Lewin F, Norell S E, Johansson H, Gustavsson P, Wennerberg J, Biörklund A, Rutqvist L E
Oncologic Centre, Karolinska Hospital, Stockholm, Sweden.
Cancer. 1998 Apr 1;82(7):1367-75. doi: 10.1002/(sici)1097-0142(19980401)82:7<1367::aid-cncr21>3.0.co;2-3.
This case-referent study was conducted to elucidate the role of selected exogenous agents in the etiology of head and neck cancer. The factors studied were tobacco smoking, alcohol intake, the use of moist oral snuff, dietary factors, occupational exposures, and oral hygiene. In this first report, the authors discuss the impact of tobacco smoking, the use of oral snuff, and alcohol consumption.
The study base was approximately 2 million person-years at risk and consisted of Swedish males age 40-79 years living in 2 geographic regions during the years 1988-1990. A total of 605 cases were identified in the base, and 756 controls were selected by stratified random sampling from population registries covering the base.
Among those who were tobacco smokers at the time of the study, the relative risk of head and neck cancer was 6.5% (95% confidence interval, 4.4-9.5%). After cessation of smoking, the risk gradually declined, and no excess risk was found after 20 years. The relative risk associated with alcohol consumption of 50 grams or more per day versus less than 10 grams per day was 5.5% (95% confidence interval, 3.1-9.6%). An almost multiplicative effect was found for tobacco smoking and alcohol consumption.
Tobacco smoking and alcohol intake had a strong interactive effect on the risk of squamous cell carcinoma of the head and neck. Moderate alcohol intake (10-19 grams per day) had little or no effect among nonsmokers. No increased risk was found for the use of Swedish oral snuff.
本病例对照研究旨在阐明特定外源性因素在头颈癌病因学中的作用。所研究的因素包括吸烟、饮酒、使用湿鼻烟、饮食因素、职业暴露和口腔卫生。在本第一篇报告中，作者讨论了吸烟、使用鼻烟和饮酒的影响。
研究人群约有200万人年的风险暴露，由1988 - 1990年间居住在2个地理区域的40 - 79岁瑞典男性组成。在该人群中总共确定了605例病例，并通过分层随机抽样从覆盖该人群的人口登记处选取了756名对照。
在研究时吸烟的人群中，头颈癌的相对风险为6.5%（95%置信区间，4.4 - 9.5%）。戒烟后，风险逐渐下降，20年后未发现额外风险。每天饮酒50克或更多与每天饮酒少于10克相比，相对风险为5.5%（95%置信区间，3.1 - 9.6%）。发现吸烟和饮酒之间几乎存在相乘效应。
吸烟和饮酒对头颈鳞状细胞癌的风险有强烈的交互作用。在不吸烟者中，适度饮酒（每天10 - 19克）几乎没有影响。未发现使用瑞典湿鼻烟会增加风险。
