Body mass index and risk of head and neck cancer in a pooled analysis of case-control studies in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium

Mia M. Gaudet, Andrew F. Olshan, Shu Chun Chuang, Julien Berthiller, Zuo Feng Zhang, Jolanta Lissowska, David Zaridze, Deborah M. Winn, Qingyi Wei, Renato Talamini, Neolilia Szeszenia-Dabrowska, Erich M. Sturgis, Stephen M. Schwartz, Peter Rudnai, Jose Eluf-Neto, Joshua Muscat, Hal Morgenstern, Ana Menezes, Elena Matos, Alexandru BucurFabio Levi, Philip Lazarus, Carlo La Vecchia, Sergio Koifman, Karl Kelsey, Rolando Herrero, Richard B. Hayes, Silva Franceschi, Victor Wunsch-Filho, Leticia Fernandez, Eleonora Fabianova, Alexander W. Daudt, Luigino Dal Maso, Maria Paula Curado, Chu Chen, Xavier Castellsague, Simone Benhamou, Paolo Boffetta, Paul Brennan, Mia Hashibe

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77 Scopus citations


Background: Head and neck cancer (HNC) risk is elevated among lean people and reduced among overweight or obese people in some studies; however, it is unknown whether these associations differ for certain subgroups or are influenced by residual confounding from the effects of alcohol and tobacco use or by other sources of biases. Methods: We pooled data from 17 case-control studies including 12 716 cases and the 17 438 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for associations between body mass index (BMI) at different ages and HNC risk, adjusted for age, sex, centre, race, education, tobacco smoking and alcohol consumption. Results: Adjusted ORs (95% CIs) were elevated for people with BMI at reference (date of diagnosis for cases and date of selection for controls) ≤18.5 kg/m2 (2.13, 1.75-2.58) and reduced for BMI >25.0-30.0 kg/m2 (0.52, 0.44-0.60) and BMI ≥30 kg/m2 (0.43, 0.33-0.57), compared with BMI >18.5-25.0 kg/m2. These associations did not differ by age, sex, tumour site or control source. Although the increased risk among people with BMI ≤18.5 kg/m2 was not modified by tobacco smoking or alcohol drinking, the inverse association for people with BMI > 25 kg/m2 was present only in smokers and drinkers. Conclusions: In our large pooled analysis, leanness was associated with increased HNC risk regardless of smoking and drinking status, although reverse causality cannot be excluded. The reduced risk among overweight or obese people may indicate body size is a modifier of the risk associated with smoking and drinking. Further clarification may be provided by analyses of prospective cohort and mechanistic studies.

Original languageEnglish (US)
Article numberdyp380
Pages (from-to)1091-1102
Number of pages12
JournalInternational journal of epidemiology
Issue number4
StatePublished - Feb 1 2010

All Science Journal Classification (ASJC) codes

  • Epidemiology


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