IJE Advance Access originally published online on December 18, 2009
International Journal of Epidemiology 2010 39(1):166-181; doi:10.1093/ije/dyp350
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Sexual behaviours and the risk of head and neck cancers: a pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium
1Lifestyle, Environment, and Cancer Group, International Agency for Research on Cancer, Lyon, France.
2School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.
3Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.
4Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France.
5Clinical and Genetic Epidemiology Research Branch, National Cancer Institute, Bethesda, MD, USA.
6Department of Epidemiology, College of Public Health, and Department of Obstetrics/Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
7Department of Cancer Epidemiology and Prevention, Institute of Carcinogenesis, N.N. Blokhin Russian Cancer Research Centre of the Russian Academy of Medical Sciences, Moscow, Russia.
8Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
9Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
10Clinic of Cranio-Maxillo-Facial Surgery, Oral Surgery and Implantology, Medical University of Warsaw, Warsaw, Poland.
11Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
12Department of Clinical Medicine, Universidade Federal de Pelotas, Pelotas, Brazil.
13Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
14Institute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires, Argentina.
15Department of Epidemiology, Escola Nacional de Saúde Pública, Rio de Janeiro, Brazil.
16Department of Community Health and Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, USA.
17Instituto de Investigación Epidemiológica, San José, Costa Rica.
18Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.
19Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de Sao Paulo, Sao Paulo, Brazil.
20National Institute of Oncology and Radiobiology, National Cancer Registry, Havana, Cuba.
21Cancer Prevention and Control Section, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
22Cancer Information Section, International Agency for Research on Cancer, Lyon, France.
23Cancer Epidemiology Research Program, Institut Català d'Oncologia, IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Catalonia, Spain.
24Genetics Section, International Agency for Research on Cancer, Lyon, France.
25The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY, USA.
26International Prevention Research Institute, Lyon, France.
27Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
*Corresponding author. Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT. E-mail: mia.hashibe{at}utah.edu
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Abstract |
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Background Sexual contact may be the means by which head and neck cancer patients are exposed to human papillomavirus (HPV).
Methods We undertook a pooled analysis of four population-based and four hospital-based case–control studies from the International Head and Neck Cancer Epidemiology (INHANCE) consortium, with participants from Argentina, Australia, Brazil, Canada, Cuba, India, Italy, Spain, Poland, Puerto Rico, Russia and the USA. The study included 5642 head and neck cancer cases and 6069 controls. We calculated odds ratios (ORs) of associations between cancer and specific sexual behaviours, including practice of oral sex, number of lifetime sexual partners and oral sex partners, age at sexual debut, a history of same-sex contact and a history of oral–anal contact. Findings were stratified by sex and disease subsite.
Results Cancer of the oropharynx was associated with having a history of six or more lifetime sexual partners [OR = 1.25, 95% confidence interval (CI) 1.01, 1.54] and four or more lifetime oral sex partners (OR = 2.25, 95% CI 1.42, 3.58). Cancer of the tonsil was associated with four or more lifetime oral sex partners (OR = 3.36, 95 % CI 1.32, 8.53), and, among men, with ever having oral sex (OR = 1.59, 95% CI 1.09, 2.33) and with an earlier age at sexual debut (OR = 2.36, 95% CI 1.37, 5.05). Cancer of the base of the tongue was associated with ever having oral sex among women (OR = 4.32, 95% CI 1.06, 17.6), having two sexual partners in comparison with only one (OR = 2.02, 95% CI 1.19, 3.46) and, among men, with a history of same-sex sexual contact (OR = 8.89, 95% CI 2.14, 36.8).
Conclusions Sexual behaviours are associated with cancer risk at the head and neck cancer subsites that have previously been associated with HPV infection.
Keywords Sexual practices, head and neck cancer, oropharyngeal neoplasms, homosexual, gay men, risk factors, pooled analyses
Accepted 20 October 2009