Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer: A bivariate spline model approach

Gioia Di Credico; Valeria Edefonti; Jerry Polesel; Francesco Pauli; Nicola Torelli; Diego Serraino; Eva Negri; Daniele Luce; Isabelle Stucker; Keitaro Matsuo; Paul Brennan; Marta Vilensky; Leticia Fernandez; Maria Paula Curado; Ana Menezes; Alexander W. Daudt; Rosalina Koifman; Victor Wunsch-Filho; Ivana Holcatova; Wolfgang Ahrens; Pagona Lagiou; Lorenzo Simonato; Lorenzo Richiardi; Claire Healy; Kristina Kjaerheim; David I. Conway; Tatiana V. Macfarlane; Peter Thomson; Antonio Agudo; Ariana Znaor; Leonardo F. Boaventura Rios; Tatiana N. Toporcov; Silvia Franceschi; Rolando Herrero; Joshua Muscat; Andrew F. Olshan; Jose P. Zevallos; Carlo La Vecchia; Deborah M. Winn; Erich M. Sturgis; Guojun Li; Eleonora Fabianova; Jolanda Lissowska; Dana Mates; Peter Rudnai; Oxana Shangina; Beata Swiatkowska; Kirsten Moysich; Zuo Feng Zhang; Hal Morgenstern; Fabio Levi; Elaine Smith; Philip Lazarus; Cristina Bosetti; Werner Garavello; Karl Kelsey; Michael McClean; Heribert Ramroth; Chu Chen; Stephen M. Schwartz; Thomas L. Vaughan; Tongzhang Zheng; Gwenn Menvielle; Stefania Boccia; Gabriella Cadoni; Richard B. Hayes; Mark Purdue; Maura Gillison; Stimson Schantz; Guo Pei Yu; Hermann Brenner; Gypsyamber D'Souza; Neil D. Gross; Shu Chun Chuang; Paolo Boffetta; Mia Hashibe; Yuan Chin Amy Lee; Luigino Dal Maso

doi:10.1016/j.oraloncology.2019.05.006

Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer: A bivariate spline model approach

Gioia Di Credico, Valeria Edefonti, Jerry Polesel, Francesco Pauli, Nicola Torelli, Diego Serraino, Eva Negri, Daniele Luce, Isabelle Stucker, Keitaro Matsuo, Paul Brennan, Marta Vilensky, Leticia Fernandez, Maria Paula Curado, Ana Menezes, Alexander W. Daudt, Rosalina Koifman, Victor Wunsch-Filho, Ivana Holcatova, Wolfgang AhrensPagona Lagiou, Lorenzo Simonato, Lorenzo Richiardi, Claire Healy, Kristina Kjaerheim, David I. Conway, Tatiana V. Macfarlane, Peter Thomson, Antonio Agudo, Ariana Znaor, Leonardo F. Boaventura Rios, Tatiana N. Toporcov, Silvia Franceschi, Rolando Herrero, Joshua Muscat, Andrew F. Olshan, Jose P. Zevallos, Carlo La Vecchia, Deborah M. Winn, Erich M. Sturgis, Guojun Li, Eleonora Fabianova, Jolanda Lissowska, Dana Mates, Peter Rudnai, Oxana Shangina, Beata Swiatkowska, Kirsten Moysich, Zuo Feng Zhang, Hal Morgenstern, Fabio Levi, Elaine Smith, Philip Lazarus, Cristina Bosetti, Werner Garavello, Karl Kelsey, Michael McClean, Heribert Ramroth, Chu Chen, Stephen M. Schwartz, Thomas L. Vaughan, Tongzhang Zheng, Gwenn Menvielle, Stefania Boccia, Gabriella Cadoni, Richard B. Hayes, Mark Purdue, Maura Gillison, Stimson Schantz, Guo Pei Yu, Hermann Brenner, Gypsyamber D'Souza, Neil D. Gross, Shu Chun Chuang, Paolo Boffetta, Mia Hashibe, Yuan Chin Amy Lee, Luigino Dal Maso

