JOSE ELUF NETO

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LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 32 Citação(ões) na Scopus
    European ancestry and polymorphisms in DNA repair genes modify the risk of melanoma: A case-control study in a high UV index region in Brazil
    (2011) GONCALVES, Fernanda T.; FRANCISCO, Guilherme; SOUZA, Sonia P. de; LUIZ, Olinda C.; FESTA-NETO, Cyro; SANCHES, Jose A.; CHAMMAS, Roger; GATTAS, Gilka J. F.; ELUF-NETO, Jose
    Background: UV radiation is the major environmental factor related to development of cutaneous melanoma. Besides sun exposure and the influence of latitude, some host characteristics such as skin phototype and hair and eye color are also risk factors for melanoma. Polymorphisms in DNA repair genes could be good candidates for susceptibility genes, mainly in geographical regions exposed to high solar radiation. Objective: Evaluate the role of host characteristic.; and DNA repair polymorphism in melanoma risk in Brazil. Methods: We carried out a hospital-based case-control study in Brazil to evaluate the contribution of host factors and polymorphisms in DNA repair to melanoma risk. A total of 412 patients (202 with melanoma and 210 controls) were analyzed regarding host characteristics for melanoma risk as well as for 11 polymorphisms in DNA repair genes. Results: We found an association of host characteristics with melanoma development, such as eye and hair color, fair skin, history of pigmented lesions removed, sunburns in childhood and adolescence, and also European ancestry. Regarding DNA repair gene polymorphisms, we found protection for the XPG 1104 His/His genotype (OR 0.32; 95% CI 0.13-0.75), and increased risk for three polymorphisms in the XPC gene (PAT+; IV-6A and 939Gln), which represent a haplotype for XPC. Melanoma risk was higher in individuals carrying the complete XPC haplotype than each individual polymorphism (OR 3.64; 95% CI 1.77-7.48). Conclusions: Our data indicate that the host factors European ancestry and XPC polymorphisms contributed to melanoma risk in a region exposed to high sun radiation.
  • article 22 Citação(ões) na Scopus
    Genome-wide association study of HPV seropositivity
    (2011) CHEN, Dan; MCKAY, James D.; CLIFFORD, Gary; GABORIEAU, Valerie; CHABRIER, Amelie; WATERBOER, Tim; ZARIDZE, David; LISSOWSKA, Jolanta; RUDNAI, Peter; FABIANOVA, Eleonora; BENCKO, Vladimir; JANOUT, Vladimir; FORETOVA, Lenka; MATES, Ioan Nicolae; SZESZENIA-DABROWSKA, Neonila; CURADO, Maria Paula; KOIFMAN, Sergio; MENEZES, Ana; WUENSCH-FILHO, Victor; ELUF-NETO, Jose; GARROTE, Leticia Fernandez; MATOS, Elena; ZELENIKA, Diana; BOLAND, Anne; BOFFETTA, Paolo; PAWLITA, Michael; LATHROP, Mark; BRENNAN, Paul
    High-risk alpha mucosal types of human papillomavirus (HPV) cause anogenital and oropharyngeal cancers, whereas beta cutaneous HPV types (e.g. HPV8) have been implicated in non-melanoma skin cancer. Although antibodies against the capsid protein L1 of HPV are considered as markers of cumulative exposure, not all infected persons seroconvert. To identify common genetic variants that influence HPV seroconversion, we performed a two-stage genome-wide association study. Genome-wide genotyping of 316 015 single nucleotide polymorphisms was carried out using the Illumina HumanHap300 BeadChip in 4811 subjects from a central European case-control study of lung, head and neck and kidney cancer that had serology data available on 13 HPV types. Only one association met genome-wide significance criteria, namely that between HPV8 seropositivity and rs9357152 [odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.24-1.50 for the minor allele G; P = 1.2 x 10(-10)], a common genetic variant (minor allele frequency = 0.33) located within the major histocompatibility complex (MHC) II region at 6p21.32. This association was subsequently replicated in an independent set of 2344 subjects from a Latin American case-control study of head and neck cancer (OR = 1.35, 95% CI = 1.18-1.56, P = 2.2 x 10(-5)), yielding P = 1.3 x 10(-14) in the combined analysis (P-heterogeneity = 0.87). No heterogeneity was noted by cancer status (controls/lung cancer cases/head and neck cancer cases/kidney cancer cases). This study provides a proof of principle that genetic variation plays a role in antibody reactivity to HPV infection.
