Risk factors for head and neck cancer in young adults: a pooled analysis in the INHANCE consortium

Tatiana Natasha Toporcov, Ariana Znaor, Zuo-Feng Zhang, Guo-Pei Yu, Deborah M Winn, Qingyi Wei, Marta Vilensky, Thomas Vaughan, Peter Thomson, Renato Talamini, Neonila Szeszenia-Dabrowska, Erich M Sturgis, Elaine Smith, Oxana Shangina, Stephen M Schwartz, Stimson Schantz, Peter Rudnai, Lorenzo Richiardi, Heribert Ramroth, Mark P PurdueAndrew F Olshan, José Eluf-Neto, Joshua Muscat, Raquel Ajub Moyses, Hal Morgenstern, Ana Menezes, Michael McClean, Keitaro Matsuo, Dana Mates, Tatiana V Macfarlane, Jolanta Lissowska, Fabio Levi, Philip Lazarus, Carlo La Vecchia, Pagona Lagiou, Sergio Koifman, Kristina Kjaerheim, Karl Kelsey, Ivana Holcatova, Rolando Herrero, Claire Healy, Richard B Hayes, Silvia Franceschi, Leticia Fernandez, Eleonora Fabianova, Alexander W Daudt, Otávio Alberto Curioni, Luigino Dal Maso, Maria Paula Curado, David I Conway, Chu Chen, Xavier Castellsague, Cristina Canova, Gabriella Cadoni, Paul Brennan, Stefania Boccia, José Leopoldo Ferreira Antunes, Wolfgang Ahrens, Antonio Agudo, Paolo Boffetta, Mia Hashibe, Yuan-Chin Amy Lee, Victor Wünsch Filho

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127 Citations (Scopus)


BACKGROUND: Increasing incidence of head and neck cancer (HNC) in young adults has been reported. We aimed to compare the role of major risk factors and family history of cancer in HNC in young adults and older patients.

METHODS: We pooled data from 25 case-control studies and conducted separate analyses for adults ≤ 45 years old ('young adults', 2010 cases and 4042 controls) and >45 years old ('older adults', 17700 cases and 22 704 controls). Using logistic regression with studies treated as random effects, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS: The young group of cases had a higher proportion of oral tongue cancer (16.0% in women; 11.0% in men) and unspecified oral cavity / oropharynx cancer (16.2%; 11.1%) and a lower proportion of larynx cancer (12.1%; 16.6%) than older adult cases. The proportions of never smokers or never drinkers among female cases were higher than among male cases in both age groups. Positive associations with HNC and duration or pack-years of smoking and drinking were similar across age groups. However, the attributable fractions (AFs) for smoking and drinking were lower in young when compared with older adults (AFs for smoking in young women, older women, young men and older men, respectively, = 19.9% (95% CI=9.8%, 27.9%), 48.9% (46.6%, 50.8%), 46.2% (38.5%, 52.5%), 64.3% (62.2%, 66.4%); AFs for drinking=5.3% (-11.2%, 18.0%), 20.0% (14.5%, 25.0%), 21.5% (5.0%, 34.9%) and 50.4% (46.1%, 54.3%). A family history of early-onset cancer was associated with HNC risk in the young [OR=2.27 (95% CI=1.26, 4.10)], but not in the older adults [OR=1.10 (0.91, 1.31)]. The attributable fraction for family history of early-onset cancer was 23.2% (8.60% to 31.4%) in young compared with 2.20% (-2.41%, 5.80%) in older adults.

CONCLUSIONS: Differences in HNC aetiology according to age group may exist. The lower AF of cigarette smoking and alcohol drinking in young adults may be due to the reduced length of exposure due to the lower age. Other characteristics, such as those that are inherited, may play a more important role in HNC in young adults compared with older adults.

Original languageEnglish
Pages (from-to)169-85
Number of pages17
JournalInternational Journal of Epidemiology
Issue number1
Early online date22 Jan 2015
Publication statusPublished - Feb 2015


  • Adult
  • Age Factors
  • Alcohol Drinking
  • Case-Control Studies
  • Female
  • Genetic Predisposition to Disease
  • Head and Neck Neoplasms
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Odds Ratio
  • Registries
  • Risk Factors
  • Sex Factors
  • Smoking
  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.


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