OBJECTIVE: We analyzed the pooled case-control data from the International Head and Neck Cancer Epidemiology (INHANCE) consortium to compare cigarette smoking and alcohol consumption risk factors for head and neck cancer between less developed and more developed countries. SUBJECTS AND METHODS: The location of each study was categorized as either a less developed or more developed country. We compared the risk of overall head and neck cancer and cancer of specific anatomic subsites associated with cigarette smoking and alcohol consumption. Additionally, age and sex distribution between categories was compared. RESULTS: The odds ratios for head and neck cancer sites associated with smoking duration differed between less developed and more developed countries. Smoking greater than 20 years conferred a higher risk for oral cavity and laryngeal cancer in more developed countries, whereas the risk was greater for oropharynx and hypopharynx cancer in less developed countries. Alcohol consumed for more than 20 years conferred a higher risk for oropharynx, hypopharynx, and larynx cancer in less developed countries. The proportion of cases that were young (<45 years) or female differed by country type for some HNC subsites. CONCLUSION: These findings suggest the degree of industrialization and economic development affects the relationship between smoking and alcohol with head and neck cancer.

Boston University School of Public Health Boston Massachusetts USA

Brown University Providence Rhode Island USA

Cancer Epidemiology Unit Centro di Riferimento Oncologico Aviano IRCCS Aviano PN Italy

Cancer Registry of Norway Oslo Norway

Cancer Research Centre Moscow Russia

College of Medicine The Pennsylvania State University Hershey Pennsylvania USA

College of Public Health University of Iowa Iowa City Iowa USA

Dental School College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK

Department of Biomedical and Clinical Sciences University of Milan Milan Italy

Department of Cancer Epidemiology and Prevention M Sklodowska Curie National Research Institute of Oncology Warsaw Poland

Department of Clinical Sciences and Community Health University of Milan Milan Italy

Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA

Department of Medical and Surgical Sciences University of Bologna Bologna Italy

Department of Otolaryngology Head and Neck Surgery Baylor College of Medicine Houston Texas USA

Department of Otolaryngology School of Medicine New York Medical College Valhalla New York USA

Department of Otorhinolaryngology School of Medicine and Surgery University of Milano Bicocca Milan Italy

Department of Woman and Child Health and Public Health Public Health Area Fondazione Policlinico Universitario A Gemelli IRCCS Roma Italia

Departments of Epidemiology and Environmental Health Sciences School of Public Health and Department of Urology Medical School University of Michigan Ann Arbor Michigan USA

Dipartimento Patologia Testa Collo e Organi di Senso Facoltà Medicina e Chirurgia Università Cattolica Sacro Cuore Roma Italy

Dipartimento Scienze dell'Invecchiamento Neurologiche Ortopediche e della Testa Collo Fondazione Policlinico Universitario A Gemelli IRCCS Roma Italy

Division of Cancer Epidemiology Nagoya University Graduate School of Medicine Nagoya Japan

Division of Clinical Epidemiology and Aging Research German Cancer Research Center Heidelberg Germany

Division of Epidemiology New York University School of Medicine New York New York USA

Division of Head and Neck Surgical Oncology Department of Otolaryngology Head and Neck Surgery Washington University School of Medicine St Louis Missouri USA

Division of Preventive Oncology German Cancer Research Center Heidelberg Germany

Division of Public Health Department of Family and Preventive Medicine and Huntsman Cancer Institute University of Utah School of Medicine Salt Lake City Utah USA

Epidemiology CIPE ACCAMARGO Sao Paulo Brazil

Escola Nacional de Saude Publica Fundacao Oswaldo Cruz Rio de Janeiro Brazil

Faculdade de Medicina da Universidade de São Paulo Instituto do Câncer do Estado de São Paulo São Paulo Brazil

Faculdade de Medicina do ABC Hospital de Ensino São Bernardo do Campo SP Brazil

Faculty of Mathematics and Computer Science Institute of Statistics Leibniz Institute for Prevention Research and Epidemiology BIPS and University of Bremen Bremen Germany

Fred Hutchinson Cancer Research Center Seattle Washington USA

German Cancer Consortium Heidelberg Germany

Heidelberg Institute of Global Health University of Heidelberg Heidelberg Germany

Hospital de Clinicas de Porto Alegre Porto Alegre Brazil

INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP Paris France

INSERM UMR 1018 Centre for Research in Epidemiology and Population Health Cancer Epidemiology Genes and Environment Team Villejuif France

Institut Catala Oncologia Barcelona Spain

Institut Universitaire de Medecine Sociale et Preventive Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne Switzerland

Institute of Hygiene and Epidemiology Prague Czech Republic

Institute of Oncology and Radiobiology Havana Cuba

Institute of Oncology Angel H Roffo University of Buenos Aires Buenos Aires Argentina

International Agency for Research on Cancer World Health Organization Lyon France

National Cancer Institute Bethesda Maryland USA

National Institute of Public Health Bucharest Romania

National Public Health Center Budapest Hungary

New York Eye and Ear Infirmary New York New York USA

Nofer Institute of Occupational Medicine Lodz Poland

Regional Authority of Public Health in Banska Bystrica Banska Bystrica Slovakia

Roswell Park Cancer Institute Buffalo New York USA

School of Medicine National and Kapodistrian University of Athens Athens Greece

Sezione di Igiene Dipartimento Universitario di Scienze della Vita e Sanità Pubblica Università Cattolica del Sacro Cuore Roma Italia

Stony Brook Cancer Center Stony Brook University Stony Brook New York USA

Thoracic Head and Neck Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA

Trinity College School of Dental Science Dublin Ireland

UCLA School of Public Health Los Angeles California USA

Univ Rennes INSERM EHESP Irset UMR_S 1085 Pointe à Pitre France

Universidade de Sao Paulo Sao Paulo Brazil

Universidade Federal de Pelotas Pelotas Brazil

University of Aberdeen Dental School Aberdeen UK

University of Hong Kong Hong Kong China

University of North Carolina School of Public Health Chapel Hill North Carolina USA

University of Padua Padova Italy

University of Turin Turin Italy

UT M D Anderson Cancer Center Houston Texas USA

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