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

Objectives: This study aimed at re-evaluating the strength and shape of the dose-response relationship between the combined (or joint) effect of intensity and duration of cigarette smoking and the risk of head and neck cancer (HNC). We explored this issue considering bivariate spline models, where smoking intensity and duration were treated as interacting continuous exposures. Materials and Methods: We pooled individual-level data from 33 case-control studies (18,260 HNC cases and 29,844 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. In bivariate regression spline models, exposures to cigarette smoking intensity and duration (compared with never smokers) were modeled as a linear piecewise function within a logistic regression also including potential confounders. We jointly estimated the optimal knot locations and regression parameters within the Bayesian framework. Results: For oral-cavity/pharyngeal (OCP) cancers, an odds ratio (OR) >5 was reached after 30 years in current smokers of ∼20 or more cigarettes/day. Patterns of OCP cancer risk in current smokers differed across strata of alcohol intensity. For laryngeal cancer, ORs >20 were found for current smokers of ≥20 cigarettes/day for ≥30 years. In former smokers who quit ≥10 years ago, the ORs were approximately halved for OCP cancers, and ∼1/3 for laryngeal cancer, as compared to the same levels of intensity and duration in current smokers. Conclusion: Referring to bivariate spline models, this study better quantified the joint effect of intensity and duration of cigarette smoking on HNC risk, further stressing the need of smoking cessation policies.

Original language	English (US)
Pages (from-to)	47-57
Number of pages	11
Journal	Oral Oncology
Volume	94
DOIs	https://doi.org/10.1016/j.oraloncology.2019.05.006
State	Published - Jul 2019

All Science Journal Classification (ASJC) codes

Oral Surgery
Oncology
Cancer Research

Access to Document

10.1016/j.oraloncology.2019.05.006

Cite this

Di Credico, G., Edefonti, V., Polesel, J., Pauli, F., Torelli, N., Serraino, D., Negri, E., Luce, D., Stucker, I., Matsuo, K., Brennan, P., Vilensky, M., Fernandez, L., Curado, M. P., Menezes, A., Daudt, A. W., Koifman, R., Wunsch-Filho, V., Holcatova, I., ... Dal Maso, L. (2019). Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer: A bivariate spline model approach. Oral Oncology, 94, 47-57. https://doi.org/10.1016/j.oraloncology.2019.05.006

@article{9bd90bcf2f774355a743f27c755a31e0,

title = "Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer: A bivariate spline model approach",

abstract = "Objectives: This study aimed at re-evaluating the strength and shape of the dose-response relationship between the combined (or joint) effect of intensity and duration of cigarette smoking and the risk of head and neck cancer (HNC). We explored this issue considering bivariate spline models, where smoking intensity and duration were treated as interacting continuous exposures. Materials and Methods: We pooled individual-level data from 33 case-control studies (18,260 HNC cases and 29,844 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. In bivariate regression spline models, exposures to cigarette smoking intensity and duration (compared with never smokers) were modeled as a linear piecewise function within a logistic regression also including potential confounders. We jointly estimated the optimal knot locations and regression parameters within the Bayesian framework. Results: For oral-cavity/pharyngeal (OCP) cancers, an odds ratio (OR) >5 was reached after 30 years in current smokers of ∼20 or more cigarettes/day. Patterns of OCP cancer risk in current smokers differed across strata of alcohol intensity. For laryngeal cancer, ORs >20 were found for current smokers of ≥20 cigarettes/day for ≥30 years. In former smokers who quit ≥10 years ago, the ORs were approximately halved for OCP cancers, and ∼1/3 for laryngeal cancer, as compared to the same levels of intensity and duration in current smokers. Conclusion: Referring to bivariate spline models, this study better quantified the joint effect of intensity and duration of cigarette smoking on HNC risk, further stressing the need of smoking cessation policies.",

