PT  - JOURNAL ARTICLE
AU  - Gwenn Menvielle
AU  - Aurore Fayossé
AU  - Loredana Radoï
AU  - Florence Guida
AU  - Marie Sanchez
AU  - Matthieu Carton
AU  - Diane Cyr
AU  - Annie Schmaus
AU  - Sylvie Cénée
AU  - Joëlle Fevotte
AU  - Patricia Delafosse
AU  - Isabelle Stücker
AU  - Danièle Luce
AU  - ICARE study group
TI  - 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
AID  - 10.1136/oemed-2015-102954
DP  - 2016 Jan 01
TA  - Occupational and Environmental Medicine
PG  - 28--33
VI  - 73
IP  - 1
4099  - http://oem.bmj.com/content/73/1/28.short
4100  - http://oem.bmj.com/content/73/1/28.full
SO  - Occup Environ Med2016 Jan 01; 73
AB  - 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.