Publikacije

Popis znanstvenih publikacija na temu oralnog karcinoma pločastih stanica koji se obnavlja svakih 6 mjeseci u vrijeme trajanja projekta

Olsen MH, Bøje CR, Kjær TK, Steding-Jessen M, Johansen C, Overgaard J, Dalton SO. Socioeconomic position and stage at diagnosis of head and neck cancer – a nationwide study from DAHANCA. Acta Oncol. 2015 May;54(5):759-66. doi: 10.3109/0284186X.2014.998279. Epub 2015 Mar 3.

Socioeconomic differences in survival after head and neck squamous cell carcinoma (HNSCC) are among the greatest for any malignancy. To improve our understanding of the mechanisms by which socioeconomic position influences HNSCC survival, we investigated the association between socioeconomic position and advanced stage HNSCC at diagnosis.Men and women with HNSCC diagnosed between 1992 and 2008 were identified in the Danish Head and Neck Cancer Group (DAHANCA) database, which contains detailed information on all cases of HNSCC treated in Denmark. Individual information on the following four socioeconomic indicators: highest attained educational level, cohabitation status, disposable income and degree of urbanisation were obtained from Statistics Denmark. For the 9683 cases on which there was full information, we estimated odds ratios (ORs) for a diagnosis of advanced stage (TNM III-IV) HNSCC in multivariate logistic regression models by site (glottic, non-glottic larynx, oropharynx, hypopharynx and oral cancer), with adjustment for age, gender, period of diagnosis, education, income, cohabitation status, degree of urbanisation and comorbidity in accordance with a causal diagram.For all HNSCC sites, the ORs for advanced stage at diagnosis were increased for patients with low income and for men living alone. For glottic and oral cancers, the ORs for advanced stage HNSCC increased systematically by decreasing length of education. Increased ORs were found for hypopharynx cancer patients living in rural areas or provincial cities. Having one or more comorbid conditions was associated with an increased OR for advanced stage oral cancer but with a decreased OR for oropharynx cancer.In this nationwide population-based study, socioeconomic differences in stage at diagnosis were found for all HNSCC subsites. Focus on the high risk for advanced stage HNSCC among vulnerable patients may be beneficial during referral and diagnosis in order to improve HNSCC outcomes.

Astrup GL, Hofsø K, Bjordal K, Guren MG, Vistad I, Cooper B, Miaskowski C, Rustøen T. Patient factors and quality of life outcomes differ among four subgroups of oncology patients based on symptom occurrence. Acta Oncol. 2017 Mar;56(3):462-470. doi: 10.1080/0284186X.2016.1273546. Epub 2017 Jan 12.

The purposes of this study were to determine if subgroups of oncology patients could be identified based on symptom occurrence rates and if these subgroups differed on a number of demographic and clinical characteristics, as well as on quality of life (QoL) outcomes.Latent class analysis (LCA) was used to identify subgroups (i.e. latent classes) of patients with distinct symptom experiences based on the occurrence rates for the 13 most common symptoms from the Memorial Symptom Assessment Scale. In total, 534 patients with breast, head and neck, colorectal, or ovarian cancer participated. Four latent classes of patients were identified based on probability of symptom occurrence: all low class [i.e. low probability for all symptoms (n = 152)], all high class (n = 149), high psychological class (n = 121), and low psychological class (n = 112). Patients in the all high class were significantly younger compared with patients in the all low class. Furthermore, compared to the other three classes, patients in the all high class had lower functional status and higher comorbidity scores, and reported poorer QoL scores. Patients in the high and low psychological classes had a moderate probability of reporting physical symptoms. Patients in the low psychological class reported a higher number of symptoms, a lower functional status, and poorer physical and total QoL scores.Distinct subgroups of oncology patients can be identified based on symptom occurrence rates. Patient characteristics that are associated with these subgroups can be used to identify patients who are at greater risk for multiple co-occurring symptoms and diminished QoL, so that these patients can be offered appropriate symptom management interventions.

Hagedoorn P, Vandenheede H, Vanthomme K, Willaert D, Gadeyne S. A cohort study into head and neck cancer mortality in Belgium (2001-11): Are individual socioeconomic differences conditional on area deprivation? Oral Oncol. 2016 Oct;61:76-82. doi: 10.1016/j.oraloncology.2016.08.014. Epub 2016 Aug 31.

The aim of this study is to assess to what extent individual and area-level socioeconomic position (SEP) are associated to head and neck cancer (HNC) mortality and to what extent they contribute to regional variation in HNC mortality in Belgium.Data on men aged 40-64 are collected from a population based dataset based on the 2001 Belgian census linked to register data on emigration and mortality for 2001-2011. Individual SEP is measured using education, employment status and housing conditions. Deprivation at municipal level is measured by a deprivation index. Absolute mortality differences are estimated by age standardised mortality rates. Multilevel Poisson models are used to estimate the association and interaction between HNC mortality and individual and area-level SEP, and to estimate the regional variation in HNC mortality.HNC mortality rates are significantly higher for men with a low SEP and men living in deprived areas. Cross-level interactions indicate that the association between individual SEP and HNC mortality is conditional on area deprivation. HNC mortality in deprived areas is especially high among high-SEP men. As a result, social disparities appear to be smaller in more deprived areas. Regional variation in HNC mortality was significant. Population composition partially explains this regional variation, while area deprivation and cross-level interactions explains little.Both individual and area-level deprivation are important determinants of HNC mortality. Underlying trends in incidence and survival, and risk factors, such as alcohol and tobacco use, should be explored further.

Van Hemelrijck WM, Willaert D, Gadeyne S. The geographic pattern of Belgian mortality: can socio-economic characteristics explain area differences? Arch Public Health. 2016 Jun 8;74:22. doi: 10.1186/s13690-016-0135-y. eCollection 2016.

Country averages for health outcomes hide important within-country variations. This paper probes into the geographic Belgian pattern of all-cause mortality and wishes to investigate the contribution of individual and area socio-economic characteristics to geographic mortality differences in men aged 45-64 during the period 2001-2011.Data originate from a linkage between the Belgian census of 2001 and register data on mortality and emigration during the period 2001-2011. Mortality rate ratios (MRRs) are estimated for districts and sub-districts compared to the Belgian average mortality level using Poisson regression modelling. Individual socio-economic position (SEP) indicators are added to examine the impact of these characteristics on the observed geographic pattern. In order to scrutinize the contribution of area-level socio-economic characteristics, random intercepts Poisson modelling is performed with predictors at the individual and the sub-district level. Random intercepts and slopes models are fitted to explore variability of individual-level SEP effects. All-cause MRRs for middle-aged Belgian men are higher in the geographic areas of the Walloon region and the Brussels-Capital Region (BCR) compared to those in the Flemish region. The highest MRRs are observed in the inner city of the BCR and in several Walloon cities. Their disadvantage can partially be explained by the lower individual SEP of men living in these areas. Similarly, the relatively low MRRs observed in the districts of Halle-Vilvoorde, Arlon and Virton can be related to the higher individual SEP. Among the area-level characteristics, both the percentage of men employed and the percentage of labourers in a sub-district have a protective effect on the individual MRR, regardless of individual SEP. Variability in individual-level SEP effects is limited.Individual SEP partly explains the observed mortality gap in Belgium for some areas. The percentage of men employed and the percentage of labourers in a sub-district have an additional effect on the individual MRR aside from that of individual SEP. However, these socio-economic factors cannot explain all of the observed differences. Other mechanisms such as public health policy, cultural habits and environmental influences contribute to the observed geographic pattern in all-cause mortality among middle-aged men.

Bryere J, Menvielle G, Dejardin O, Launay L, Molinie F, Stucker I, Luce D, Launoy G; ICARE group. Neighborhood deprivation and risk of head and neck cancer: A multilevel analysis from France. Oral Oncol. 2017 Aug;71:144-149. doi: 10.1016/j.oraloncology.2017.06.014. Epub 2017 Jun 26.