author = "{Di Credico}, Gioia and Valeria Edefonti and Jerry Polesel and Francesco Pauli and Nicola Torelli and Diego Serraino and Eva Negri and Daniele Luce and Isabelle Stucker and Keitaro Matsuo and Paul Brennan and Marta Vilensky and Leticia Fernandez and Curado, {Maria Paula} and Ana Menezes and Daudt, {Alexander W.} and Rosalina Koifman and Victor Wunsch-Filho and Ivana Holcatova and Wolfgang Ahrens and Pagona Lagiou and Lorenzo Simonato and Lorenzo Richiardi and Claire Healy and Kristina Kjaerheim and Conway, {David I.} and Macfarlane, {Tatiana V.} and Peter Thomson and Antonio Agudo and Ariana Znaor and {Boaventura Rios}, {Leonardo F.} and Toporcov, {Tatiana N.} and Silvia Franceschi and Rolando Herrero and Joshua Muscat and Olshan, {Andrew F.} and Zevallos, {Jose P.} and {La Vecchia}, Carlo and Winn, {Deborah M.} and Sturgis, {Erich M.} and Guojun Li and Eleonora Fabianova and Jolanda Lissowska and Dana Mates and Peter Rudnai and Oxana Shangina and Beata Swiatkowska and Kirsten Moysich and Zhang, {Zuo Feng} and Hal Morgenstern and Fabio Levi and Elaine Smith and Philip Lazarus and Cristina Bosetti and Werner Garavello and Karl Kelsey and Michael McClean and Heribert Ramroth and Chu Chen and Schwartz, {Stephen M.} and Vaughan, {Thomas L.} and Tongzhang Zheng and Gwenn Menvielle and Stefania Boccia and Gabriella Cadoni and Hayes, {Richard B.} and Mark Purdue and Maura Gillison and Stimson Schantz and Yu, {Guo Pei} and Hermann Brenner and Gypsyamber D'Souza and Gross, {Neil D.} and Chuang, {Shu Chun} and Paolo Boffetta and Mia Hashibe and Lee, {Yuan Chin Amy} and {Dal Maso}, Luigino",