  • article 156 Citação(ões) na Scopus
    A Genome-Wide Association Study of Upper Aerodigestive Tract Cancers Conducted within the INHANCE Consortium
    (2011) MCKAY, James D.; Therese Truong; GABORIEAU, Valerie; CHABRIER, Amelie; CHUANG, Shu-Chun; BYRNES, Graham; ZARIDZE, David; SHANGINA, Oxana; SZESZENIA-DABROWSKA, Neonila; LISSOWSKA, Jolanta; RUDNAI, Peter; FABIANOVA, Eleonora; BUCUR, Alexandru; BENCKO, Vladimir; HOLCATOVA, Ivana; JANOUT, Vladimir; FORETOVA, Lenka; LAGIOU, Pagona; TRICHOPOULOS, Dimitrios; BENHAMOU, Simone; BOUCHARDY, Christine; AHRENS, Wolfgang; MERLETTI, Franco; RICHIARDI, Lorenzo; TALAMINI, Renato; BARZAN, Luigi; KJAERHEIM, Kristina; MACFARLANE, Gary J.; MACFARLANE, Tatiana V.; SIMONATO, Lorenzo; CANOVA, Cristina; AGUDO, Antonio; CASTELLSAGUE, Xavier; LOWRY, Ray; CONWAY, David I.; MCKINNEY, Patricia A.; HEALY, Claire M.; TONER, Mary E.; ZNAOR, Ariana; CURADO, Maria Paula; KOIFMAN, Sergio; MENEZES, Ana; WUENSCH-FILHO, Victor; NETO, Jose Eluf; GARROTE, Leticia Fernandez; BOCCIA, Stefania; CADONI, Gabriella; ARZANI, Dario; OLSHAN, Andrew F.; WEISSLER, Mark C.; FUNKHOUSER, William K.; LUO, Jingchun; LUBINSKI, Jan; TRUBICKA, Joanna; LENER, Marcin; OSZUTOWSKA, Dorota; SCHWARTZ, Stephen M.; CHEN, Chu; FISH, Sherianne; DOODY, David R.; MUSCAT, Joshua E.; LAZARUS, Philip; GALLAGHER, Carla J.; CHANG, Shen-Chih; ZHANG, Zuo-Feng; WEI, Qingyi; STURGIS, Erich M.; WANG, Li-E; FRANCESCHI, Silvia; HERRERO, Rolando; KELSEY, Karl T.; MCCLEAN, Michael D.; MARSIT, Carmen J.; NELSON, Heather H.; ROMKES, Marjorie; BUCH, Shama; NUKUI, Tomoko; ZHONG, Shilong; LACKO, Martin; MANNI, Johannes J.; PETERS, Wilbert H. M.; HUNG, Rayjean J.; MCLAUGHLIN, John; VATTEN, Lars; NJOLSTAD, Inger; GOODMAN, Gary E.; FIELD, John K.; LILOGLOU, Triantafillos; VINEIS, Paolo; CLAVEL-CHAPELON, Francoise; PALLI, Domenico; TUMINO, Rosario; KROGH, Vittorio; PANICO, Salvatore; GONZALEZ, Carlos A.; QUIROS, J. Ramon; MARTINEZ, Carmen; NAVARRO, Carmen; ARDANAZ, Eva; LARRANAGA, Nerea; KHAW, Kay-Tee; KEY, Timothy; BUENO-DE-MESQUITA, H. Bas; PEETERS, Petra H. M.; TRICHOPOULOU, Antonia; LINSEISEN, Jakob; BOEING, Heiner; HALLMANS, Goran; OVERVAD, Kim; TJONNELAND, Anne; KUMLE, Merethe; RIBOLI, Elio; VAELK, Kristjan; VOODERN, Tonu; METSPALU, Andres; ZELENIKA, Diana; BOLAND, Anne; DELEPINE, Marc; FOGLIO, Mario; LECHNER, Doris; BLANCHE, Helene; GUT, Ivo G.; GALAN, Pilar; HEATH, Simon; HASHIBE, Mia; HAYES, Richard B.; BOFFETTA, Paolo; LATHROP, Mark; BRENNAN, Paul
    Genome-wide association studies (GWAS) have been successful in identifying common genetic variation involved in susceptibility to etiologically complex disease. We conducted a GWAS to identify common genetic variation involved in susceptibility to upper aero-digestive tract (UADT) cancers. Genome-wide genotyping was carried out using the Illumina HumanHap300 beadchips in 2,091 UADT cancer cases and 3,513 controls from two large European multi-centre UADT cancer studies, as well as 4,821 generic controls. The 19 top-ranked variants were investigated further in an additional 6,514 UADT cancer cases and 7,892 controls of European descent from an additional 13 UADT cancer studies participating in the INHANCE consortium. Five common variants presented evidence for significant association