While it is known that cancer risk is related to area-level socioeconomic status, the extent to which these inequalities are explained by contextual effects is poorly documented especially for head and neck cancer.A case-control study, ICARE, included 2415 head and neck cancer cases and 3555 controls recruited between 2001 and 2007 from 10 French regions retrieved from a general cancer registry. Individual socioeconomic status was assessed using marital status, highest educational level and occupational social class. Area-level socioeconomic status was assessed using the French version of the European Deprivation Index (EDI). The relationship between both individual and area-based socioeconomic level and the risk of head and neck cancer was assessed by multilevel analyses.A higher risk for head and neck cancer was found in divorced compared with married individuals (OR=2.14, 95% CI=1.78-2.57), for individuals with a basic school-leaving qualification compared with those with higher education (OR=4.55 95% CI=3.72-5.57), for manual workers compared with managers (OR=4.91, 95% CI=3.92-6.15) and for individuals living in the most deprived areas compared with those living in the most affluent ones (OR=1.98, 95% CI=1.64-2.41). The influence of area-level socioeconomic status measured by EDI remained after controlling for individual socioeconomic characteristics (OR=1.51; 95% confidence interval: 1.23-1.85, p-value=0.0003).The role of individual socioeconomic status in the risk of head and neck cancer is undeniable, although contextual effects of deprived areas also increase the susceptibility of individuals developing the disease.

Shin JY, Yoon JK, Shin AK, Blumenfeld P, Mai M, Diaz AZ. Association of Insurance and Community-Level Socioeconomic Status With Treatment and Outcome of Squamous Cell Carcinoma of the Pharynx. JAMA Otolaryngol Head Neck Surg. 2017 Sep 1;143(9):899-907. doi: 10.1001/jamaoto.2017.0837.

This study extracted data from more than 1500 Commission on Cancer-accredited facilities collected in the National Cancer Database. A total of 35 559 patients diagnosed with SCC of the pharynx from 2004 through 2013 were identified. The χ2 test, Kaplan-Meier method, and Cox regression models were used to analyze data from April 1, 2016, through April 16, 2017.Among the 35 559 patients identified (75.6% men and 24.4% women; median age, 61 years [range, 18-90 years]), 15 146 (42.6%) had Medicare coverage; 13 061 (36.7%), private insurance; 4881 (13.7%), Medicaid coverage; and 2471 (6.9%), no insurance. Uninsured patients and Medicaid recipients were more likely to be younger, black, or Hispanic; to have lower median household income and lower educational attainment; to present with higher TNM stages of disease; and to start primary treatment at a later time from diagnosis. Those with private insurance (reference group) had significantly better overall survival than uninsured patients (hazard ratio [HR], 1.72; 95% CI, 1.59-1.87), Medicaid recipients (HR, 1.99; 95% CI, 1.88-2.12), or Medicare recipients (HR, 2.07; 95% CI, 1.99-2.16), as did those with median household income of at least $63 000 (reference) vs $48 000 to $62 999 (HR, 1.19; 95% CI, 1.13-1.26), $38 000 to $47 999 (HR, 1.31; 95% CI, 1.24-1.38), and less than $38 000 (HR, 1.51; 95% CI, 1.43-1.59). On multivariable analysis, insurance status and median household income remained independent prognostic factors for overall survival even after accounting for educational attainment, race, Charlson/Deyo comorbidity score, disease site, and TNM stage of disease.Insurance status and household income level are associated with outcome in patients with SCC of the pharynx. Those without insurance and with lower household income may significantly benefit from improving access to adequate, timely medical care. Additional investigations are necessary to develop targeted interventions to optimize access to standard medical treatments, adherence to physician management recommendations, and subsequently, prognosis in these patients at risk.

Andrade JO, Santos CA, Oliveira MC. Associated factors with oral cancer: a study of case control in a population of the Brazil’s Northeast. Rev Bras Epidemiol. 2015 Oct-Dec;18(4):894-905. doi: 10.1590/1980-5497201500040017.

This study aimed at assessing the association between factors such as age, sex, skin color, occupation, educational level, marital status, place of residence, and tobacco and alcohol consumptions and oral cancer in individuals in a city in the northeast of Brazil between 2002 and 2012.This is a case-control study. The case group consisted of 127 people attended at the Oral Injury Reference Center with histopathological diagnosis of oral squamous cell carcinoma. The control group consisted of 254 individuals treated at the same center. The study considered two controls for each case. The cases and controls were adjusted according to sex and age. Univariate and bivariate analyses were performed (Pearson χ2-test) to verify the correlation between the dependent variable (oral cancer) and the independent variables; odds ratio (OR) and the confidence interval of 95% (95%CI) were calculated. Finally, in the multivariate analysis, it was used as the hierarchical model with logistic regression to explain the interrelationships between the independent variables and oral cancer.Consumption of more than 20 cigarettes per day [OR = 6.64; 95%CI 2.07 – 21.32; p ≤ 0.001], an excessive alcohol consumption [OR = 3.25; 95%CI 1.03 – 10.22; p ≤ 0.044], and the synergistic consumption of tobacco and alcohol [OR = 9.65; 95%CI 1.57 – 59.08; p ≤ 0.014] are the most important risk factors for oral cancer.It was concluded that tobacco and alcohol consumptions are the most important factors for the development of oral cancer. Sociodemographic factors were not associated with this neoplasm after adjusting for smoking and drinking.

Lagergren J, Andersson G, Talbäck M, Drefahl S, Bihagen E, Härkönen J, Feychting M, Ljung R. Marital status, education, and income in relation to the risk of esophageal and gastric cancer by histological type and site. Cancer. 2016 Jan 15;122(2):207-12. doi: 10.1002/cncr.29731. Epub 2015 Oct 8.

A nationwide, Swedish population-based cohort study from 1991 to 2010 included individuals who were 50 years old or older. Data on exposures, covariates, and outcomes were obtained from well-maintained registers. Four esophagogastric tumor subtypes were analyzed in combination and separately: esophageal adenocarcinoma, esophageal squamous cell carcinoma, cardia adenocarcinoma, and noncardia gastric adenocarcinoma. Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and adjusted for confounders.Among 4,734,227 participants (60,634,007 person-years), 24,095 developed esophageal or gastric cancer. In comparison with individuals in a long marriage, increased IRRs were found among participants who were in a shorter marriage or were never married, remarried, divorced, or widowed. These associations were indicated for each tumor subtype but were generally stronger for esophageal squamous cell carcinoma. Higher education and income were associated with decreased IRRs in a seemingly dose-response manner and similarly for each subtype. In comparison with the completion of only primary school, higher tertiary education rendered an IRR of 0.64 (95% CI, 0.60-0.69) for men and an IRR of 0.68 (95% CI, 0.61-0.75) for women. Comparing participants in the highest and lowest income brackets (highest 20% vs lowest 20%) revealed an IRR of 0.74 (95% CI, 0.70-0.79) for men and an IRR of 0.83 (95% CI, 0.76-0.91) for women.Divorce, widowhood, living alone, low educational attainment, and low income increase the risk of each subtype of esophageal and gastric cancer. These associations require attention when high-risk individuals are being identified

Baishya N, Das AK, Krishnatreya M, Das A, Das K, Kataki AC, Nandy P. A Pilot Study on Factors Associated with Presentation Delay in Patients Affected with Head and Neck Cancers. Asian Pac J Cancer Prev. 2015;16(11):4715-8.

