Types of alcoholic beverages, pattern of drinking and the risk of upper aerodigestive tract cancer: European multicenter case-control study ARCAGE

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Background: Alcohol consumption is a well established risk factor for upper aerodigestive tract (UADT) cancer with a known dose-response relationship. However, only a few studies have evaluated the influence of drinking patterns on the risk of UADT cancer, and the results on the risk across different types of alcoholic beverage (beer, wine, liquor) are inconsistent. To evaluate these and other risk factors, we conducted a multicenter study on UADT cancer in Europe.
 Methods: Our study included 2,347 cases and 2,254 controls from 14 centers in 10 European countries. All cases were histologically or cytologically confirmed, and controls were frequency matched by sex, age and center. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age, sex, center, education level, vegetable and fruit intake, packyears of tobacco (cigarette, cigar, pipe) smoking, and frequency of alcohol drinking where appropriate.
 RESULTS: The risk of UADT cancer by frequency, duration and cumulative consumption was similar for drinking wine only, beer only or liquor only. Compared to never drinkers, the ORs for UADT cancer risk of drinking <1 drink/day were 1.2 (95% CI: 0.9, 1.6) for alcohol overall, 1.1 (0.8, 1.6) for wine only, 2.0 (1.4, 2.9) for beer only and 0.9 (0.5, 1.7) for liquor only. ORs for drinking 1+ drinks/day were 2.2 (1.7, 2.9) for alcohol overall, 6.7 (3.8, 11.8) for wine only, 3.1 (1.8, 5.2) for beer only and 2.8 (0.6, 11.9) for liquor only. Among never smokers, the ORs for drinking any type of alcohol were 0.9 (0.6, 1.4) for <1 drink/day, 0.8 (0.4, 1.3) for 1-2 drinks/day and 2.1 (1.1, 4.2) for 3+ drinks/day. The UADT cancer risk for frequency, duration and cumulative consumption was slightly lower among those who drank only with meals [ORs: 1.1 (0.8, 1.5) for <1 drink/day, 1.0 (0.7, 1.5) for 1-2 drinks/day, 2.2 (1.4, 3.4) for 3+ drinks/day] compared to subjects who drank also between meals [ORs: 1.4 (1.0, 1.9) for <1 drink/day, 1.8 (1.3, 2.6) for 1-2 drinks/day, 3.2 (2.2, 4.5) for 3+ drinks/day]. The associations between drinking and UADT cancer risk were stronger among those who drank before noon [ORs: 2.0 (1.3, 3.3) for <1 drink/day, 2.5 (1.6, 3.8) for 1-2 drinks/day, 5.0 (3.2, 7.6) for 3+ drinks/day] than among those who never drank before noon [ORs: 1.1 (0.8, 1.4) for <1 drink/day, 1.2 (0.9, 1.6) for 1-2 drinks/day, 1.9 (1.3, 2.8) for 3+ drinks/day]. The ORs for UADT cancer risk of <1 drink/day, 1-2 drinks/day, 3+ drinks/day, respectively, were 1.1 (0.8, 1.4), 1.3 (1.0, 1.8), 3.2 (2.3, 4.4) for drinkers who binge drank <1 time/month and 2.1 (1.2, 3.8), 2.5 (1.5, 4.3), 3.8 (2.4, 6.2) for drinkers who binge drank 1+ times/month.
 Conclusion: Our results suggest that there are no major differences in the carcinogenic effect of wine, beer and liquor on the risk of UADT cancer. The association between drinking and the risk of UADT cancer appears to be independent from that of tobacco smoking.