ALCOHOL, TOBACCO AND AGE FACTORS IN THE RELATIVE FREQUENCY OF CANCER AMONG MALES WITH AND WITHOUT LIVER CIRRHOSIS

Abstract

Keller, A. Z. (Veterans Administration, 151G, Washington, DC 20420). Alcohol, tobacco and age factors in the relative frequency of cancer among males with and without liver cirrhosis. Am J Epidemiol 106:194–202, 1977. Attributes of age, anatomical sites of cancer and the daily use of tobacco and alcohol were investigated among 286 males with liver cirrhosis and cancer and among 374 males with only cancer, to determine: 1) whether males with liver cirrhosis are more likely to have cancer of an anatomical site or tissue either earlier or with greater frequency than comparable males who do not have liver cirrhosis; and 2) whether there are risk factors common to liver cirrhosis and a specific cancer which might explain any notable difference in cancer frequency. These patients, discharged during the same year from 171 VA hospitals in the US, constituted a 100% sample of cirrhotics with cancer and a 2% sample of non-cirrhotics with cancer. All relative frequencies and standard errors of their differences were standardized on age. Findings reported: 1) Among patients with liver cirrhosis and cancer, liver cirrhosis was usually diagnosed four or more years before a squamous cell carcinoma of the mouth, pharynx or larynx; and most digestive organ cancers were diagnosed concurrently with liver cirrhosis. 2) Oral, pharyngeal, respiratory, digestive, genitourinary and skin cancers were manifest essentially three or more years earlier in cirrhotics than in non-cirrhotics. 3) Only cancers of the mouth plus pharynx and digestive organs were significantly excessive among liver cirrhosis patients. 4) Such risk factors in liver cirrhosis as the excessive use of whiskey, tobacco plus alcohol, and mixed alcoholic beverages were positively associated with cancers of the oral cavity and liver. 5) The relative frequency of cancer of the floor of mouth and liver was increased significantly in cancer patients with cirrhosis who also smoked and drank heavily. Since glycogen is stored and metabolized at either tissue site, glucose metabolism is speculated to be a common factor in the pathogenesis of both cancers. These results emphasize the crucial roles of tobacco, alcohol and age factors in the epidemiology of liver cirrhosis and cancer.