Patient delay can contribute to a poor outcome in the management of head and neck cancers (HNC). The main objective of the present study was to investigate the factors associated with patient delay in our population.Patients with cancers of the head and neck attending a regional cancer center of North East India were consecutively interviewed during the period from June 2014 to November 2014. The participation of patients was voluntary. The questionnaire included information on age, gender, residential status, educational qualification, monthly family income, any family history of cancer, and history of prior awareness on cancer from television (TV) program and awareness program.Of 311 (n) patients, with an age range of 14-88 years (mean 55.4 years), 81.7% were males and 18.3% females (M:F=4.4). The overall median delay was 90 days (range=7 days-365 days), in illiterate patients the median delay was 90 days and 60 days in literate patients (P=0.002), the median delay in patients who had watched cancer awareness program on TV was 60 days and in patients who were unaware about cancer information from TV program had a median delay of 90 days (p=0.00021) and delay of <10 weeks was seen in 139 (44.6%) patients, a delay of 10-20 weeks in 98 (31.5%) patients, and a delay of 20-30 weeks in 63 (20.2%) patients.Education and awareness had a significant impact in reduction of median patient delay in our HNC cases.

Brusselaers N, Mattsson F, Lindblad M, Lagergren J. Association between education level and prognosis after esophageal cancer surgery: a Swedish population-based cohort study. PLoS One. 2015 Mar 26;10(3):e0121928. doi: 10.1371/journal.pone.0121928. eCollection 2015.

An association between education level and survival after esophageal cancer has recently been indicated, but remains uncertain. We conducted a large study with long follow-up to address this issue.This population-based cohort study included all patients operated for esophageal cancer in Sweden between 1987 and 2010 with follow-up until 2012. Level of education was categorized as compulsory (≤9 years), intermediate (10-12 years), or high (≥13 years). The main outcome measure was overall 5-year mortality after esophagectomy. Cox regression was used to estimate associations between education level and mortality, expressed as hazard ratios (HRs) with 95% confidence intervals (CIs), with adjustment for sex, age, co-morbidity, tumor stage, tumor histology, and assessing the impact of education level over time.Compared to patients with high education, the adjusted HR for mortality was 1.29 (95% CI 1.07-1.57) in the intermediate educated group and 1.42 (95% CI 1.17-1.71) in the compulsory educated group. The largest differences were found in early tumor stages (T-stage 0-1), with HRs of 1.73 (95% CI 1.00-2.99) and 2.58 (95% CI 1.51-4.42) for intermediate and compulsory educated patients respectively; and for squamous cell carcinoma, with corresponding HRs of 1.38 (95% CI 1.07-1.79) and 1.52 (95% CI 1.19-1.95) respectively.This Swedish population-based study showed an association between higher education level and improved survival after esophageal cancer surgery, independent of established prognostic factors. The associations were stronger in patients of an early tumor stage and squamous cell carcinoma.

Santi I, Kroll LE, Dietz A, Becher H, Ramroth H. To what degree is the association between educational inequality and laryngeal cancer explained by smoking, alcohol consumption, and occupational exposure? Scand J Work Environ Health. 2014 May 1;40(3):315-22. doi: 10.5271/sjweh.3403. Epub 2013 Nov 18.

The aim of this study was to measure the extent to which the association between socioeconomic status and laryngeal cancer among males is mediated by smoking, alcohol consumption, and occupational exposure.We used Karlson et al’s decomposition method for logit models, which returns the percentage of change in odds ratios (OR) due to confounding. This population-based, case-control study on laryngeal cancer was conducted in Germany in 1998-2000 and included 208 male cases and 702 controls. Information on occupational history, smoking, alcohol consumption, and education was collected through face-to-face interviews. Jobs coded according to ISCO-68 were linked to a recently developed job-classification index covering physical and psychosocial dimensions. A sub-index focused on jobs involving potentially carcinogenic agents (CAI) for the upper-aero digestive tract.When adjusted for smoking and alcohol consumption, higher OR were found for lower education. This OR decreased after further adjustment using the overall job index [2.9, 95% confidence interval (95% CI) 1.4-6.2], similar to the OR using the sub-index CAI (OR 2.7, 95% CI 1.3-5.8). Applying the Karlson et al method, 25.4% (95% CI 22.6-28.2%) of the reduction in these OR was due to occupational exposure (CAI), while smoking and alcohol consumption contributed to around 26.1% (95% CI 23.2-28.9%) and 2.7% (95% CI 1.7-3.8%), respectively.Occupational aspects, in particular the exposure to carcinogenic agents, explain a large portion of the association between low educational level and laryngeal cancer risk among males. Occupational effects are now easier to quantify using this recently developed and easily applicable index.

Santi I, Kroll LE, Dietz A, Becher H, Ramroth H. Occupation and educational inequalities in laryngeal cancer: the use of a job index. BMC Public Health. 2013 Nov 19;13:1080. doi: 10.1186/1471-2458-13-1080.

Previous studies tried to assess the association between socioeconomic status and laryngeal cancer. Alcohol and tobacco consumption explain already a large part of the social inequalities. Occupational exposures might explain a part of the remaining but the components and pathways of the socioeconomic contribution have yet to be fully disentangled. The aim of this study was to evaluate the role of occupation using different occupational indices, differentiating between physical, psycho-social and toxic exposures and trying to summarize the occupational burden into one variable.A population-based case-control study conducted in Germany in 1998-2000 included 208 male cases and 702 controls. Information on occupational history, smoking, alcohol consumption and education was collected with face-to-face interviews. A recently developed job-classification index was used to account for the occupational burden. A sub-index focussed on jobs involving potentially carcinogenic agents (CAI) for the upper aero digestive tract.When adjusted for smoking and alcohol consumption, higher odds ratios (ORs) were found for lower education. This OR decreased after further adjustment using the physical and psycho-social job indices (OR = 3.2, 95%-CI: 1.5-6.8), similar to the OR using the sub-index CAI (OR = 3.0, 95%-CI: 1.4-6.5).The use of an easily applicable control variable, simply constructed on standard occupational job classifications, provides the possibility to differentiate between educational and occupational contributions. Such an index might indirectly reflect the effect of carcinogenic agents, which are not collected in many studies.

Menvielle G, Rey G, Jougla E, Luce D. Diverging trends in educational inequalities in cancer mortality between men and women in the 2000s in France. BMC Public Health. 2013 Sep 10;13:823. doi: 10.1186/1471-2458-13-823.

Socioeconomic inequalities in cancer mortality have been observed in different European countries and the US until the end of the 1990s, with changes over time in the magnitude of these inequalities and contrasted situations between countries. The aim of this study is to estimate relative and absolute educational differences in cancer mortality in France between 1999 and 2007, and to compare these inequalities with those reported during the 1990s.Data from a representative sample including 1% of the French population were analysed. Educational differences among people aged 30-74 were quantified with hazard ratios and relative indices of inequality (RII) computed using Cox regression models as well as mortality rate difference and population attributable fraction.In the period 1999-2007, large relative inequalities were found among men for total cancer and smoking and/or alcohol related cancers mortality (lung, head and neck, oesophagus). Among women, educational differences were reported for total cancer, head and neck and uterus cancer mortality. No association was found between education and breast cancer mortality. Slight educational differences in colorectal cancer mortality were observed in men and women. For most frequent cancers, no change was observed in the magnitude of relative inequalities in mortality between the 1990s and the 2000s, although the RII for lung cancer increased both in men and women. Among women, a large increase in absolute inequalities in mortality was observed for all cancers combined, lung, head and neck and colorectal cancer. In contrast, among men, absolute inequalities in mortality decreased for all smoking and/or alcohol related cancers.Although social inequalities in cancer mortality are still high among men, an encouraging trend is observed. Among women though, the situation regarding social inequalities is less favourable, mainly due to a health improvement limited to higher educated women. These inequalities may be expected to further increase in future years.

Jemal A, Simard EP, Xu J, Ma J, Anderson RN. Selected cancers with increasing mortality rates by educational attainment in 26 states in the United States, 1993-2007. Cancer Causes Control. 2013 Mar;24(3):559-65. doi: 10.1007/s10552-012-9993-y. Epub 2012 May 22.