in the combined analysis (p <= 5 x 10(-7)). Two novel variants were identified, a 4q21 variant (rs1494961, p = 1 x 10(-8)) located near DNA repair related genes HEL308 and FAM175A (or Abraxas) and a 12q24 variant (rs4767364, p = 2 x 10(-8)) located in an extended linkage disequilibrium region that contains multiple genes including the aldehyde dehydrogenase 2 (ALDH2) gene. Three remaining variants are located in the ADH gene cluster and were identified previously in a candidate gene study involving some of these samples. The association between these three variants and UADT cancers was independently replicated in 5,092 UADT cancer cases and 6,794 controls non-overlapping samples presented here (rs1573496-ADH7, p = 5 x 10(-8); rs1229984-ADH1B, p = 7 x 10(-9); and rs698-ADH1C, p = 0.02). These results implicate two variants at 4q21 and 12q24 and further highlight three ADH variants in UADT cancer susceptibility.
  • article 64 Citação(ões) na Scopus
    Arg72Pro TP53 polymorphism and cancer susceptibility: a comprehensive meta-analysis of 302 case-control studies
    (2011) FRANCISCO, Guilherme; MENEZES, Paulo Rossi; ELUF-NETO, Jose; CHAMMAS, Roger
    Arg72Pro is a common polymorphism in TP53, showing differences in its biological functions. Case-control studies have been performed to elucidate the role of Arg72Pro in cancer, although the results are conflicting and heterogeneous. Here, we analyzed pooled data from case-control studies to determine the role of Arg72Pro in different cancer sites. We performed a systematic review and meta-analysis of 302 case-control studies that analyzed Arg72Pro in cancer susceptibility. Odds ratios were estimated for different tumor sites using distinct genetic models, and the heterogeneity between studies was explored using I(2) values and meta-regression. We adopted quality criteria to classify the studies. Subgroup analyses were done for tumor sites according to ethnicity, histological, and anatomical sites. Results indicated that Arg72Pro is associated with higher susceptibility to cancer in some tumor sites, mainly hepatocarcinoma. For some tumor sites, quality of studies was associated with the size of genetic association, mainly in cervical, head and neck, gastric, and lung cancer. However, study quality did not explain the observed heterogeneity substantially. Meta-regression showed that ethnicity, allelic frequency and genotyping method were responsible for a substantial part of the heterogeneity observed. Our results suggest ethnicity and histological and anatomical sites may modulate the penetrance of Arg72Pro in cancer susceptibility. This meta-analysis denotes the importance for more studies with good quality and that the covariates responsible for heterogeneity should be controlled to obtain a more conclusive response about the function of Arg72Pro in cancer.
  • article 24 Citação(ões) na Scopus
    Education, tobacco smoking, alcohol consumption, and IL-2 and IL-6 gene polymorphisms in the survival of head and neck cancer
    (2011) LOPEZ, R. V. M.; ZAGO, M. A.; ELUF-NETO, J.; CURADO, M. P.; DAUDT, A. W.; SILVA-JUNIOR, W. A. da; ZANETTE, D. L.; LEVI, J. E.; CARVALHO, M. B. de; KOWALSKI, L. P.; ABRAHAO, M.; GOIS-FILHO, J. F. de; BOFFETTA, P.; WUENSCH-FILHO, V.
