Studies of alcoholic patients have consistently reported increased risks of cancers of the oral cavity and pharynx, oesophagus, liver, larynx, lung and uterine cervix (Sundby, 1967;Pell and D'Alonzo, 1973;Hakulinen et al, 1974;Monson and Lyon, 1975;Robinette et al, 1979;Schmidt and Popham, 1981;Prior, 1988;Adami et al, 1992;Tønnesen et al, 1994;Sigvardsson et al, 1996). Given the correlation between alcohol intake and smoking, it is likely that smoking contributes importantly to the excesses in risk, notably for lung cancer (Blot and Fraumeni, 1996). Relatively small sample sizes have limited the interpretation of previous studies of cancer among alcoholics. For example, in only one study (Tønnesen et al, 1994) were more than 100 cases of head and neck cancer observed. As a consequence, there is limited information on cancer risk by site within head and neck organs and by histological type. Such information would help to better characterize the carcinogenic effect of alcohol, as well as to guide the clinical management of alcoholic patients.We report the results of the follow-up of a large series of patients hospitalized for alcoholism in Sweden during 1965-1994. Our specific goals were to assess the risk of subsite-and histopathology-specific cancers of the head and neck and lung among this population, and to identify whether this risk is modified by demographic characteristics such as gender and age.
METHODSThe study is based on a linkage between the Swedish In-patient Register and the National Cancer Register. We have previously reported details on the In-patient Register (Lagiou et al, 2001).We considered all records in the In-patient Register with a hospital discharge diagnosis of alcoholism (International Classification of Diseases [ICD]-7 codes 307 and 322 (WHO, 1955); ICD-8 codes 291 and 303 (WHO, 1965); and ICD-9 codes 291, 303 and 305A (WHO, 1975) ) among patients aged 20 or over and hospitalized during 1965-1994. We identified 196 803 unique national registration numbers that met our inclusion criteria. When linking records to the Registries of Population, Death and Emigration, we identified 7790 records with incorrect national registration numbers, 2192 records of patients who died during hospitalization, and 294 records of patients who emigrated before hospitalization; these were all excluded from the study. We finally linked the cohort to the National Cancer Register, which was founded in 1958 and is estimated to be 98% complete (Mattson, 1975), with the aim of identifying cases of cancer that occurred among the patients in the cohort either before (prevalent cases) or after (incidence cases) the first hospital discharge with diagnosis of alcoholism. Cancers were classified according to the ICD-7 (WHO, 1955). We excluded 3405 patients with a prevalent cancer diagnosed before the first hospitalization for alcoholism. A further 455 patients were excluded at various steps of the linkage procedures because of inconsistencies of gender, date of birth or death, etc. We excluded the first year of obs...