Mortality rates continue to increase for liver, esophagus, and pancreatic cancers in non-Hispanic whites and for liver cancer in non-Hispanic blacks. However, the extent to which trends vary by socioeconomic status (SES) is unknown.We calculated age-standardized death rates for liver, esophagus, and pancreas cancers for non-Hispanic whites and non-Hispanic blacks aged 25-64 years by sex and level of education (≤12, 13-15, and ≥16 years, as a SES proxy) during 1993-2007 using mortality data from 26 states with consistent education information on death certificates. Temporal trends were evaluated using log-linear regression, and rate ratios (RRs) with 95 % confidence intervals (CIs) compared death rates in persons with ≤12 versus ≥16 years of education.Generally, death rates increased for cancers of the liver, esophagus, and pancreas in non-Hispanic whites and non-Hispanic blacks (liver cancer only) with ≤12 and 13-15 years of education, with steeper increases in the least educated group. In contrast, rates remained stable in persons with ≥16 years of education. During 1993-2007, the RR (rates in ≤12 versus ≥16 years of education) increased for all three cancers, particularly for liver cancer among men which increased from 1.76 (95 % CI, 1.38-2.25) to 3.23 (95 % CI, 2.78-3.75) in non-Hispanic whites and from 1.28 (95 % CI, 0.71-2.30) to 3.64 (95 % CI, 2.44-5.44) in non-Hispanic blacks.The recent increase in mortality rates for liver, esophagus, and pancreatic cancers in non-Hispanic whites and for liver cancer in non-Hispanic blacks reflects increases among those with lower education levels.

Chen AY, DeSantis C, Jemal A. US mortality rates for oral cavity and pharyngeal cancer by educational attainment. Arch Otolaryngol Head Neck Surg. 2011 Nov;137(11):1094-9. doi: 10.1001/archoto.2011.180.

To describe trends in mortality rates for patients with oral cavity and pharynx cancer by educational attainment, race/ethnicity, sex, and association with human papillomavirus infection.Twenty-six states.White and black men and women aged 25 to 64 years.Age-standardized mortality rates for 2005 to 2007 and trends for 1993 to 2007.

From 1993 to 2007, overall mortality rates for patients with oral cavity and pharynx cancer decreased among black and white men and women; however, rates among white men have stabilized since 1999. The largest decreases in mortality rates were among black men and women with 12 years of education (-4.95% and -3.72%, respectively). Mortality rates for patients with oral cavity and pharynx cancers decreased significantly among men and women with more than 12 years of education, regardless of race/ethnicity (except for black women), whereas rates increased among white men with less than 12 years of education. Mortality trends vary substantially for human papillomavirus-related and human papillomavirus-unrelated sites.We observed decreasing mortality rates for patients with oral cavity and pharyngeal cancer among whites and blacks; however, decreases were greatest among those with at least 12 years of education. This difference in mortality trends may reflect the changing prevalence of smoking and sexual behaviors among populations of different educational attainment.

Johnson S, Corsten MJ, McDonald JT, Gupta M. Cancer prevalence and education by cancer site: logistic regression analysis. J Otolaryngol Head Neck Surg. 2010 Oct;39(5):555-60.

Previously, using the American National Health Interview Survey (NHIS) and a logistic regression analysis, we found that upper aerodigestive tract (UADT) cancer is correlated with low socioeconomic status (SES). The objective of this study was to determine if this correlation between low SES and cancer prevalence exists for other cancers.We again used the NHIS and employed education level as our main measure of SES. We controlled for potentially confounding factors, including smoking status and alcohol consumption.We found that only two cancer subsites shared the pattern of increased prevalence with low education level and decreased prevalence with high education level: UADT cancer and cervical cancer.UADT cancer and cervical cancer were the only two cancers identified that had a link between prevalence and lower education level. This raises the possibility that an associated risk factor for the two cancers is causing the relationship between lower education level and prevalence.

Mouw T, Koster A, Wright ME, Blank MM, Moore SC, Hollenbeck A, Schatzkin A. Education and risk of cancer in a large cohort of men and women in the United States. PLoS One. 2008;3(11):e3639. doi: 10.1371/journal.pone.0003639. Epub 2008 Nov 4.

Education inequalities in cancer incidence have long been noted. It is not clear, however, whether such inequalities persist in the United States, especially for less common malignancies and after adjustment for individual risk factors.Within the NIH-AARP Diet and Health Study, we examined the association between education and the risk of developing cancers in a prospective cohort of 498,455 participants who were 50-71 year old and without cancer at enrollment in 1995/96. During a maximum 8.2 years of follow-up we identified 40,443 cancers in men and 18,367 in women. In age-adjusted models, the least educated men (<high school), compared to those with the most education (post-graduate), had increased risks of developing cancers of the esophagus (RR: 2.64, 95%CI:1.86-3.75), head and neck (1.98, 1.54-2.54), stomach (2.32, 1.68-3.18), colon (1.31, 1.12-1. 53), rectum (1.68, 1.32-2.13), liver (1.90, 1.22-2.95), lung (3.67, 3.25-4.15), pleura (4.01, 1.91-8.42), bladder (1.56,1.33-1.83) and combined smoking-related cancers (2.41, 2.22-2.62). In contrast, lower education level was associated with a decreased risk of melanoma of the skin (0.43, 0.35-0.54) and local prostate cancers (0.79, 0.74-0.85). Women with the least education had increased risks of colon (1.60, 1.24-2.05), lung (2.14, 1.79-2.56), kidney (1.68, 1.12-2.54) and combined smoking-related cancers (1.66, 1.43-1.92) but a lower risk of melanoma of the skin (0.33, 0.22-0.51), endometrial (0.67, 0.51-0.89) and invasive breast cancers (0.72, 0.61-0.84). Adjustment for smoking and other risk factors did not eliminate these associations, except those for cancers of the head and neck, colon, and liver in men and kidney in women.We found a higher risk of malignant disease, particularly smoking- related cancers, among those in the lowest educational attainment category. Only some of the educational gradient is attributable to smoking. The persistence of substantial education inequalities in cancer incidence poses a challenge for etiologic research and public health policy.

Pinar T, Akdur R, Tuncbilek A, Altundag K, Cengiz M. The relationship between occupations and head and neck cancers. J Natl Med Assoc. 2007 Jan;99(1):64, 68-71.

The objective of this study was to investigate the relationship between occupation and head and neck cancers.In this case-control study, 206 Turkish patients with head and neck cancers comprised the case group. The control group consisted of 206 age- and sex-matched patients without malignant disease. All patients completed a questionnaire regarding occupation; tobacco and alcohol consumption; educational status; and history of any systemic disease, benign head and neck disease, and cancer among family members. High-risk jobs were considered those in the industries of construction, wood, mining, metal, chemistry and agriculture.Patients with head and neck cancers worked in high-risk occupations more frequently than did controls [odds ratio (OR): 3.42, p<0.05]. Cancer risk decreased with the increase in time interval between quitting the high-risk job and time of interview. Smokers were at higher risk than nonsmokers (OR: 3.33, p<0.05). The risk was also higher in patients who drank alcohol regularly (OR: 1.59, p<0.05). However, occupation was found to be an independent high-risk factor for head and neck cancers in regression analysis. Frequency of benign head and neck disease and family history of cancer were not significant risk factors (p>0.05).Our analysis showed that occupation and smoking were significant independent risk factors for the development of head and neck cancers among workers.

Menvielle G, Luce D, Goldberg P, Leclerc A. Smoking, alcohol drinking, occupational exposures and social inequalities in hypopharyngeal and laryngeal cancer. Int J Epidemiol. 2004 Aug;33(4):799-806. Epub 2004 May 20.

