Alcohol consumption and upper aerodigestive tract squamous cell carcinoma: evidence from 28 prospective cohorts

Elmira Ebrahimi, Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
Sabine Naudin, Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
Niki Dimou, Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
Ana-Lucia Mayén, Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
Molin Wang, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
Christian C. Abnet, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
Agneta Åkesson, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Matthew J. Barnett, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
Rino Bellocco, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Amy Berrington de Gonzalez, Division of Genetics and Epidemiology, Institute of Cancer Research, London, MD, UK.
Stephanie E. Bonn, Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.
Chu Chen, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
David C. Christiani, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
Tracy E. Crane, Medical Oncology, Miller School of Medicine, University of Miami, Miami, FL, USA.
A Heather Eliassen, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
Jo L. Freudenheim, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
Yu-Tang Gao, Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Montse Garcia-Closas, Division of Genetics and Epidemiology, Institute of Cancer Research, London, MD, UK.
Gretchen Gierach, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
Edward L. Giovannucci, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
Inger T. Gram, Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Niclas Håkansson, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Mayo Hirabayashi, Division of Prevention, Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
Tao Hou, Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
Brian Z. Huang, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
José-Maria Huerta, Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain.
Harindra Jayasekara, Cancer Epidemiology Division, Cancer Council Victoria, East Melbourne, Victoria, Australia.
Woon-Puay Koh, Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Singapore.
James V. Lacey, Beckman Research Institute, City of Hope, Duarte, CA, USA.
Ylva Trolle Lagerros, Department of Medicine (Huddinge), Karolinska Institutet, Stockholm, Sweden.
Erikka Loftfield, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
Robert J. MacInnis, Cancer Epidemiology Division, Cancer Council Victoria, East Melbourne, Victoria, Australia.

Document Type

Journal Article

Publication Date

9-22-2025

Journal

Journal of the National Cancer Institute

DOI

10.1093/jnci/djaf230

Keywords

Alcohol Drinking; Cohort Studies; Neoplasms; Smoking; Upper aero-digestive tract cancers

Abstract

BACKGROUND: This study aimed to investigate the association between alcohol consumption and squamous cell cancers of the upper aerodigestive tract (UADT), using data from 28 cohorts within the Pooling Project of Prospective Studies of Diet and Cancer (DCPP). METHODS: Individual-level data from 2,365,437 participants were pooled. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models to quantify the association between alcohol consumption (grams/day) and UADT cancers risk, adjusting for potential confounders. Analyses were conducted by sex, smoking status, geographic region, and alcoholic beverages. RESULTS: Over a median follow-up of 15.5 years, 6,903 UADT cancer cases were identified. Alcohol consumption was positively associated with UADT cancers risk overall. Even at intakes as low as 5-<15 g/day the HR estimate was 1.12 (95% CI 1.03,1.21) compared with the reference group (0.1-<5 g/day). The HR10g/day (95% CI) was 1.16 (1.14,1.18) for women and 1.12 (1.11,1.13) for men (pheterogeneity<0.0001). HR10g/day estimates were 1.14 (1.13,1.15) in current, 1.10 (1.09,1.12) in former, and 1.15 (1.12,1.18) in never-smokers. Consistent UADT HR10g/day estimates were observed across all beverage types. HR10g/day estimates varied across geographic regions, with HR10g/day (95% CI) equal to 1.15 (1.14,1.17) in Europe-Australia, 1.13 (1.11,1.15) in Asia, and 1.11 (1.09,1.12) in North America (pheterogeneity<0.0001). CONCLUSION: Alcohol consumption was associated with UADT cancer risk, irrespective of smoking status or beverage type. However, due to differential baseline risks, alcohol is expected to impact the UADT cancer burden more in smokers than never-smokers. These findings support public health strategies to reduce alcohol consumption.

Department

Exercise and Nutrition Sciences

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