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

Effects of tobacco smoking and alcohol use on risks of cancers of thelarynx and lung have been evaluated extensively in industrialized countries.Few studies on the effect of these risk factors have been reported fromdeveloping countries. We conducted a case-control study to evaluate risks oflaryngeal and lung cancers in men by subsite and cell type in relation tosmoking and alcohol drinking in Turkey, a country where smoking and alcoholconsumption patterns are different from those in industrialized countries. Weidentified 832 laryngeal and 1,210 lung cancer cases and 829 controls withinformation on smoking and alcohol use (amount and duration) and histologiccell type from an oncology treatment center of a Social Security Agencyhospital in Istanbul, Turkey, admitted between 1979 and 1984. Both laryngealand lung cancer showed significant associations with smoking and alcoholdrinking, but no monotonic dose-response was obtained for alcohol drinking.Among smokers, the highest risks were observed in the supraglottis region ofthe larynx (odds ratio [OR] = 4.1) after adjustment for age and alcohol use.Among alcohol drinkers, the highest risks were observed in the glottis regionof the larynx (OR = 1.7) after adjustment for age and smoking. In theanalysis by the cell type of lung cancer among ever-smokers, small cell typeshowed the highest risk (OR = 5.4), while it showed no association withalcohol drinking. Cumulative cigarette use (pack-years) and number ofcigarettes per day showed stronger associations than years smoked for bothcancer sites. The relative risks of joint exposure to smoking and alcoholwere 12.2 for laryngeal cancer and 14.1 for lung cancer among heavy smokersand heavy alcohol drinkers. This study provides epidemiologic evidence fromTurkey that smoking and alcohol use are associated with risks of cancers ofthe larynx and lung.