Elsevier

Preventive Medicine

Volume 32, Issue 4, April 2001, Pages 359-370
Preventive Medicine

Regular Article
Reevaluation of the Confounding Effect of Cigarette Smoking on the Relationship between Alcohol Use and Lung Cancer Risk, with Larynx Cancer Used as a Positive Control

https://doi.org/10.1006/pmed.2000.0818Get rights and content

Abstract

Background. The effect of smoking on lung cancer risk has been well documented, while the effect of alcohol remains controversial. We examined the hypothesis that the apparent association between alcohol intake and lung cancer risk is fully due to the confounding effect of cigarette smoke.

Methods. Our sample of hospitalized patients included 2,953 male and 1,622 female lung cancer cases; 521 male and 159 female larynx cancers cases; and 8,169 male and 4,154 female controls, admitted to participating hospitals between 1981 and 1994. All controls had been diagnosed with non-smoking-related diseases. Larynx cancer was used as a positive control for lung cancer. Relative risks were estimated through odds ratios, adjusted through multiple logistic regression.

Results. Although the odds ratios for alcohol had been significantly elevated prior to adjustment for smoking (OR = 2.4, 95% CI = 2.0–2.8), alcohol had no effect on lung cancer following this adjustment (OR = 1.2, 95% CI = 1.0–1.4). By contrast, the effect of alcohol on larynx cancer remained high even after adjustment for smoking (OR = 5.6, 95% CI = 3.7–8.6).

Conclusion. The often-reported association between alcohol and lung cancer risk can be fully explained by the confounding effect of cigarette use.

References (51)

  • JD Potter et al.

    Alcohol, beer and lung cancer—a meaningful relationship?

    Int J Cancer

    (1982)
  • EV Bandera et al.

    Alcohol consumption and lung cancer in White males

    Cancer Causes Control

    (1992)
  • H Swoboda et al.

    Mortality from cancer of the head and neck, lung and esophagus in eastern Austria between 1960 and 1989

    Eur Arch Oto-Rhino-Laryngol

    (1994)
  • J Simon et al.

    Alcohol and health—friend or foe?

    Casopis Lekaru Ceskych

    (1994)
  • SA Ahrendt et al.

    Alcohol consumption and cigarette smoking increase the frequency of p53 mutations in non-small cell lung cancer

    Cancer Res

    (2000)
  • BP Dunn et al.

    DNA adducts in bronchial biopsies

    Int J Cancer

    (1991)
  • RJ Pierce et al.

    Dietary and alcohol intake, smoking pattern, occupational risk and family history in lung cancer patients: results of a case-control study in males

    Nutr Cancer

    (1989)
  • C Huang et al.

    A case-control study of dietary factors inpatients with lung cancer

    Biomed Environ Sci

    (1992)
  • HE Restrepo et al.

    A case-control study of tobacco-related cancers in Colombia

    Bull Pan Am Health Org

    (1989)
  • GN Stemmermann et al.

    Prospective study of alcohol intake and large bowel cancer

    Dig Dis Sci

    (1990)
  • T Gordon et al.

    Drinking and mortality: the Framingham Study

    Am J Epidemiol

    (1984)
  • S Kono et al.

    Alcohol and mortality: a cohort study of male Japanese physicians

    Int J Epidemiol

    (1986)
  • M Dosemeci et al.

    Tobacco, alcohol use, and risks of laryngeal and lung cancer by subsite and histologic type in Turkey

    Cancer Causes Control

    (1997)
  • EV Bandera et al.

    Diet and alcohol consumption and lung cancer risk in the New York State Cohort

    Cancer Causes Control

    (1997)
  • K Woodson et al.

    Association between alcohol and lung cancer in the alpha-tocopheral, beta-carotene cancer prevention study in Finland

    Cancer Causes Control

    (1999)
  • Cited by (26)

    • Alcohol consumption and lung cancer risk in never smokers

      2016, Gaceta Sanitaria
      Citation Excerpt :

      A flowchart of the process appears in Figure 2. Among the 17 included studies, the distribution by study design was as follows: 2 meta-analysis,13,14 1 systematic review,12 5 cohort studies,22–26 1 pooling study of cohort studies,27 4 population based case-control studies,15,28–30 3 hospital based case-control studies16,31,32 and 1 nested case-control study.33 Studies were conducted in a wide geographical distribution, covering: United States of America, Japan, Canada, China, Czech Republic, Poland, France, Italy, Spain, The Netherlands, United Kingdom, Greece, Germany, Sweden, Norway and Denmark.

    • Alcohol consumption and lung cancer risk in never smokers: A meta-analysis

      2011, Annals of Oncology
      Citation Excerpt :

      A further 19 epidemiological studies investigating the association between alcohol consumption and lung cancer risk were excluded since they did not report any risk estimate in never smokers. Three cohort studies [6, 7, 18]; 1 pooled analysis of 7 prospective studies conducted in the United States, Canada and The Netherlands [5]; and 6 case–control studies [4,19–23], leading to a total of 10 studies, met the inclusion criteria and were included in the analysis. Overall, the meta-analysis was based on a total of 1913 lung cancer cases.

    • Alcohol drinking and laryngeal cancer: Overall and dose-risk relation - A systematic review and meta-analysis

      2010, Oral Oncology
      Citation Excerpt :

      Finally, 40 publications were included in this meta-analysis.2,10–48 Two of the articles had possible partial overlap with a few other studies.35,37 Three of the authors reviewed potentially relevant articles.

    • Challenges in interpreting study results: The conflict between appearance and reality

      2006, Journal of the American Dental Association
      Citation Excerpt :

      It is known that people who drink are more likely to smoke (the exposures are associated) and that smoking is a major risk factor for lung cancer (independent risk factor). If smoking is not considered in the data analysis, drinking alcoholic beverages will appear to be a strong risk factor when, in fact, alcohol is not a risk factor for lung cancer and the results were due to the smoking.10 Effect modification occurs when the effect of the risk factor on an outcome can vary, depending on the value of another variable.11

    View all citing articles on Scopus

    Supported by Public Health Service Grant CA32617 from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services.

    f1

    † Deceased.

    2

    To whom correspondence and reprint requests should be addressed at American Health Foundation, 300 East 42nd Street, New York, New York 10017.

    View full text