note = "Funding Information: This work was supported by grants from the: National Institutes of Health (NIH) [no grant number provided for the INHANCE Pooled Data Project, grant numbers P01CA068384 , K07CA104231 for the New York Multicenter study, grant numbers R01CA048996 , R01DE012609 for the Seattle (1985-1995) study, grant number TW001500 for the Fogarty International Research Collaboration Award (FIRCA) supporting the Iowa study, grant number R01CA061188 for the North Carolina (1994-1997) study, grant numbers P01CA068384 , K07CA104231 , R01DE013158 for the Tampa study, grant numbers P50CA090388 , R01DA011386 , R03CA077954 , T32CA009142 , U01CA096134 , R21ES011667 for the Los Angeles study, grant numbers R01ES011740 , R01CA100264 for the Houston study, grant numbers R01CA078609 , R01CA100679 for the Boston study, grant number R01CA051845 for the MSKCC study, grant number R01CA030022 for the Seattle-Leo study, grant number DE016631 for the Baltimore study]; National Cancer Institute (NCI) at the National Institutes of Health (NIH) [grant number R03CA113157 for the INHANCE Pooled Data Project, no grant number provided for the Intramural Programs supporting the Puerto Rico and the US Multicenter studies, grant number R01CA90731-01 for the North Carolina (2002-2006) study]; National Institute of Dental and Craniofacial Research (NIDCR) at the National Institutes of Health (NIH) [grant number R03DE016611 for the INHANCE Pooled Data Project, grant numbers R01DE011979 , R01DE013110 for the Iowa study, no grant number provided for the Intramural Program supporting the Puerto Rico study]; Italian Association for Research on Cancer (AIRC) [no grant number provided for the Milan (1984-1989) study, for the Aviano study, for the Italy Multicenter study and for the Rome study, grant number 10068 for the Milan study (2006-2009)]; Italian League against Cancer [no grant number provided for the Aviano and Italy Multicenter studies]; Italian Ministry of Research [no grant number provided for the Aviano and Italy Multicenter studies]; the Swiss Research against cancer/Oncosuisse [grant numbers KFS-700 , OCS-1633 for the Swiss study]; World Cancer Research Fund [no grant number provided for the Central Europe study]; European Commission [grant number IC18-CT97-0222 (INCO-DC Program) for the Latin America study, grant number IC15-CT98-0332 (INCO-COPERNICUS Program) for the Central Europe study]; Veterans Affairs Merit Review Funds [no grant number provided for the Iowa study]; National Institute of Environmental Health Sciences (NIEHS) [grant number P30ES010126 for the North Carolina (1994-1997) study, grant number P30ES010126 for the North Carolina (2002-2006) study]; Alper Research Program for Environmental Genomics of the UCLA Jonsson Comprehensive Cancer Center [no grant number provided for the Los Angeles study]; Fondo para la Investigacion Cientifica y Tecnologica Argentina (FONCYT) [no grant number provided for the Latin America study]; Institut Hospital del Mar d{\textquoteright}Investigacions Mediqu{\`e}s (IMIM) [no grant number provided for the Latin America study]; Funda{\c c}{\~a}o de Amparo {\`a} Pesquisa no Estado de S{\~a}o Paulo (FAPESP) [grant number 01/01768-2 for the Latin America study, grant numbers GENCAPO 04/12054-9, 10/51168-0 for the Sao Paulo study]; Fondo de Investigaciones Sanitarias (FIS) of the Spanish Government [grant number FIS 97/0024, FIS 97/0662, BAE 01/5013 for the International Multicenter study]; International Union Against Cancer (UICC) [no grant number provided for the International Multicenter study]; Yamagiwa-Yoshida Memorial International Cancer Study Grant [no grant number provided for the International Multicenter study]; European Community (5th Framework Programme) [grant number QLK1-CT-2001-00182 for the Western Europe study]; Ministry of Science, Research and Arts Baden-Wurttemberg [no grant number provided for the Germany-Saarland study]; German Ministry of Education and Research [grant number 01 GB9702/3 for the Germany-Heidelberg study]; Scientific Research grant from the Ministry of Education, Science, Sports, Culture and Technology of Japan [grant number 17015052 for the Japan (2001-2005) study]; Third-Term Comprehensive 10-Year Strategy for Cancer Control from the Ministry of Health, Labor and Welfare of Japan [grant number H20-002 for the Japan (2001-2005) study]; Johns Hopkins Richard Gelb Cancer Prevention Award [no grant number provided for the HOTSPOT study]; Italian Foundation for Cancer Research (FIRC) [no grant number provided for the Milan study (2006-2009)]; Italian Ministry of Education - PRIN 2009 Program [grant number X8YCBN for the Milan study (2006-2009)]; VE was supported by Universit{\`a} degli Studi di Milano {\textquoteleft}Young Investigator Grant Program 2017{\textquoteright}. Publisher Copyright: {\textcopyright} 2019 Elsevier Ltd",

