Sexual behaviours and the risk of head and neck cancers: A pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium

Julia E. Heck, Julien Berthiller, Salvatore Vaccarella, Deborah M. Winn, Elaine M. Smith, Oxana Shan'gina, Stephen M. Schwartz, Mark P. Purdue, Agnieszka Pilarska, Jose E. Eluf-Neto, Ana Menezes, Michael D. McClean, Elena Matos, Sergio Koifman, Karl T. Kelsey, Rolando Herrero, Richard B. Hayes, Silvia Franceschi, Victor W. Wünsch-Filho, Leticia FernándezAlexander W. Daudt, Maria Paula Curado, Chu Chen, Xavier Castellsague, Gilles Ferro, Paul Brennan, Paolo Boffetta, Mia Hashibe

Research output: Contribution to journalArticlepeer-review

277 Scopus citations


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 InternationalHead 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.

Original languageEnglish
Pages (from-to)166-181
Number of pages16
JournalInternational Journal of Epidemiology
Issue number1
StatePublished - 18 Dec 2009


  • Gay men
  • Head and neck cancer
  • Homosexual
  • Oropharyngeal neoplasms
  • Pooled analyses
  • Risk factors
  • Sexual practices


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