[Alcohol and cancer]. / Alcool et cancer.

Regular consumption of alcoholic beverages increases the risk of cancer in the upper aero-digestive tract and in the liver. There is a dose-response relationship and the effects are combined with those of tobacco, according to a multiplicative model. The biologic mechanisms are unclear. Prevention is theoretically possible, but the risks concern levels of consumption generally considered as safe.

Nutrient intake patterns and gastric cancer risk: a case-control study in Belgium.

A case-control study on gastric cancer risk in relation to nutrient composition of diet was conducted in the 2 Belgian provinces of Oost-Vlaanderen and Liège as part of a large epidemiological study on cancers of the digestive tract, also including colorectal cancer. The statistical analysis was carried out on a total of 301 men and women aged 35-74 years with histologically confirmed stomach tumors and 2,851 population controls. Dietary intake assessments were obtained by interview, using a dietary history questionnaire. Gastric cancer risk was increased for diets rich in mono- and disaccharides, according to statistical models based on energy-adjusted residuals [odds ratio (OR) = 1.88 for upper vs. lower quartiles of energy-adjusted intakes] or energy decomposition models, but showed no increase for high intake of polysaccharides. Intake of polyunsaturated fats, particularly linoleic acid, was inversely associated with gastric cancer risk. High intake of vitamin C, beta carotene and vitamins B1 (thiamine), B3 (nicotinic acid) or B6 (pyridoxine) was also associated with decreased risk, whereas increased risk was observed for high intake of vitamin A (retinol) or vitamin B2 (riboflavin). Many of these associations between gastric cancer risk and nutrient composition were similar to those found in the analysis of a parallel study on cancers of the colon and rectum.

Incidence of tobacco and alcohol-related cancers in western Europe.

The relative importance of the tobacco and alcohol-related cancer burden varies across countries. Within western Europe, the incidence of lung cancer has a clearly different geographical pattern to the incidence of alcohol-related cancer. Each country's public health policies should take into account its own tobacco and alcohol-related morbidities.

Diet and cancers of the larynx and hypopharynx: the IARC multi-center study in southwestern Europe.

The main causes of cancer of the larynx and hypopharynx are smoking cigarettes and drinking alcohol. However, for these as well as for other cancers of the upper aerodigestive tract, some dietary components, mainly low consumption of fruit and vegetables, have been observed to be associated with increased cancer risk. We report results from a multicenter case-control study carried out in six regions of Europe located in northern Spain, northern Italy, Switzerland, and France. A total of 1,147 males with cancer (cases) and 3,057 population controls were interviewed on usual diet, lifelong drinking and smoking habits, and occupational history. Cancer cases had histologically verified epidermoid carcinomas. The cancers were classified in two anatomic sub-entities: the epilarynx (hypopharynx and upper part of the larynx), which enters into contact with the bolus and the air; and the endolarynx, through which air and tobacco smoke pass, but not the bolus. A previous report from this study found that alcohol drinking presents a greater risk factor for cancer of the epilarynx than for cancer of the endolarynx. The main results regarding diet indicate that high intake of fruit, vegetables, vegetable oil, fish, and low intake of butter and preserved meats were associated with reduced risk of both epilaryngeal and endolaryngeal cancers, after adjustment for alcohol, tobacco, socioeconomic status, and non-alcohol energy intake. Among nutrients, a reduced risk was found for high intake of vitamins C and E and for a high polyunsaturated/saturated fatty acids (P/S) ratio. While these variables are relevant in scoring nutritional behaviour, it remains unresolved whether the biologic properties of these nutrients play a role in the apparent protective effect.

Laryngeal cancer.

By and large, the incidence of laryngeal cancer is tending to increase over time in much of the world, often in parallel with changes in tobacco and/or alcohol consumption. There are encouraging examples of declining trends that can be attributed to decreasing use of either tobacco or alcohol. These observations are in line with what is known about the multiplicative effects of both exposures. Since it is now well known that the epidemiology of cancer of the epilarynx differs from that of the endolarynx, it is highly desirable that in the future, this should be better reflected in the way laryngeal tumours are classified. There is good reason to believe that a change in alcohol consumption would have an effect on neoplasms of the epilarynx, whereas a change in tobacco consumption would affect incidence of neoplasms of the lower larynx. To examine this hypothesis, combined analyses of both lung and laryngeal cancer trends may have to be carried out together and compared, as in a recent Italian study (Capocaccia et al, in press). Research along these lines should provide a better understanding of how time trends in laryngeal cancer incidence can be related to changes in either tobacco and/or alcohol consumption. We know enough to believe that continuous efforts to reduce the consumption of either factor would result in a decrease in laryngeal cancer and that the biggest effect could be expected from a simultaneous reduction in alcohol and tobacco consumption (Tuyns, 1991).

Diet and gastric cancer. A case-control study in Belgium.

A case-control study was carried out in 2 Belgian provinces with contrasting gastric-cancer mortality. The results were analyzed for the total study group and also separately in each of the 4 sub-groups: men and women in each province. Only risks which appeared consistently in at least 3 of these 4 sub-groups were retained in the discussion. Consumption of most vegetables, either cooked or raw, and of fresh fruit was found to be protective. There was an increased risk associated with meal and flour products, including white bread. Added sugar also increased the risk of gastric cancer. Consumption of lean meat was associated with a decreased risk. There was no clear effect for most sources of fat, but for oils with a high P/S ratio there was a decreased risk. Together with our earlier finding on salt, these results are to a large extent similar to those of other recent studies on gastric cancer.

Oesophageal cancer in France and Switzerland: recent time trends.