year = "2019",

month = jul,

doi = "10.1016/j.oraloncology.2019.05.006",

language = "English (US)",

volume = "94",

pages = "47--57",

journal = "Oral Oncology",

issn = "1368-8375",

publisher = "Elsevier Limited",

}

Di Credico, G, Edefonti, V, Polesel, J, Pauli, F, Torelli, N, Serraino, D, Negri, E, Luce, D, Stucker, I, Matsuo, K, Brennan, P, Vilensky, M, Fernandez, L, Curado, MP, Menezes, A, Daudt, AW, Koifman, R, Wunsch-Filho, V, Holcatova, I, Ahrens, W, Lagiou, P, Simonato, L, Richiardi, L, Healy, C, Kjaerheim, K, Conway, DI, Macfarlane, TV, Thomson, P, Agudo, A, Znaor, A, Boaventura Rios, LF, Toporcov, TN, Franceschi, S, Herrero, R, Muscat, J, Olshan, AF, Zevallos, JP, La Vecchia, C, Winn, DM, Sturgis, EM, Li, G, Fabianova, E, Lissowska, J, Mates, D, Rudnai, P, Shangina, O, Swiatkowska, B, Moysich, K, Zhang, ZF, Morgenstern, H, Levi, F, Smith, E, Lazarus, P, Bosetti, C, Garavello, W, Kelsey, K, McClean, M, Ramroth, H, Chen, C, Schwartz, SM, Vaughan, TL, Zheng, T, Menvielle, G, Boccia, S, Cadoni, G, Hayes, RB, Purdue, M, Gillison, M, Schantz, S, Yu, GP, Brenner, H, D'Souza, G, Gross, ND, Chuang, SC, Boffetta, P, Hashibe, M, Lee, YCA & Dal Maso, L 2019, 'Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer: A bivariate spline model approach', Oral Oncology, vol. 94, pp. 47-57. https://doi.org/10.1016/j.oraloncology.2019.05.006

TY - JOUR

T1 - Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer

T2 - A bivariate spline model approach

AU - Di Credico, Gioia

AU - Edefonti, Valeria

AU - Polesel, Jerry

AU - Pauli, Francesco

AU - Torelli, Nicola

AU - Serraino, Diego

AU - Negri, Eva

AU - Luce, Daniele

AU - Stucker, Isabelle

AU - Matsuo, Keitaro

AU - Brennan, Paul

AU - Vilensky, Marta

AU - Fernandez, Leticia

AU - Curado, Maria Paula

AU - Menezes, Ana

AU - Daudt, Alexander W.

AU - Koifman, Rosalina

AU - Wunsch-Filho, Victor

AU - Holcatova, Ivana

AU - Ahrens, Wolfgang

AU - Lagiou, Pagona

AU - Simonato, Lorenzo

AU - Richiardi, Lorenzo

AU - Healy, Claire

AU - Kjaerheim, Kristina

AU - Conway, David I.

AU - Macfarlane, Tatiana V.

AU - Thomson, Peter

AU - Agudo, Antonio

AU - Znaor, Ariana

AU - Boaventura Rios, Leonardo F.

AU - Toporcov, Tatiana N.

AU - Franceschi, Silvia

AU - Herrero, Rolando

AU - Muscat, Joshua

AU - Olshan, Andrew F.

AU - Zevallos, Jose P.

AU - La Vecchia, Carlo

AU - Winn, Deborah M.

AU - Sturgis, Erich M.

AU - Li, Guojun

AU - Fabianova, Eleonora

AU - Lissowska, Jolanda

AU - Mates, Dana

AU - Rudnai, Peter

AU - Shangina, Oxana

AU - Swiatkowska, Beata

AU - Moysich, Kirsten

AU - Zhang, Zuo Feng

AU - Morgenstern, Hal

AU - Levi, Fabio

AU - Smith, Elaine

AU - Lazarus, Philip

AU - Bosetti, Cristina

AU - Garavello, Werner

AU - Kelsey, Karl

AU - McClean, Michael

AU - Ramroth, Heribert

AU - Chen, Chu

AU - Schwartz, Stephen M.

AU - Vaughan, Thomas L.

AU - Zheng, Tongzhang

AU - Menvielle, Gwenn

AU - Boccia, Stefania

AU - Cadoni, Gabriella

AU - Hayes, Richard B.

AU - Purdue, Mark

AU - Gillison, Maura

AU - Schantz, Stimson

AU - Yu, Guo Pei

AU - Brenner, Hermann

AU - D'Souza, Gypsyamber

AU - Gross, Neil D.

