Negri E, La Vecchia C, Franceschi S, Tavani A
Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Cancer Epidemiol Biomarkers Prev. 1993 May-Jun;2(3):189-93.
Using data from a case-control study conducted between 1984 and 1992 in the provinces of Milan and Pordenone, northern Italy, on 439 cases of oral and pharyngeal cancers and 2106 hospital controls, we computed the population attributable risk for oropharyngeal cancer in relation to tobacco, alcohol, and a measure of low beta-carotene intake. Two different models were used for estimating relative risks, one assuming that the three factors act multiplicatively on the relative risk and the second estimating separately each combination of alcohol and tobacco and assuming a multiplicative model only for beta-carotene. The estimated attributable risks were similar for the two models considered. For both models and both sexes, the single factor with the highest attributable risk was smoking, which accounted for 81-87% of oral cancers in males and for 42-47% in females. Alcohol explained about 60% of male cases, but only 15% of female ones, and low beta-carotene accounted for 24% of total cases (25% of males, 17% of females). Together the three factors were responsible for 91-94% of oropharyngeal cancers in males, 51-57% in females, and 85-88% in both sexes combined. The present knowledge of major identified risk factors could, in principle, reduce the burden of the disease in Italy from 2400 to about 200 deaths per year for males and from 500 to 230 for females, thus explaining the difference in incidence and mortality between the two sexes.
利用1984年至1992年在意大利北部米兰省和波代诺内省进行的一项病例对照研究的数据，该研究涉及439例口腔和咽癌患者以及2106名医院对照者，我们计算了与烟草、酒精和低β-胡萝卜素摄入量相关的口咽癌人群归因风险。使用了两种不同的模型来估计相对风险，一种假设这三个因素对相对风险起相乘作用，另一种分别估计酒精和烟草的每种组合，并仅对β-胡萝卜素假设一个相乘模型。所考虑的两种模型的估计归因风险相似。对于这两种模型和男女两性，归因风险最高的单一因素是吸烟，吸烟导致男性口腔癌的81% - 87%，女性的42% - 47%。酒精导致男性病例的约60%，但女性仅为15%，低β-胡萝卜素占总病例的24%（男性为25%，女性为17%）。这三个因素共同导致男性口咽癌的91% - 94%，女性的51% - 57%，以及两性合计的85% - 88%。目前已知的主要确定风险因素原则上可以将意大利该疾病的负担从每年男性2400例死亡降至约200例，女性从500例降至230例，从而解释了两性之间发病率和死亡率的差异。
