Open Access Highly Accessed Research article

Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck cancer: results from the Netherlands Cohort Study

Denise HE Maasland1*, Piet A van den Brandt1, Bernd Kremer2, R Alexandra (Sandra) Goldbohm3 and Leo J Schouten1

Author Affiliations

1 Department of Epidemiology, GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616 Maastricht 6200, MD, The Netherlands

2 Department of Otorhinolaryngology, Head & Neck Surgery, GROW - School for Oncology & Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands

3 TNO, Leiden, The Netherlands

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BMC Cancer 2014, 14:187  doi:10.1186/1471-2407-14-187

Published: 14 March 2014



Prospective data on alcohol consumption, cigarette smoking and risk of head-neck cancer (HNC) subtypes, i.e. oral cavity cancer (OCC), oro-/hypopharyngeal cancer (OHPC), and laryngeal cancer (LC), are limited. We investigated these associations within the second largest prospective study on this topic so far, the Netherlands Cohort Study.


120,852 participants completed a questionnaire on diet and other cancer risk factors in 1986. After 17.3 years of follow-up, 395 HNC (110 OCC, 83 OHPC, and 199 LC) cases and 4288 subcohort members were available for case-cohort analysis using Cox proportional hazards models.


For total HNC, the multivariable adjusted incidence rate ratio (RR) was 2.74 (95% confidence interval (CI) 1.85-4.06) for those drinking ≥30 g ethanol/day compared with abstainers; in subtypes, RRs were 6.39 for OCC, 3.52 for OHPC, and 1.54 for LC. Compared with never cigarette smokers, current cigarette smokers had a RR of 4.49 (95%CI 3.11-6.48) for HNC overall, and 2.11 for OCC, 8.53 for OHPC, and 8.07 for LC. A significant, positive, multiplicative interaction between categories of alcohol consumption and cigarette smoking was found for HNC overall (P interaction 0.03).


Alcohol consumption and cigarette smoking were independently associated with risk of HNC overall, with a positive, multiplicative interaction. The strength of these associations differed among HNC-subtypes: OCC was most strongly associated with alcohol consumption but most weakly with cigarette smoking, whereas LC was not statistically significantly associated with alcohol consumption.

Alcohol consumption; Cigarette smoking; Cohort studies; Etiology; Head-neck cancer; Head-neck cancer subtypes