AU - Chuang, Shu Chun

AU - Boffetta, Paolo

AU - Hashibe, Mia

AU - Lee, Yuan Chin Amy

AU - Dal Maso, Luigino

N1 - Funding Information: This work was supported by grants from the: National Institutes of Health (NIH) [no grant number provided for the INHANCE Pooled Data Project, grant numbers P01CA068384 , K07CA104231 for the New York Multicenter study, grant numbers R01CA048996 , R01DE012609 for the Seattle (1985-1995) study, grant number TW001500 for the Fogarty International Research Collaboration Award (FIRCA) supporting the Iowa study, grant number R01CA061188 for the North Carolina (1994-1997) study, grant numbers P01CA068384 , K07CA104231 , R01DE013158 for the Tampa study, grant numbers P50CA090388 , R01DA011386 , R03CA077954 , T32CA009142 , U01CA096134 , R21ES011667 for the Los Angeles study, grant numbers R01ES011740 , R01CA100264 for the Houston study, grant numbers R01CA078609 , R01CA100679 for the Boston study, grant number R01CA051845 for the MSKCC study, grant number R01CA030022 for the Seattle-Leo study, grant number DE016631 for the Baltimore study]; National Cancer Institute (NCI) at the National Institutes of Health (NIH) [grant number R03CA113157 for the INHANCE Pooled Data Project, no grant number provided for the Intramural Programs supporting the Puerto Rico and the US Multicenter studies, grant number R01CA90731-01 for the North Carolina (2002-2006) study]; National Institute of Dental and Craniofacial Research (NIDCR) at the National Institutes of Health (NIH) [grant number R03DE016611 for the INHANCE Pooled Data Project, grant numbers R01DE011979 , R01DE013110 for the Iowa study, no grant number provided for the Intramural Program supporting the Puerto Rico study]; Italian Association for Research on Cancer (AIRC) [no grant number provided for the Milan (1984-1989) study, for the Aviano study, for the Italy Multicenter study and for the Rome study, grant number 10068 for the Milan study (2006-2009)]; Italian League against Cancer [no grant number provided for the Aviano and Italy Multicenter studies]; Italian Ministry of Research [no grant number provided for the Aviano and Italy Multicenter studies]; the Swiss Research against cancer/Oncosuisse [grant numbers KFS-700 , OCS-1633 for the Swiss study]; World Cancer Research Fund [no grant number provided for the Central Europe study]; European Commission [grant number IC18-CT97-0222 (INCO-DC Program) for the Latin America study, grant number IC15-CT98-0332 (INCO-COPERNICUS Program) for the Central Europe study]; Veterans Affairs Merit Review Funds [no grant number provided for the Iowa study]; National Institute of Environmental Health Sciences (NIEHS) [grant number P30ES010126 for the North Carolina (1994-1997) study, grant number P30ES010126 for the North Carolina (2002-2006) study]; Alper Research Program for Environmental Genomics of the UCLA Jonsson Comprehensive Cancer Center [no grant number provided for the Los Angeles study]; Fondo para la Investigacion Cientifica y Tecnologica Argentina (FONCYT) [no grant number provided for the Latin America study]; Institut Hospital del Mar d’Investigacions Mediquès (IMIM) [no grant number provided for the Latin America study]; Fundação de Amparo à Pesquisa no Estado de São Paulo (FAPESP) [grant number 01/01768-2 for the Latin America study, grant numbers GENCAPO 04/12054-9, 10/51168-0 for the Sao Paulo study]; Fondo de Investigaciones Sanitarias (FIS) of the Spanish Government [grant number FIS 97/0024, FIS 97/0662, BAE 01/5013 for the International Multicenter study]; International Union Against Cancer (UICC) [no grant number provided for the International Multicenter study]; Yamagiwa-Yoshida Memorial International Cancer Study Grant [no grant number provided for the International Multicenter study]; European Community (5th Framework Programme) [grant number QLK1-CT-2001-00182 for the Western Europe study]; Ministry of Science, Research and Arts Baden-Wurttemberg [no grant number provided for the Germany-Saarland study]; German Ministry of Education and Research [grant number 01 GB9702/3 for the Germany-Heidelberg study]; Scientific Research grant from the Ministry of Education, Science, Sports, Culture and Technology of Japan [grant number 17015052 for the Japan (2001-2005) study]; Third-Term Comprehensive 10-Year Strategy for Cancer Control from the Ministry of Health, Labor and Welfare of Japan [grant number H20-002 for the Japan (2001-2005) study]; Johns Hopkins Richard Gelb Cancer Prevention Award [no grant number provided for the HOTSPOT study]; Italian Foundation for Cancer Research (FIRC) [no grant number provided for the Milan study (2006-2009)]; Italian Ministry of Education - PRIN 2009 Program [grant number X8YCBN for the Milan study (2006-2009)]; VE was supported by Università degli Studi di Milano ‘Young Investigator Grant Program 2017’. Publisher Copyright: © 2019 Elsevier Ltd

