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The joint effect of asbestos exposure, tobacco smoking and alcohol drinking on laryngeal cancer risk: evidence from the French population-based case–control study, ICARE
  1. Gwenn Menvielle1,
  2. Aurore Fayossé2,3,
  3. Loredana Radoï4,5,
  4. Florence Guida4,6,
  5. Marie Sanchez4,6,
  6. Matthieu Carton7,8,
  7. Diane Cyr7,8,
  8. Annie Schmaus7,8,
  9. Sylvie Cénée4,6,
  10. Joëlle Fevotte9,
  11. Patricia Delafosse10,
  12. Isabelle Stücker4,6,
  13. Danièle Luce2,3,
  14. ICARE study group
    1. 1Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
    2. 2Inserm U 1085—IRSET, Pointe-à-Pitre, France
    3. 3University of Rennes 1, Rennes, France
    4. 4Inserm UMRS 1018, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer, Villejuif, France
    5. 5University of Paris Descartes, Paris, France
    6. 6University of Paris Sud 11, Kremlin-Bicêtre, France
    7. 7Inserm Epidemiologic Cohorts Unit—UMS 011 INSERM-UVSQ, Villejuif, France
    8. 8University of Versailles St-Quentin, Villejuif, France
    9. 9Unité Mixte de Recherche Épidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE), Université Claude Bernard Lyon 1, Lyon, France
    10. 10Isère Cancer Registry, Grenoble, France
    1. Correspondence to Dr Gwenn Menvielle, ERES—IPLESP Inserm U1136, Bat 15/16, 16 ave Paul Vaillant Couturier, Villejuif Cedex 94807, France; gwenn.menvielle{at}


    Objective The objective of the study was to investigate the joint effect of occupational exposure to asbestos, and tobacco and alcohol consumption, on the risk of laryngeal cancer among men.

    Methods We used data from a large population-based case–control study conducted in France. We estimated two-way and three-way interactions between asbestos exposure (never vs ever exposed), tobacco consumption (<20 vs ≥20 pack-years) and alcohol consumption (<5 vs ≥5 drinks per day). The interaction on an additive scale was assessed by estimating the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction, and the interaction on a multiplicative scale was assessed by estimating the multiplicative interaction parameter (ψ). Multiplicative interactions were also assessed using fractional polynomials for alcohol drinking, tobacco smoking and asbestos exposure.

    Results When compared with light-to-moderate smokers and drinkers never exposed to asbestos, the increase in laryngeal cancer risk was smallest among light-to-moderate drinkers and smokers exposed to asbestos (OR=2.23 (1.08 to 4.60)), and highest among heavy smokers and drinkers ever exposed to asbestos (OR=69.39 (35.54 to 135.5)). We found an additive joint effect between asbestos exposure and alcohol consumption (RERI=4.75 (−4.29 to 11.12)), whereas we observed a more than additive joint effect between asbestos exposure and tobacco consumption (RERI=8.50 (0.71 to 23.81)), as well as between asbestos exposure, and tobacco and alcohol consumption (RERI=26.57 (11.52 to 67.88)). However, our results did not suggest any interaction on a multiplicative scale.

    Conclusions Our results suggest that asbestos exposure, in combination with tobacco and alcohol exposure, accounted for a substantial number of laryngeal cancer cases. Our findings therefore highlight the need for prevention in activities, such as construction work, where exposure to asbestos-containing materials remains.

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