GP1d - Alcohol and Head and Neck Cancer: Is There a Safer Way to Drink? An Observational Study of a Large National Cohort

Abstract: Statement of the problem:
Despite declines in smoking rates, within countries like the United States and United Kingdom, the incidence of head and neck cancer (HNC) is increasing. This may be in part due to alcohol being a neglected risk factor. While the true independent effect of alcohol is difficult to determine, it may be contributing to this rise in HNC cases.1 There are several proposed biological mechanisms that alcohol may lead to HNC for example DNA damage from acetaldehyde. However, specific behavioral components of alcohol drinking (e.g. binge drinking, frequency of drinking, alcoholism, and beverage type) that may increase HNC risk remains unclear.

Geneticists and psychiatrists are searching for better biological understandings of the effect of alcohol drinking behaviors on cancer, which in turn, may aid development of prevention strategies other than teetotalism.2

This study aimed to estimate the association between a range of alcohol phenotypes and HNC risk within a large population-based study in search for a more effective public health message and to help identify high risk groups.

Material and methods:
Alcohol phenotype data including alcohol consumption, drinking frequency, alcohol with meals, weekly intake, beverage type e.g. beer/wine/spirits and drinking behavior data on alcohol misuse, alcohol disorders and hazardous drinking patterns were derived from a national biobank of 500,000 participants with record linkage to cancer databases. The World Health Organization AUDIT score for alcohol use disorder was utilized. HNC cases obtained from this biobank using ICD-10 codes encompassing oral cavity, oropharyngeal, and laryngeal cancer. Salivary gland and nasopharyngeal cancers were excluded.

Methods of data analysis:
Multivariable logistic regression analyses were conducted, and models were adjusted for age, sex, ethnicity, years of education, income, deprivation, and smoking.

Results:
1,172 HNC cases and 406,026 controls were identified. Self-reported previous alcohol consumption, harmful alcohol intake (≥ 35 units/week), beer consumption and daily drinking were associated with an increased risk of overall HNC. There was a greater proportion of male (61%) HNC cases, that frequently binge drank alcohol (≥ 6 or more drinks on one occasion of drinking) compared to females (39%) that binge drank. Male cases also binge drank more frequently than females. Specific behaviors such as alcohol consumed with meals and particular alcohol types, including white wine and red wine, appeared protective. The WHO AUDIT score was a sensitive risk assessment tool for laryngeal cancer risk.

Outcomes Data:
Previous alcohol drinking status was associated with HNC risk (odds ratio (OR) 3.13, 95% Confidence Intervals (95% CI) 1.85, 5.30), P < .0001. Harmful alcohol intake (≥ 35 units/week) was associated with an increased risk of HNC (OR 1.50, 95% CI 1.15, 1.94, P = .003). Consuming alcohol with meals appeared to have a protective effect on overall HNC risk (OR 0.54, 95%CI 0.44, 0.65, P < .0001). Alcohol use disorder was associated with increased odds for laryngeal cancer (OR 1.99, 95%CI 1.12, 3.56, P = .02).

Conclusions:
This study further highlights associations between alcohol daily intake frequency, harmful consumption levels, and alcohol abuse with HNC risk. This work supports calls for better prevention and education around alcohol as a risk factor. The findings support the use of clinical screening aids such as the Alcohol Use Disorders Identification Tool in better identifying patients at high risk of laryngeal cancer. Further work to implement these and preventive interventions, other than abstinence, in oral and maxillofacial settings is required.

References
1. Gormley M, Dudding T, et al. A multivariable Mendelian randomization analysis investigating smoking and alcohol consumption in oral and oropharyngeal cancer. Nature Communications. 2020;11(1):6071
2. Koo HY, Han K, et al. Alcohol Drinking Pattern and Risk of Head and Neck Cancer: A Nationwide Cohort Study. International Journal of Environmental Research and Public Health. 2021;18(21):11204