Racial differences in the relationship between tobacco, alcohol, and the risk of head and neck cancer: pooled analysis of US studies in the INHANCE Consortium

Abstract

There have been few published studies on differences between Blacks and Whites in the estimated effects of alcohol and tobacco use on the incidence of head and neck cancer (HNC) in the United States. Previous studies have been limited by small numbers of Blacks. Using pooled data from 13 US case-control studies of oral, pharyngeal, and laryngeal cancers in the International Head and Neck Cancer Epidemiology Consortium, this study comprised a large number of Black HNC cases (n = 975). Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for several tobacco and alcohol consumption characteristics. Blacks were found to have consistently stronger associations than Whites for the majority of tobacco consumption variables. For example, compared to never smokers, Blacks who smoked cigarettes for > 30 years had an OR 4.53 (95% CI 3.22-6.39), which was larger than that observed in Whites (OR 3.01, 95% CI 2.73-3.33; p < 0.0001). The ORs for alcohol use were also larger among Blacks compared to Whites. Exclusion of oropharyngeal cases attenuated the racial differences in tobacco use associations but not alcohol use associations. These findings suggest modest racial differences exist in the association of HNC risk with tobacco and alcohol consumption.

Early glottic cancer in a veteran population: Impact of race on management and outcomes

“…In this study, patients are referred to as “black” or “white” rather than Caucasian or African American. This nomenclature is consistent with our previous publication and existing literature . For the purpose of the current analysis, skin malignancies were not included as a secondary malignancy.…”

“…Most recently, our collaborators identified a subset of mitochondrial alterations which demonstrate enrichment in African American patients and are preserved in LASCC . Others have shown on a population level, that black patients who smoke and consume large amounts of alcohol have a higher risk for head and neck cancers than white patients who have similar behaviors …”

Head and neck cancer prevention: from primary prevention to impact of clinicians on reducing burden

“…Associations for cigarette smoking and HNC were modestly higher among blacks compared with whites, whereas estimates of association of alcohol use and HNC were similar or slightly higher. After the exclusion of oropharyngeal cases, which are known to be more likely HPV-negative among black Americans [42], the differences by race for tobacco use remained but were attenuated while alcohol use associations were not [58]. The reason for these differences in risk by race is not known, but could possibly be due to differences in alcohol and tobacco metabolism, differing usage, and cessation patterns by race [58].…”

“…Even within the United States, racial disparities may be explained only partly by risk factor prevalence differences. A large and pooled case-control study was able to more precisely estimate associations between cigarette smoking and alcohol use and HNC by subsite in blacks in the United States [58]. Associations for cigarette smoking and HNC were modestly higher among blacks compared with whites, whereas estimates of association of alcohol use and HNC were similar or slightly higher.…”

Epidemiological and histopathological characteristics of head and neck cancers in Bhutan from 2011 to 2017: a retrospective descriptive study

“…There could be a play of genetic predisposition and differences in exposure to risk factors to account for this variation. The susceptibility to risk factors varies between races as shown in the differences between whites and blacks when exposed to the same risk factors, viz, smoking and alcohol [30].…”