    The association of education, tobacco smoking, alcohol consumption, and interleukin-2 (IL-2 +114 and -384) and -6 (IL-6 -174) DNA polymorphisms with head and neck squamous cell carcinoma (HNSCC) was investigated in a cohort study of 445 subjects. IL-2 and IL-6 genotypes were determined by real-time PCR. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) of disease-specific survival according to anatomical sites of the head and neck. Mean age was 56 years and most patients were males (87.6%). Subjects with 5 or more years of schooling had better survival in larynx cancer. Smoking had no effect on HNSCC survival, but alcohol consumption had a statistically significant effect on larynx cancer. IL-2 gene +114 G/T (HR = 0.52; 95% CI = 0.15-1.81) and T/T (HR = 0.22; 95% CI = 0.02-3.19) genotypes were associated with better survival in hypopharynx cancer. IL-2 + 114 G/T was a predictor of poor survival in oral cavity/oropharynx cancer and larynx cancer (HR = 1.32; 95% CI = 0.61-2.85). IL-2 -384 G/T was associated with better survival in oral cavity/oropharynx cancer (HR = 0.80; 95% CI = 0.45-1.42) and hypopharynx cancer (HR = 0.68; 95% CI = 0.21-2.20), but an inverse relationship was observed for larynx cancer. IL-6 -174 G/C was associated with better survival in hypopharynx cancer (HR = 0.68; 95% CI = 0.26-1.78) and larynx cancer (HR = 0.93; 95% CI = 0.42-2.07), and C/C reduced mortality in larynx cancer. In general, our results are similar to previous reports on the value of education, smoking, alcohol consumption, and IL-2 and IL-6 genetic polymorphisms for the prognosis of HNSCC, but the risks due to these variables are small and estimates imprecise.
  • article 14 Citação(ões) na Scopus
    A Sex-Specific Association between a 15q25 Variant and Upper Aerodigestive Tract Cancers
    (2011) CHEN, Dan; TRUONG, Therese; GABORIEAU, Valerie; BYRNES, Graham; CHABRIER, Amelie; CHUANG, Shu-chun; OLSHAN, Andrew F.; WEISSLER, Mark C.; LUO, Jingchun; ROMKES, Marjorie; BUCH, Shama; NUKUI, Tomoko; FRANCESCHI, Silvia; HERRERO, Rolando; TALAMINI, Renato; KELSEY, Karl T.; CHRISTENSEN, Brock; MCCLEAN, Michael D.; LACKO, Martin; MANNI, Johannes J.; PETERS, Wilbert H. M.; LUBINSKI, Jan; TRUBICKA, Joanna; LENER, Marcin; MUSCAT, Joshua E.; LAZARUS, Philip; WEI, Qingyi; STURGIS, Erich M.; ZHANG, Zuo-Feng; CHANG, Shen-Chih; WANG, Renyi; SCHWARTZ, Stephen M.; CHEN, Chu; BENHAMOU, Simone; LAGIOU, Pagona; HOLCATOV, Ivana; RICHIARDI, Lorenzo; KJAERHEIM, Kristina; AGUDO, Antonio; CASTELLSAGUE, Xavier; MACFARLANE, Tatiana V.; BARZAN, Luigi; CANOVA, Cristina; THAKKER, Nalin S.; CONWAY, David I.; ZNAOR, Ariana; HEALY, Claire M.; AHRENS, Wolfgang; ZARIDZE, David; SZESZENIA-DABROWSKA, Neonila; LISSOWSKA, Jolanta; FABIANOVA, Eleonora; BUCUR, Alexandru; BENCKO, Vladimir; FORETOVA, Lenka; JANOUT, Vladimir; CURADO, Maria Paula; KOIFMAN, Sergio; MENEZES, Ana; WUENSCH-FILHO, Victor; ELUF-NETO, Jose; FERNANDEZ, Leticia; BOCCIA, Stefania; HASHIBE, Mia; HAYES, Richard B.; BOFFETTA, Paolo; BRENNAN, Paul; MCKAY, James D.
