J Korean Med Sci.  2024 Jun;39(22):e185. 10.3346/jkms.2024.39.e185.

The Combined Effects of Alcohol Consumption and Smoking on Cancer Risk by Exposure Level: A Systematic Review and Meta-Analysis

• Jun S
• Park H
• Kim UJ
• Lee HA
• Park B
• Lee SY
• Jee SH
• Park H

• KMID: 2556299
• DOI: http://doi.org/10.3346/jkms.2024.39.e185

Abstract

Background
Alcohol consumption is a major risk factor for cancer, and when combined with smoking, the risk increases. Nevertheless, few studies have comprehensively evaluated the combined effects of alcohol consumption and smoking on the risk of various cancer types. Therefore, to assess these effects, we conducted a systematic review and meta-analysis.
Methods
We performed a systematic search of five literature databases, focusing on cohort and case-control studies. Considering exposure levels, we quantified the combined effects of alcohol consumption and smoking on cancer risk and assessed multiplicative interaction effects.
Results
Of 4,452 studies identified, 24 (4 cohort studies and 20 case-control studies) were included in the meta-analysis. We detected interaction effect of light alcohol and moderate smoking on head and neck cancer risk (relative risk [RR], 4.26; 95% confidence interval [CI], 2.50–7.26; I² = 65%). A synergistic interaction was observed in heavy alcohol and heavy smoking group (RR, 35.24; 95% CI, 23.17–53.58; I² = 69%). In more detailed cancer types, the interaction effect of heavy alcohol and heavy smoking was noticeable on oral (RR, 36.42; 95% CI, 24.62–53.87; I² = 46%) and laryngeal (RR, 38.75; 95% CI, 19.25–78.01; I² = 69%) cancer risk.
Conclusion
Our study provided a comprehensive summary of the combined effects of alcohol consumption and smoking on cancers. As their consumption increased, the synergy effect became more pronounced, and the synergy effect was evident especially for head and neck cancer. These findings provide additional evidence for the combined effect of alcohol and smoking in alcohol guidelines for cancer prevention.

Keyword

Systematic Review; Meta-Analysis; Alcohol Drinking; Smoking; Neoplasms

Figure

• 

  Fig. 1 Flowchart of the selection of studies for inclusion in the meta-analysis.

• 

  Fig. 2 Relative risks of head and neck cancer associated with the combined effects of alcohol consumption and smoking. Head and neck cancer included cancers of the oral, pharyngeal, and laryngeal. Alcohol consumption was classified as none, light (< 12.5 g/day), moderate (12.5–49.9 g/day), or heavy (≥ 50.0 g/day). Smoking was classified as none, moderate (< 20 cig/day), or heavy (≥ 20 cig/day).aWhen comparing the pooled relative risk of the combination of alcohol consumption and smoking group and the corresponding alcohol consumption group alone, the P value was smaller than 0.05.bWhen comparing the pooled relative risk of the combination of alcohol consumption and smoking group and the corresponding smoking group alone, the P value was smaller than 0.05.

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