PY - 2019/7

Y1 - 2019/7

N2 - Objectives: This study aimed at re-evaluating the strength and shape of the dose-response relationship between the combined (or joint) effect of intensity and duration of cigarette smoking and the risk of head and neck cancer (HNC). We explored this issue considering bivariate spline models, where smoking intensity and duration were treated as interacting continuous exposures. Materials and Methods: We pooled individual-level data from 33 case-control studies (18,260 HNC cases and 29,844 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. In bivariate regression spline models, exposures to cigarette smoking intensity and duration (compared with never smokers) were modeled as a linear piecewise function within a logistic regression also including potential confounders. We jointly estimated the optimal knot locations and regression parameters within the Bayesian framework. Results: For oral-cavity/pharyngeal (OCP) cancers, an odds ratio (OR) >5 was reached after 30 years in current smokers of ∼20 or more cigarettes/day. Patterns of OCP cancer risk in current smokers differed across strata of alcohol intensity. For laryngeal cancer, ORs >20 were found for current smokers of ≥20 cigarettes/day for ≥30 years. In former smokers who quit ≥10 years ago, the ORs were approximately halved for OCP cancers, and ∼1/3 for laryngeal cancer, as compared to the same levels of intensity and duration in current smokers. Conclusion: Referring to bivariate spline models, this study better quantified the joint effect of intensity and duration of cigarette smoking on HNC risk, further stressing the need of smoking cessation policies.

AB - Objectives: This study aimed at re-evaluating the strength and shape of the dose-response relationship between the combined (or joint) effect of intensity and duration of cigarette smoking and the risk of head and neck cancer (HNC). We explored this issue considering bivariate spline models, where smoking intensity and duration were treated as interacting continuous exposures. Materials and Methods: We pooled individual-level data from 33 case-control studies (18,260 HNC cases and 29,844 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. In bivariate regression spline models, exposures to cigarette smoking intensity and duration (compared with never smokers) were modeled as a linear piecewise function within a logistic regression also including potential confounders. We jointly estimated the optimal knot locations and regression parameters within the Bayesian framework. Results: For oral-cavity/pharyngeal (OCP) cancers, an odds ratio (OR) >5 was reached after 30 years in current smokers of ∼20 or more cigarettes/day. Patterns of OCP cancer risk in current smokers differed across strata of alcohol intensity. For laryngeal cancer, ORs >20 were found for current smokers of ≥20 cigarettes/day for ≥30 years. In former smokers who quit ≥10 years ago, the ORs were approximately halved for OCP cancers, and ∼1/3 for laryngeal cancer, as compared to the same levels of intensity and duration in current smokers. Conclusion: Referring to bivariate spline models, this study better quantified the joint effect of intensity and duration of cigarette smoking on HNC risk, further stressing the need of smoking cessation policies.

UR - http://www.scopus.com/inward/record.url?scp=85065698410&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065698410&partnerID=8YFLogxK

U2 - 10.1016/j.oraloncology.2019.05.006

DO - 10.1016/j.oraloncology.2019.05.006

M3 - Article

C2 - 31178212

AN - SCOPUS:85065698410

SN - 1368-8375

VL - 94

SP - 47

EP - 57

JO - Oral Oncology

JF - Oral Oncology

ER -

Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer: A bivariate spline model approach

Abstract

All Science Journal Classification (ASJC) codes

Access to Document

Other files and links

Fingerprint

Cite this