Social inequalities with regard to hypopharyngeal and laryngeal cancers are observed in many countries. Differences in alcohol and tobacco consumption are often proposed as an explanation for this finding. The aim of this work was to determine the extent to which alcohol and tobacco consumption, and occupational exposure, explain these inequalities.A hospital-based case-control study included 504 male cases (105 with glottic, 80 with supraglottic, 97 with epilaryngeal, and 201 with hypopharyngeal cancers) and 242 male controls with non-respiratory cancers. Information about sociodemographic characteristics, detailed alcohol and tobacco consumption, educational level, and occupational history were collected. Odds ratios (OR) and their 95% CI were computed using logistic regressions.When controlling for age only, laryngeal and hypopharyngeal cancers were strongly associated with educational level (OR for low versus high level = 3.22, 95% CI: 2.01, 5.18) and with all indicators based on occupation (OR for ever versus never manual worker = 2.54, 95% CI: 1.78, 3.62). When adjusted for alcohol and tobacco consumption, the OR decreased, but remained significant for occupation (OR for ever manual worker = 1.91, 95% CI: 1.23, 2.95). After further adjustment for occupational exposures, significant associations were no longer observed. Associations differed between subsites.Social inequalities observed for these cancers are not totally explained by alcohol and tobacco consumption; a substantial proportion could be attributable to occupational exposures.

Konski A, Berkey BA, Kian Ang K, Fu KK. Effect of education level on outcome of patients treated on Radiation Therapy Oncology Group Protocol 90-03. Cancer. 2003 Oct 1;98(7):1497-503.

It has been hypothesized that people in lower socioeconomic groups have worse outcomes because they present with advanced-stage cancers or receive inadequate treatment. The authors investigated this hypothesis by using education level as a proxy for socioeconomic status in patients treated on Radiation Therapy Oncology Group (RTOG) Protocol 90-03.RTOG 90-03 was a Phase III randomized trial investigating four different radiation fractionation schedules in the treatment of locally advanced head and neck carcinomas. Overall survival and locoregional control rates were analyzed by education level as measured by patient response on the demographic form at study entry.A significant difference was observed in the distribution of patients by education level between the standard fractionated radiation treatment arm and the hyperfractionated radiation treatment arm. More patients in the standard fractionated treatment arm had a higher education level (P = 0.018). Patients attending college had highly and significantly better overall survival and locoregional control than the other groups combined (P = 0.0056 and P = 0.025, respectively: from Cox proportional hazards models stratified by assigned treatment with educational level, T classification, N classification, Karnofsky performance status, primary site, and race). Multivariate analysis revealed that education level was significant for predicting both overall survival and locoregional control when comparing attended college/technical school compared with all other education levels.Patients attending college or technical school had improved overall survival and locoregional control. These differences cannot be explained by differences in tumor stage or treatment. Poorer overall health or lack of support systems contributing to these results needs to be investigated further.

 

Amizadeh M, Safari-Kamalabadi M, Askari-Saryazdi G, Amizadeh M, Reihani-Kermani H.Pesticide Exposure and Head and Neck Cancers: A Case-Control Study in an Agricultural Region. Iran J Otorhinolaryngol. 2017 Sep;29(94):275-285.

Causes of head and neck cancers (HNCs) are multifactorial, and few studies have investigated the association between chemical exposure and HNCs. The objective of this study was to investigate associations between HNCs, agricultural occupations, and pesticide exposure. The potential for the accumulation of pesticides in the adipose tissue of patients was also investigated.A structured questionnaire was used to collect information on demographics, occupation, and exposure to pesticides in a hospital-based case-control study. Pesticide residue in the adipose tissue of the neck in both cases and controls was also monitored via gas chromatography-mass spectroscopy.Thirty-one HNC cases were included in this study as well as 32 gender-, age-, and smoking-matched controls. An agricultural occupation was associated with HNC (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.13-9.43) after controlling for age, sex, and smoking. Pesticide exposure was associated with total HNC cases (OR, 7.45; 95% CI, 1.78-3.07) and larynx cancer (OR, 9.33; 95% CI, 1.65-52.68). A dose-response pattern was observed for HNC cases (P=0.06) and larynx cancer (P=0.01). In tracing the pesticide residue, five chlorinated pesticides, namely dichlorodiphenyltrichloroethane (DDT), dichlorodipheny-ldichloroethane (DDD), dichlorodiphenyldichloroethylene (DDE), dieldrin, and lindane, were identified in the adipose tissue. Chlorinated pesticide detection was significantly associated with HNC (OR, 3.91; 95% CI 0.9-0.16.9).HNCs were found to be associated with pesticide exposure after controlling for confounders. A high education level was identified as a modifying factor decreasing the risk of HNCs. Further studies with larger number of subjects are recommended to assess these relationships in greater detail.

Fan CY, Chao HL, Lin CS, Huang WY, Chen CM, Lin KT, Lin CL, Kao CH.Risk of depressive disorder among patients with head and neck cancer: A nationwide population-based study. Head Neck. 2018 Feb;40(2):312-323. doi: 10.1002/hed.24961. Epub 2017 Sep 30.

We identified 48 548 patients from the National Health Insurance Research Database (NHIRD) in Taiwan who were newly diagnosed with head and neck cancer between 2000 and 2010. Each patient was randomly frequency-matched with an individual without head and neck cancer, based on index year, sex, age, occupation category, urbanization level, monthly income, and comorbidities. The Cox proportional Registry of Catastrophic Illnesses Patient Database regression analysis was performed to estimate the effect of head and neck cancer on the risk of depressive disorder.Patients with head and neck cancer had a significantly higher risk of depressive disorder than the matched cohort (adjusted hazard ratio [HR] 3.32; 95% confidence interval [CI] 3.05-3.61), with the highest risk seen in the hypopharynx and oropharynx.Patients with head and neck cancer had >3 times the incidence of depressive disorder, relative to the comparison group. Psychological evaluation and support are essential in head and neck cancer survivors.

.Pokharel M, Shrestha I, Dhakal A, Amatya RC. Socio Demographic Predictors in Delayed Presentation of Head and Neck Cancer. Kathmandu Univ Med J (KUMJ). 2016 Jul-Sept.;14(55):274-278.

Background Head and neck cancer is a major public health problem worldwide. In spite of the increase in incidence, there has been paucity of research on socio demographic factors influencing head and neck cancer. Objective To study the influence of various socio demographic factors on late presentation of head and neck cancer. Method Prospective, analytical study conducted in 69 patients with Head and neck malignancies in Department of Otorhinolaryngology and Head and Neck surgery, Kathmandu University School of Medical sciences between January 2015 to January 2016. Collected data were entered and analyzed using IBM SPSS statistical software 21.0. All the socio demographic variables were compared between the early and late presentation groups of patient using Chi-square test. A ‘p’ value of < 0.05 was considered statistically significant. Result Forty eight were male and 21 were female. The age of patients ranged from 34 to 70 years (mean age 52.03). Twenty patients were diagnosed in stage I, 13 in stage II, 20 in stage III and 16 in stage IV. Significant association was seen between stage of head and neck cancer and duration of illness (p=0.007), educational status of patient (p=0.003) and educational status of patient’s care taker (p=0.005). However, no statistical association was seen between stage at diagnosis of head and neck cancer and gender, type of family, previous consultation, systems of alternative medicine adopted before diagnosis, smoking habit, alcohol intake, tobacco chewing habit and occupation. Conclusion The results of this study suggest that educational status may influence the presentation of head and neck cancer.

Barul C, Fayossé A, Carton M, Pilorget C, Woronoff AS, Stücker I, Luce D; ICARE study group. Occupational exposure to chlorinated solvents and risk of head and neck cancer in men: a population-based case-control study in France. Environ Health. 2017 Jul 24;16(1):77. doi: 10.1186/s12940-017-0286-5.