    Background: Sequence variants located at 15q25 have been associated with lung cancer and propensity to smoke. We recently reported an association between rs16969968 and risk of upper aerodigestive tract (UADT) cancers (oral cavity, oropharynx, hypopharynx, larynx, and esophagus) in women (OR = 1.24, P = 0.003) with little effect in men (OR = 1.04, P = 0.35). Methods: In a coordinated genotyping study within the International Head and Neck Cancer Epidemiology (INHANCE) consortium, we have sought to replicate these findings in an additional 4,604 cases and 6,239 controls from 10 independent UADT cancer case-control studies. Results: rs16969968 was again associated with UADT cancers in women (OR = 1.21, 95% CI = 1.08-1.36, P = 0.001) and a similar lack of observed effect in men [OR = 1.02, 95% CI = 0.95-1.09, P = 0.66; P-heterogeneity (P-het) = 0.01]. In a pooled analysis of the original and current studies, totaling 8,572 UADT cancer cases and 11,558 controls, the association was observed among females (OR = 1.22, 95% CI = 1.12-1.34, P = 7 x 10(-6)) but not males (OR = 1.02, 95% CI = 0.97-1.08, P = 0.35; P-het = 6 x 10(-4)). There was little evidence for a sex difference in the association between this variant and cigarettes smoked per day, with male and female rs16969968 variant carriers smoking approximately the same amount more in the 11,991 ever smokers in the pooled analysis of the 14 studies (P-het = 0.86). Conclusions: This study has confirmed a sex difference in the association between the 15q25 variant rs16969968 and UADT cancers. Impact: Further research is warranted to elucidate the mechanisms underlying these observations. Cancer Epidemiol Biomarkers Prev; 20(4); 658-64. (C) 2011 AACR.
  • article 51 Citação(ões) na Scopus
    Alcohol and tobacco, and the risk of cancers of the upper aerodigestive tract in Latin America: a case-control study
    (2011) SZYMANSKA, K.; HUNG, R. J.; WUENSCH-FILHO, V.; ELUF-NETO, J.; CURADO, M. P.; KOIFMAN, S.; MATOS, E.; MENEZES, A.; FERNANDEZ, L.; DAUDT, A. W.; BOFFETTA, P.; BRENNAN, P.
    Cancers of the upper aerodigestive tract (UADT; including oral cavity, pharynx, larynx and oesophagus) have high incidence rates all over the world, and they are especially frequent in some parts of Latin America. However, the data on the role of the major risk factors in these areas are still limited. We have evaluated the role of alcohol and tobacco consumption, based on 2,252 upper aerodigestive squamous-cell carcinoma cases and 1,707 controls from seven centres in Brazil, Argentina, and Cuba. We show that alcohol drinkers have a risk of UADT cancers that is up to five times higher than that of never-drinkers. A very strong effect of aperitifs and spirits as compared to other alcohol types was observed, with the ORs reaching 12.76 (CI 5.37-30.32) for oesophagus. Tobacco smokers were up to six times more likely to develop aerodigestive cancers than never-smokers, with the ORs reaching 11.14 (7.72-16.08) among current smokers for hypopharynx and larynx cancer. There was a trend for a decrease in risk after quitting alcohol drinking or tobacco smoking for all sites. The interactive effect of alcohol and tobacco was more than multiplicative. In this study, 65% of all UADT cases were attributable to a combined effect of alcohol and tobacco use. In this largest study on UADT cancer in Latin America, we have shown for the first time that a prevailing majority of UADT cancer cases is due to a combined effect of alcohol and tobacco use and could be prevented by quitting the use of either of these two agents.
  • article 156 Citação(ões) na Scopus
    Low human papillomavirus prevalence in head and neck cancer: results from two large case-control studies in high-incidence regions
    (2011) RIBEIRO, Karina Braga; LEVI, Jose Eduardo; PAWLITA, Michael; KOIFMAN, Sergio; MATOS, Elena; ELUF-NETO, Jose; WUNSCH-FILHO, Victor; CURADO, Maria Paula; SHANGINA, Oxana; ZARIDZE, David; SZESZENIA-DABROWSKA, Neonila; LISSOWSKA, Jolanta; DAUDT, Alexander; MENEZES, Ana; BENCKO, Vladimir; MATES, Dana; FERNANDEZ, Leticia; FABIANOVA, Eleonora; GHEIT, Tarik; TOMMASINO, Massimo; BOFFETTA, Paolo; BRENNAN, Paul; WATERBOER, Tim
    Background Recent studies support an important role for human papillomavirus (HPV) in a subgroup of head and neck squamous cell carcinomas (HNSCC). We have evaluated the HPV deoxyribonucleic acid (DNA) prevalence as well as the association between serological response to HPV infection and HNSCC in two distinct populations from Central Europe (CE) and Latin America (LA). Methods Cases (n = 2214) and controls (n = 3319) were recruited from 1998 to 2003, using a similar protocol including questionnaire and blood sample collection. Tumour DNA from 196 fresh tissue biopsies was analysed for multiple HPV types followed by an HPV type-specific polymerase chain reaction (PCR) protocol towards the E7 gene from HPV 16. Using multiplex serology, serum samples were analysed for antibodies to 17 HPV types. Statistical analysis included the estimation of adjusted odds ratios (ORs) and the respective 95% confidence intervals (CIs). Results HPV16 E7 DNA prevalence among cases was 3.1% (6/196), including 4.4% in the oropharynx (3/68), 3.8% in the hypopharynx/larynx (3/78) and 0% among 50 cases of oral cavity carcinomas. Positivity for both HPV16 E6 and E7 antibodies was associated with a very high risk of oropharyngeal cancer (OR = 179, 95% CI 35.8-899) and hypopharyngeal/laryngeal cancer (OR = 14.9, 95% CI 2.92-76.1). Conclusions A very low prevalence of HPV DNA and serum antibodies was observed among cases in both CE and LA. The proportion of head and neck cancer caused by HPV may vary substantially between different geographical regions and studies that are designed to evaluate the impact of HPV vaccination on HNSCC need to consider this heterogeneity.