This paper reports the incidence of oesophageal carcinoma in five cancer registries from France and in a further two from the francophone regions of Switzerland. The cancers are segregated into the two main histological types (squamous cell carcinoma and adenocarcinoma). In Belgium the proportion of adenocarcinomas is much higher than in any of the French registries. A study of time trends shows no clear trend in overall incidence of oesophageal cancer. There is a trend towards an increasing proportion of adenocarcinomas with time, that is most apparent in Doubs, Dijon and Vaud registries.

Alcohol-related cancers in Mediterranean countries.

In most countries bordering the Mediterranean, alcohol ranks second to tobacco as a risk factor for cancer. It is directly implicated in cancer of the mouth, larynx, hypopharynx and esophagus. For all these cancers a dose-response relationship has been demonstrated as well as a combination with the effect of tobacco, the two effects being multiplicative. Alcohol is also responsible for liver cancer developing on alcoholic cirrhosis. In addition, it has been suggested that alcohol consumption may be related to an increased risk of breast cancer.

Cancer of the larynx/hypopharynx, tobacco and alcohol: IARC international case-control study in Turin and Varese (Italy), Zaragoza and Navarra (Spain), Geneva (Switzerland) and Calvados (France).

A case-control study on larynx and hypopharynx cancer was carried out in 6 populations including the city of Turin and the province of Varese (Italy), the provinces of Navarra and Zaragoza (Spain), the canton of Geneva (Switzerland), and the département of Calvados (France). This report presents an analysis of the risk associated with alcohol and tobacco consumption based on 1,147 male cases and 3,057 male population controls. Special attention was given to the study of the risk at various sites of larynx and hypopharynx. The effect of tobacco is similar for all sites and the risk associated with ever smoking is on the order of 10. The risks from alcohol drinking depend on site. They are similar for epilarynx and hypopharynx (RR = 4.3, for more than 80 g/day) and lower for endolarynx (RR = 2.1, for more than 80 g/day). For all sites the risk decreases after quitting (RR = 0.3 after 10 years); exclusive use of filter cigarettes is protective (RR = 0.5 relative to smokers of plain cigarettes only) as is exclusive use of blond tobacco (RR = 0.5 relative to smokers of black tobacco only). Inhalation increases the risk of endolaryngeal cancer but not that of hypopharynx or epilarynx. The relative risks for joint exposure to alcohol and tobacco are consistent with a multiplicative model.

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. I. Study design and dietary habits.

Diet, tobacco and alcohol consumption, and occupational histories have been investigated in stratified random samples of the adult population in 6 areas in France (departement of Calvados), Italy (province of Varese and city of Torino), Spain (provinces of Navarra and Zaragoza) and Switzerland (canton of Geneva), to be used as a reference group in a case-control study on cancer of the larynx and hypopharynx. Out of a total of 8,074 sampled subjects, 5,564 could be interviewed. Sampling procedures are described, and reasons for non-response are analysed. Everywhere the intake of the 4 energy providing nutrients (particularly alcohol) was much greater in men than in women. In both sexes, total caloric intake was higher in Calvados and in Italy than elsewhere. There were wide inter-area variations in the consumption of butter + milk products and oils, resulting in a polyunsaturated/saturated fatty acid ratio ranging from 0.27 in Calvados to 0.54-0.65 in Spain. Among nutrients suggested to be involved in cancer aetiology, inter-area differences in daily intake were up to 3-fold for carotene and smaller for vitamin C and fibre. The proportion of lipids, fibres, vitamin C and carotene provided by different foods varied widely between areas, thus suggesting that in etiological cancer studies consideration should be given not only to nutrients but also to foods providing them.

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. III. Consumption of alcohol.

Individual present and life time intake of aethanol has been studied in population samples of six areas of Italy (Torino, Varese), Spain (Navarra, Zaragoza), Switzerland (Geneva) and France (Calvados); 2,965 men and 2,369 women were interviewed. Abstinent men were no more than 4% except in Zaragoza (11.5%); 49 to 61% drank between 20 and 80 g. aethanol a day and 21 to 26% more than 80 g. (36% in Navarra). Women drank much less and were more often abstinent: 50 to 94% of them did not drink or drank less than 20 g. a day. Wine was the most commonly consumed beverage (over 60% of total alcohol intake), except in Calvados where cider was still largely consumed (over 30%). Such differences in drinking habits by sex and region are of major public health importance. They do not appear in national sales statistics which must be complemented by surveys on individuals.

Salt and gastrointestinal cancer.

This study reports on the taste for salt among patients with gastric, colon, or rectal cancers and among population controls, within the scope of an investigation on those cancers in two Belgian provinces. Among people who systematically added salt to their food, the relative risks observed were as follows: 1.78 for gastric cancer, 1.53 for colon cancer, and 1.74 for rectal cancer. Even though all three were statistically significant, these increases are moderate and may be due to interaction with other, as yet unknown casual factors.

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. II. Tobacco smoking.

This paper describes the smoking habits of six populations in France, Switzerland, Italy and Spain. A total of 2,965 men and 2,369 women have been interviewed. The proportion of ever smoking men is almost the same (75 to 80%) everywhere but in Geneva and Calvados a higher proportion of smokers quitted the habit (over 30%). In females, on the contrary, the prevalences of ever smokers is higher in Torino (42%) and Geneva (36%) than in Spain (25%) and Calvados (19%). Young females, however, tend to smoke more and intercountry differences tend to disappear. In both sexes successive generations begin to smoke earlier. Exclusive use of black tobacco is still very high in Calvados (90%) and Navarra (80%) whilst it tends to disappear in Italy (30%). Plain cigarettes decrease everywhere, especially in Spain and Varese, but they are still smoked by the majority of men in Calvados. The results suggest that the tobacco epidemic is still increasing in those areas where it began more recently.