Few epidemiological studies have investigated the link between occupational exposure to solvents and head and neck cancer risk, and available findings are sparse and inconsistent. The objective of this study was to examine the association between occupational exposure to chlorinated solvents and head and neck cancer risk.We analyzed data from 4637 men (1857 cases and 2780 controls) included in a population-based case-control study, ICARE (France). Occupational exposure to five chlorinated solvents (perchloroethylene [PCE], trichloroethylene [TCE], methylene chloride [MC], chloroform [CF], and carbon tetrachloride [CT]) was assessed through job-exposure matrices. Odds ratios (ORs) and confidence intervals (95% CI) were estimated by unconditional logistic regression, adjusted for age, tobacco smoking, alcohol consumption, asbestos exposure, and other potential confounders.We observed no association between chlorinated solvent exposure and head and neck cancer risk, despite a non-significant increase in risk among subjects who had the highest cumulative level of exposure to PCE, (OR = 1.81; 95% CI = 0.68 to 4.82). In subsite analysis, the risk of laryngeal cancer increased with cumulative exposure to PCE (p for trend = 0.04). The OR was 3.86 (95% CI = 1.30 to 11.48) for those exposed to the highest levels of PCE. A non-significant elevated risk of hypopharyngeal cancer was also observed in subjects exposed to the highest levels of MC (OR = 2.36; 95% CI = 0.98 to 5.85).Our findings provide evidence that high exposure to PCE increases the risk of laryngeal cancer, and suggest an association between exposure to MC and hypopharyngeal cancer. Exposure to other chlorinated solvents was not associated with the risk of head and neck cancer.

Steenland K, Barry V, Anttila A, Sallmén M, McElvenny D, Todd AC, Straif K. A cohort mortality study of lead-exposed workers in the USA, Finland and the UK. Occup Environ Med. 2017 Nov;74(11):785-791. doi: 10.1136/oemed-2017-104311. Epub 2017 May 25.

To investigate further whether inorganic lead is a carcinogen among adults, or associated with increased blood pressure and kidney damage, via a large mortality study.We conducted internal analyses via Cox regression of mortality in three cohorts of lead-exposed workers with blood lead (BL) data (USA, Finland, UK), including over 88 000 workers and over 14 000 deaths. Our exposure metric was maximum BL. We also conducted external analyses using country-specific background rates.The combined cohort had a median BL of 26 µg/dL, a mean first-year BL test of 1990 and was 96% male. Fifty per cent had more than one BL test (mean 7). Significant (p<0.05) positive trends, using the log of each worker’s maximum BL, were found for lung cancer, chronic obstructive pulmonary disease (COPD), stroke and heart disease, while borderline significant trends (0.05≤p≤0.10) were found for bladder cancer, brain cancer and larynx cancer. Most results were consistent across all three cohorts. In external comparisons, we found significantly elevated SMRs for those with BLs>40 µg/dL; for bladder, lung and larynx cancer; and for COPD. In a small subsample of the US cohort (n=115) who were interviewed, we found no association between smoking and BL.We found strong positive mortality trends, with increasing BL level, for several outcomes in internal analysis. Many of these outcomes are associated with smoking, for which we had no data. A borderline trend was found for brain cancer, not associated with smoking.

Xie SH, Yu IT, Tse LA, Au JSK, Lau JSM. Occupational risk factors for nasopharyngeal carcinoma in Hong Kong Chinese: a case-referent study. Int Arch Occup Environ Health. 2017 Jul;90(5):443-449. doi: 10.1007/s00420-017-1212-4. Epub 2017 Mar 2.

We conducted a case-referent study with 352 incident cases and 410 referents recruited between June 2010 and December 2012. Full occupational histories were obtained via face-to-face interviews. Unconditional logistic regressions were performed to estimate the odds ratios (ORs) for NPC associated with occupational risk factors.Workers of craft related trades and elementary occupations were at elevated NPC risk with the adjusted ORs of 2.09 [95% confidence interval (CI) 1.09, 4.01] and 2.14 (95% CI 1.04, 4.41), respectively, compared with those clerical support workers as the reference group. Occupational exposures to cotton dust, chemical fumes, and welding fumes were significantly associated with increased NPC risk after adjustment for confounders [adjusted ORs (95% CIs) 1.93 (1.13, 3.28), 13.11 (1.53, 112.17), and 9.18 (1.05, 80.35), respectively]. We also observed significant exposure-response relationship for the duration of exposure to cotton dust (P for trend = 0.0175). Those with occupational exposure to cotton dust for 15 years or more were at significantly increased risk of NPC (adjusted OR 2.08, 95% CI 1.01, 4.28).This study indicates that employment in craft related trades and elementary occupations, as well as occupational exposures to chemical fumes, welding fumes, and cotton dust may be associated with an increased risk of NPC. Further epidemiological studies remain warranted to clarify the roles of specific occupational risk factors on NPC development.

Zeng F, Lerro C Lavoué J, Huang H, Siemiatycki J, Zhao N, Ma S, Deziel NC, Friesen MC, Udelsman R, Zhang Y. Occupational exposure to pesticides and other biocides and risk of thyroid cancer. Occup Environ Med. 2017 Jul;74(7):502-510. doi: 10.1136/oemed-2016-103931. Epub 2017 Feb 15.

Using data from a population-based case-control study involving 462 incident thyroid cancer cases and 498 controls in Connecticut collected in 2010-2011, we examined the association with occupational exposure to biocides and pesticides through a job-exposure matrix. We used unconditional logistic regression models to estimate OR and 95% CI, adjusting for potential confounders. Individuals who were occupationally ever exposed to biocides had an increased risk of thyroid cancer (OR=1.65, 95% CI 1.16 to 2.35), and the highest risk was observed for the high cumulative probability of exposure (OR=2.18, 95% CI 1.28 to 3.73). The observed associations were similar when we restricted to papillary thyroid cancer and well-differentiated thyroid cancer. Stronger associations were observed for thyroid microcarcinomas (tumour size ≤1 cm). No significant association was observed for occupational exposure to pesticides.Our study provides the first evidence linking occupational exposure to biocides and risk of thyroid cancer. The results warrant further investigation.

Andrade JO, Santos CA, Oliveira MC. Associated factors with oral cancer: a study of case control in a population of the Brazil’s Northeast. Rev Bras Epidemiol. 2015 Oct-Dec;18(4):894-905. doi: 10.1590/1980-5497201500040017.

This study aimed at assessing the association between factors such as age, sex, skin color, occupation, educational level, marital status, place of residence, and tobacco and alcohol consumptions and oral cancer in individuals in a city in the northeast of Brazil between 2002 and 2012.This is a case-control study. The case group consisted of 127 people attended at the Oral Injury Reference Center with histopathological diagnosis of oral squamous cell carcinoma. The control group consisted of 254 individuals treated at the same center. The study considered two controls for each case. The cases and controls were adjusted according to sex and age. Univariate and bivariate analyses were performed (Pearson χ2-test) to verify the correlation between the dependent variable (oral cancer) and the independent variables; odds ratio (OR) and the confidence interval of 95% (95%CI) were calculated. Finally, in the multivariate analysis, it was used as the hierarchical model with logistic regression to explain the interrelationships between the independent variables and oral cancer.Consumption of more than 20 cigarettes per day [OR = 6.64; 95%CI 2.07 – 21.32; p ≤ 0.001], an excessive alcohol consumption [OR = 3.25; 95%CI 1.03 – 10.22; p ≤ 0.044], and the synergistic consumption of tobacco and alcohol [OR = 9.65; 95%CI 1.57 – 59.08; p ≤ 0.014] are the most important risk factors for oral cancer.It was concluded that tobacco and alcohol consumptions are the most important factors for the development of oral cancer. Sociodemographic factors were not associated with this neoplasm after adjusting for smoking and drinking.

Ba Y, Huang H, Lerro CC, Li S, Zhao N, Li A, Ma S, Udelsman R, Zhang Y. Occupation and Thyroid Cancer: A Population-Based, Case-Control Study in Connecticut. J Occup Environ Med. 2016 Mar;58(3):299-305. doi: 10.1097/JOM.0000000000000637.