  • article 19 Citação(ões) na Scopus
    Education Level Explains Differences in Stroke Incidence among City Districts in Joinville, Brazil: A Three-Year Population-Based Study
    (2011) CABRAL, Norberto L.; LONGO, Alexandre; MORO, Carla; FERST, Priscila; OLIVEIRA, Fabiano A.; VIEIRA, Celso V.; ELUF-NETO, Jose; FONSECA, Luiz Augusto M.; GONCALVES, Anderson R. R.
    Background: Current evidence suggests an inverse association between socioeconomic status and stroke incidence. Our aim was to measure the variation in incidence among different city districts (CD) and their association with socioeconomic variables. Methods: We prospectively ascertained all possible stroke cases occurring in the city of Joinville during the period 2005-2007. We determined the incidence for each of the 38 CD, age-adjusted to the population of Joinville. By linear regression analysis, we correlated incidence data with mean years of education (MYE) and mean income per month (MIPM). Results: Of the 1,734 stroke cases registered, 1,034 were first-ever strokes. In the study period, the crude incidence in Joinville was 69.5 per 100,000 (95% confidence interval, 65.3-73.9). The stroke incidence among CD ranged from 37.5 (22.2-64.6) to 151.0 per 100,000 (69.0-286.6). The stroke incidence was inversely correlated with years of education (r = -0.532; p<0.001). MYE and MIPM were strongly related (R = 0.958), resulting in exclusion of MIPM by collinearity. Conclusions: Years of education can explain a wide incidence variation among CD. These results may be useful to guide the allocation of resources in primary prevention policies.
  • article 51 Citação(ões) na Scopus
    How much do smoking and alcohol consumption explain socioeconomic inequalities in head and neck cancer risk?
    (2011) BOING, A. F.; ANTUNES, J. L. Ferreira; CARVALHO, M. Brasilino de; GOIS FILHO, J. Francisco de; KOWALSKI, L. P.; MICHALUART JR., P.; ELUF-NETO, J.; BOFFETTA, P.; WUENSCH-FILHO, V.
    Background A higher burden of head and neck cancer has been reported to affect deprived populations. This study assessed the association between socioeconomic status and head and neck cancer, aiming to explore how this association is related to differences of tobacco and alcohol consumption across socioeconomic strata. Methods We conducted a case-control study in Sao Paulo, Brazil (1998-2006), including 1017 incident cases of oral, pharyngeal and laryngeal cancer, and 951 sex- and age-matched controls. Education and occupation were distal determinants in the hierarchical approach; cumulative exposure to tobacco and alcohol were proximal risk factors. Outcomes of the hierarchical model were compared with fully adjusted ORs. Results Individuals with lower education (OR 2.27; 95% CI 1.61 to 3.19) and those performing manual labour (OR 1.55; 95% CI 1.26 to 1.92) had a higher risk of disease. However, 54% of the association with lower education and 45% of the association with manual labour were explained by proximal lifestyle exposures, and socioeconomic status remained significantly associated with disease when adjusted for smoking and alcohol consumption. Conclusions Socioeconomic differences in head and neck cancer are partially attributable to the distribution of tobacco smoking and alcohol consumption across socioeconomic strata. Additional mediating factors may explain the remaining variation of socioeconomic status on head and neck cancer.