Smoking and alcohol in the etiology of oral cancer: gender-specific risk profiles in the south of Greece

Zavras, A.I; Douglass, C.W; Joshipura, K; Wu, T; Laskaris, G; Petridou, E; Dokianakis, G; Segas, J; Lefantzis, D; Nomikos, P; Wang, Y.F; Diehl, S.R

« Previous Next »Oral Oncology
Volume 37, Issue 1 , Pages 28-35, January 2001

Smoking and alcohol in the etiology of oral cancer: gender-specific risk profiles in the south of Greece

A.I Zavras
- Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Suite 004, Boston, MA 02115, USA
C.W Douglass
- Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Suite 004, Boston, MA 02115, USA
K Joshipura
- Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Suite 004, Boston, MA 02115, USA
T Wu
- Craniofacial Epidemiology and Genetics Branch, National Institute of Dental and Craniofacial Research, Building 45, Room 4as-43G, Bethesda, MD 20892-6401, USA
G Laskaris
- Oral Medicine Department, A. Sygros Hospital, University of Athens Medical School, 37 Ipsiladou Street, Athens 10676, Greece
E Petridou
- Department of Hygiene and Epidemiology, Athens University Medical School, 75 M. Asias Street, Athens 11527, Greece
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
G Dokianakis
- ENT Clinic, Red Cross Hospital of Athens, Athens, Greece
J Segas
- Department of Ear, Nose & Throat, Athens University Medical School and Hippokrateion Hospital, 4 Semitelou Street, Athens 11528, Greece
D Lefantzis
- ENT Clinic, Red Cross Hospital of Athens, Athens, Greece
P Nomikos
- 75 M. Asias Street, Athens 11527, Greece
Y.F Wang
- Craniofacial Epidemiology and Genetics Branch, National Institute of Dental and Craniofacial Research, Building 45, Room 4as-43G, Bethesda, MD 20892-6401, USA
S.R Diehl
- Craniofacial Epidemiology and Genetics Branch, National Institute of Dental and Craniofacial Research, Building 45, Room 4as-43G, Bethesda, MD 20892-6401, USA
- Corresponding author. Tel.: +1-301-594-4830; fax: +1-301-480-8327

Received 14 April 2000; accepted 2 May 2000.

Abstract

Oral and pharyngeal cancer (OC) mortality is very low in Greece, especially among men, compared to other European countries. We conducted a case-control study of OC in Athens, and obtained information on tobacco, alcohol use and other potential risk factors and confounding variables for 110 incident cases and 115 hospital-based controls. We used multivariate logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Tobacco smoking (packyears, P_trend=0.01) and alcohol use (drinks/week, P_trend=0.07) were independent risk factors, with a multiplicative effect for combined exposures (OR, 8.3; 95% CI, 2.4–29.1, for >28 alcohol drinks/week and >50 packyears of cigarette smoking). The type of alcoholic beverage also seemed important: drinking ouzo and tsipouro (liquors of high ethanol concentration) was associated with greater increased OC risk than drinking comparable amounts of wine, beer or dark spirits. While alcohol drinking is more common for male cases versus controls, few men reported regularly consuming large quantities of ethanol associated with highest risk of OC in other studies. This may partially explain the low rates of male OC mortality in Greece. Among the 38% of our cases who were women, however, neither smoking nor alcohol drinking frequencies were significantly elevated compared to controls, and so the etiology of OC risk in females requires further investigation.

Keywords: Mouth neoplasms, Pharyngeal neoplasms, Tobacco, Smoking, Alcohol, Risk factors, Women's health, Greece