A population-based, case-control study involving 462 histologically confirmed incident cases and 498 controls was conducted in Connecticut in 2010 to 2011.A significantly increased risk of thyroid cancer, particularly papillary microcarcinoma, was observed for those working as the health care practitioners and technical workers, health diagnosing and treating practitioners, and registered nurses. Those working in building and grounds cleaning, maintenance occupations, pest control, retail sales, and customer service also had increased risk for papillary thyroid cancer. Subjects who worked as cooks, janitors, cleaners, and customer service representatives were at an increased risk of papillary thyroid cancer with tumor size more than 1 cm.Certain occupations were associated with an increased risk of thyroid cancer, with some tumor size and subtype specificity.

Fogleman EV, Eliot M, Michaud DS, Nelson HH, McClean MD Langevin SM, Kelsey KT Occupational asphalt is not associated with head and neck cancer. Occup Med (Lond). 2015 Oct;65(7):570-3. doi: 10.1093/occmed/kqv102. Epub 2015 Aug 13.

Epidemiologic studies that evaluate the relationship between occupational asphalt exposure and head and neck cancer have had a limited ability to control for known risk factors such as smoking, alcohol and human papillomavirus (HPV).To better elucidate this relationship by including known risk factors in a large case-control study of head and neck squamous cell carcinoma (HNSCC) from the greater Boston area.We analysed the relationship between occupational asphalt exposure and HNSCC among men in the Greater Boston area of Massachusetts. Analyses were conducted using unconditional multivariable logistic regression, performed with adjustments for age, race, education, smoking, alcohol consumption and HPV serology.There were 753 cases and 913 controls. No associations between HNSCC and occupational asphalt exposure (neither among ever-exposed nor by occupational duration) were observed for exposures in any occupation or those restricted to the construction industry. We also observed no associations in subgroup analyses of never-smokers and ever-smokers. Adjusting for known risk factors further reduced the estimated effect of asphalt exposure on HNSCC risk.We found no evidence for an association between occupational asphalt exposure and HNSCC. The null findings from this well-controlled analysis could suggest that the risk estimates stemming from occupational cohort studies may be overestimated due to uncontrolled confounding and enhance the literature available for weighing cancer risk from occupational exposure to bitumen.

Langevin SM, McClean MD, Michaud DS, Eliot M, Nelson HH, Kelsey KT. Occupational dust exposure and head and neck squamous cell carcinoma risk in a population-based case-control study conducted in the greater Boston area. Cancer Med. 2013 Dec;2(6):978-86. doi: 10.1002/cam4.155. Epub 2013 Nov 4.

Head and neck cancers account for an estimated 549,000 global cancer diagnoses each year. While tobacco use, alcohol consumption, and HPV16 infection are considered to be the major risk factors for this disease, occupational risk factors, including exposure to asbestos, have also been described, although dust exposures other than asbestos have been historically understudied. We have investigated the relationship between occupational exposures to five types of dusts, including sawdust, concrete dust, leather dust, metal dust, and chimney soot, and head and neck squamous cell carcinomas (HNSCC) in the greater Boston area. We report findings from a population-based case-control study involving 951 incident HNSCC cases and 1193 controls, frequency matched on age (±3 years), sex, and town/neighborhood of residence. Multivariable logistic regression was used to assess the association between occupational exposure to each type of dust and HNSCC, overall and by primary tumor site. After adjusting for age, sex, race, smoking, alcohol consumption, education, and HPV16 serology, laryngeal carcinoma risk increased for each decade of occupational exposure to sawdust (OR = 1.2, 95% CI: 1.0, 1.3) and metal dust (OR = 1.2, 95% CI: 1.0, 1.4); and HNSCC risk increased for each decade of occupational leather dust exposure (OR = 1.5, 95% CI: 1.2, 1.9). We have provided evidence for an association between occupational sawdust and metal dust and laryngeal squamous cell carcinoma, and leather dust and HNSCC, with increasing risk with longer duration at the exposed occupation.

Purdue MP, Järvholm B, Bergdahl IA, Hayes RB, Baris D. Occupational exposures and head and neck cancers among Swedish construction workers. Scand J Work Environ Health. 2006 Aug;32(4):270-5.

Occupational exposures in the construction industry may increase the risk of head and neck cancers, although the epidemiologic evidence is limited by problems of low study power and inadequate adjustment for tobacco use. In an attempt to address this issue, the relationship between selected occupational exposures and head and neck cancer risk was investigated using data from a large cohort of Swedish construction workers.Altogether 510 squamous cell carcinomas of the head and neck (171 in the oral cavity, 112 in the pharynx, 227 in the larynx) were identified during 1971-2001 among 307 799 male workers in the Swedish construction industry. Exposure to diesel exhaust, asbestos, organic solvents, metal dust, asphalt, wood dust, stone dust, mineral wool, and cement dust was assessed using a semi-quantitative job-exposure matrix. Rate ratios (RR) and 95% confidence intervals (95% CI) were calculated for head and neck cancers in relation to occupational exposure, using Poisson regression with adjustment for age and smoking status.Asbestos exposure was related to an increased laryngeal cancer incidence (RR 1.9, 95% CI 1.2-3.1). Excesses of pharyngeal cancer were observed among workers exposed to cement dust (RR 1.9, 95% CI 1.2-3.1). No occupational exposures were associated with oral cavity cancer. These findings did not materially change upon additional adjustment for cigarette pack-years.These findings offer further evidence that asbestos increases the risk of laryngeal cancer. The observation of a positive association between cement dust exposure and pharyngeal cancer warrants further investigation.

Langevin SM, O’Sullivan MH, Valerio JL, Pawlita M, Applebaum KM, Eliot M, McClean MD, Kelsey KT. Occupational asbestos exposure is associated with pharyngeal squamous cell carcinoma in men from the greater Boston area. Occup Environ Med. 2013 Dec;70(12):858-63. doi: 10.1136/oemed-2013-101528. Epub 2013 Sep 27.

Asbestos is the name given to a group of naturally occurring silicate mineral fibres that were widely used in industry during the 20th century due to their desirable physical properties. Although use in the USA has fallen over the last three decades, significant exposure in the developing world continues and the burden of disease is considerable. Asbestos is a known risk factor for several malignant diseases, including lung cancer and mesothelioma, and has more recently been implicated in pharyngeal and laryngeal cancer. However, studies of asbestos and cancers of the larynx or pharynx with adequate sample size that control for major head and neck squamous cell carcinoma (HNSCC) risk factors remain relatively sparse.We report findings from a case-control study of 674 incident male HNSCC cases from the greater Boston region and 857 population-based male controls, matched on age (±3 years), sex, and town or neighbourhood of residence. Multivariable logistic regression was used to assess the association between occupational asbestos exposure and HNSCC by primary tumour site.190 cases (28.2%) and 203 controls (23.7%) reported occupational exposure to asbestos. Occupational asbestos exposure was associated with elevated risk of pharyngeal carcinoma in men (OR 1.41, 95% CI 1.01 to 1.97), adjusted for age, race, smoking, alcohol consumption, education, income and HPV16 serology, with borderline increasing risk for each decade in the exposed occupation (OR 1.10, 95% CI 0.99 to 1.23).These observations are consistent with mounting evidence that asbestos is a risk factor for pharyngeal cancer.

 

 

 

 

Riechelmann H.Occupational exposure and cancer of the oral cavity and pharynx]. Laryngorhinootologie. 2002 Aug;81(8):573-9.

 

Occupational risk factors for the development of laryngeal cancer are well accepted, whereas the etiologic relationship between occupational exposure to various noxious influences and the development of cancer of the oral cavity and pharynx remain a matter of debate. Based on published data, occupational risk factors for cancer of the oral cavity and pharynx should be evaluated.Publications since 1990 listed in the National Library of Medicine, textbooks and data obtained from the German Employer’s Liability Insurance Association were evaluated.In several tobacco- and alcohol-adjusted case-control and cohort studies, an association with occupation in construction and metalworking industries, as painters, carpenters and machine operators was consistently found. The relative risks or standardized mortality rates ranged between 1.5 and 3. Some recent investigations found an association for workers in the paper and rubber industry. The results in regard to the textile and woodworking industry were inconclusive.

