobacco and alcohol consumption in the oral cavity cancer burden in France and gives an indication of the proportion of cases attributable to other risk factors. Most of oral cavity cancers are attributable to concurrent smoking and drinking and would be potentially preventable through smoking or drinking cessation. If the majority of cases are explained by recognized or suspected risk factors in men, a substantial number of cancers in women are probably due to still unexplored factors that remain to be clarified by future studies.
人群归因风险（PARs）是估计癌症发病中风险因素负担的有用工具。很少有研究单独估计口腔癌与吸烟、单独饮酒及其联合消费的PARs，但没有一项研究按亚部位、性别或年龄进行分层分析。在口腔癌的疑似风险因素中，仅有两项研究报告了与头颈癌家族史相关的PAR。本研究的目的是在法国估计口腔癌与几种已确认和疑似风险因素的PARs，包括总体以及按亚部位、性别和年龄分层的情况。
我们分析了基于人群的病例对照研究ICARE研究中纳入的689例口腔癌病例和3481例对照的数据。使用无条件逻辑回归模型来估计比值比（ORs）、PARs和95%置信区间（95%CI）。
单独饮酒的PAR为0.3%（95%CI -3.9%；+3.9%），单独吸烟的PAR为12.7%（6.9%-18.0%），二者联合消费的PAR为69.9%（64.4%-74.7%）。男性中酒精和烟草联合消费的PAR为74%（66.5%-79.9%），女性为45.4%（32.7%-55.6%）。在疑似风险因素中，访谈前2年体重指数<25 kg·m⁻²、从不喝茶以及头颈癌家族史分别解释了35.3%（25.7%-43.6%）、30.3%（14.4%-43.3%）和5.8%（0.6%-10.8%）的癌症负担。所有风险因素解释了约93%（88.3%-95.6%）的口腔癌，男性为94.3%（88.4%-97.2%），女性仅为74.1%（47.0%-87.3%）。
我们的研究强调了烟草和酒精联合消费在法国口腔癌负担中的作用，并指出了可归因于其他风险因素的病例比例。大多数口腔癌可归因于同时吸烟和饮酒，通过戒烟或戒酒可能会预防。如果大多数病例可由男性中已确认或疑似的风险因素解释，那么女性中的大量癌症可能归因于仍未探索的因素，有待未来研究加以阐明。