Pukkala E, Martinsen JI, Lynge E, Gunnarsdottir HK, Sparén P, Tryggvadottir L, Weiderpass E, Kjaerheim K. Occupation and cancer – follow-up of 15 million people in five Nordic countries. Acta Oncol. 2009;48(5):646-790. doi: 10.1080/02841860902913546.

We present up to 45 years of cancer incidence data by occupational category for the Nordic populations. The study covers the 15 million people aged 30-64 years in the 1960, 1970, 1980/1981 and/or 1990 censuses in Denmark, Finland, Iceland, Norway and Sweden, and the 2.8 million incident cancer cases diagnosed in these people in a follow-up until about 2005. The study was undertaken as a cohort study with linkage of individual records based on the personal identity codes used in all the Nordic countries. In the censuses, information on occupation for each person was provided through free text in self-administered questionnaires. The data were centrally coded and computerised in the statistical offices. For the present study, the original occupational codes were reclassified into 53 occupational categories and one group of economically inactive persons. All Nordic countries have a nation-wide registration of incident cancer cases during the entire study period. For the present study the incident cancer cases were classified into 49 primary diagnostic categories. Some categories have been further divided according to sub-site or morphological type. The observed number of cancer cases in each group of persons defined by country, sex, age, period and occupation was compared with the expected number calculated from the stratum specific person years and the incidence rates for the national population. The result was presented as a standardised incidence ratio, SIR, defined as the observed number of cases divided by the expected number. For all cancers combined (excluding non-melanoma skin cancer), the study showed a wide variation among men from an SIR of 0.79 (95% confidence interval 0.66-0.95) in domestic assistants to 1.48 (1.43-1.54) in waiters. The occupations with the highest SIRs also included workers producing beverage and tobacco, seamen and chimney sweeps. Among women, the SIRs varied from 0.58 (0.37-0.87) in seafarers to 1.27 (1.19-1.35) in tobacco workers. Low SIRs were found for farmers, gardeners and teachers. Our study was able to repeat most of the confirmed associations between occupations and cancers. It is known that almost all mesotheliomas are associated with asbestos exposure. Accordingly, plumbers, seamen and mechanics were the occupations with the highest risk in the present study. Mesothelioma was the cancer type showing the largest relative differences between the occupations. Outdoor workers such as fishermen, gardeners and farmers had the highest risk of lip cancer, while the lowest risk was found among indoor workers such as physicians and artistic workers. Studies of nasal cancer have shown increased risks associated with exposure to wood dust, both for those in furniture making and for those exposed exclusively to soft wood like the majority of Nordic woodworkers. We observed an SIR of 1.84 (1.66-2.04) in male and 1.88 (0.90-3.46) in female woodworkers. For nasal adenocarcinoma, the SIR in males was as high as 5.50 (4.60-6.56). Male waiters and tobacco workers had the highest risk of lung cancer, probably attributable to active and passive smoking. Miners and quarry workers also had a high risk, which might be related to their exposure to silica dust and radon daughters. Among women, tobacco workers and engine operators had a more than fourfold risk as compared with the lung cancer risk among farmers, gardeners and teachers. The occupational risk patterns were quite similar in all main histological subtypes of lung cancer. Bladder cancer is considered as one of the cancer types most likely to be related to occupational carcinogens. Waiters had the highest risk of bladder cancer in men and tobacco workers in women, and the low-risk categories were the same ones as for lung cancer. All this can be accounted for by smoking. The second-highest SIRs were among chimney sweeps and hairdressers. Chimney sweeps are exposed to carcinogens such as polycyclic aromatic hydrocarbons from the chimney soot, and hairdressers’ work environment is also rich in chemical agents. Exposure to the known hepatocarcinogens, the Hepatitis B virus and aflatoxin, is rare in the Nordic countries, and a large proportion of primary liver cancers can therefore be attributed to alcohol consumption. The highest risks of liver cancer were seen in occupational categories with easy access to alcohol at the work place or with cultural traditions of high alcohol consumption, such as waiters, cooks, beverage workers, journalists and seamen. The risk of colon cancer has been related to sedentary work. The findings in the present study did not strongly indicate any protective role of physical activity. Colon cancer was one of the cancer types showing the smallest relative variation in incidence between occupational categories. The occupational variation in the risk of female breast cancer (the most common cancer type in the present series, 373 361 cases) was larger, and there was a tendency of physically demanding occupations to show SIRs below unity. Women in occupations which require a high level of education have, on average, a higher age at first child-birth and elevated breast cancer incidence. Women in occupational categories with the highest average number of children had markedly lower incidence. In male breast cancer (2 336 cases), which is not affected by the dominating reproductive factors, there was a suggestion of an increase in risk in occupations characterised by shift work. Night-shift work was recently classified as probably carcinogenic, with human evidence based on breast cancer research. The most common cancer among men in the present cohort was prostate cancer (339 973 cases). Despite the huge number of cases, we were unable to demonstrate any occupation-related risks. The observed small occupational variation could be easily explained by varying PSA test frequency. The Nordic countries are known for equity and free and equal access to health care for all citizens. The present study shows that the risk of cancer, even under these circumstances, is highly dependent on the person’s position in the society. Direct occupational hazards seem to explain only a small percentage of the observed variation – but still a large number of cases – while indirect factors such as life style changes related to longer education and decreasing physical activity become more important. This publication is the first one from the extensive Nordic Occupational Cancer (NOCCA) project. Subsequent studies will focus on associations between specific work-related factors and cancer diseases with the aim to identify exposure-response patterns. In addition to the cancer data demonstrated in the present publication, the NOCCA project produced Nordic Job Exposure Matrix (described in separate articles in this issue of Acta Oncologica) that transforms information about occupational title histories to quantitative estimates of specific exposures. The third essential component is methodological development related to analysis and interpretation of results based on averaged information of exposures and co-factors in the occupational categories. In cases with moderate isolated tobacco or moderate isolated alcohol consumption, the risk attributable to occupational factors and smoking or drinking are of similar magnitude. According to German jurisdiction, a partial compensation of the acquired disability is then justified. In pronounced combined tobacco and alcohol consumption, the non-occupational risk factors increase exponentially and occupational risks attain marginal weight.

Andersen A, Barlow L, Engeland A, Kjaerheim K, Lynge E, Pukkala E. Work-related cancer in the Nordic countries. Scand J Work Environ Health. 1999;25 Suppl 2:1-116.

This report presents 20 years’ of cancer incidence data by occupational group for the Nordic populations. The study covers the 10 million people aged 25-64 years at the time of the 1970 censuses in Denmark, Finland, Norway, and Sweden, and the 1 million incident cancer cases diagnosed among these people during the subsequent 20 years. The project was undertaken as a cohort study with linkage of individual records based on the personal identification numbers used in all the Nordic countries. In the 1970 censuses, information on occupation for each economically active member of the household was provided in free text in self-administered questionnaires. The data were centrally coded and computerized in the statistical offices. Norway, Sweden, and Finland used the Nordic Classification of Occupations, while Denmark used a national coding scheme. However, all the data could be reclassified into 53 occupational groups and 1 group of economically inactive persons. Person-years at risk were accumulated from 1 January 1971 until the date of emigration, date of death or 31 December 1987 in Denmark, 1989 in Sweden, 1990 in Finland, and 1991 in Norway. The 4 countries all had nationwide registration of incident cancer cases during the entire study period. All incident cancer cases during the individual risk periods were included in the analysis. Despite minor differences between the countries, the International Classification of Diseases, 7th revision, formed the core basis for the diagnostic coding in all 4 countries. For the present study the incident cancer cases have been classified into 35 broad diagnostic groups. The observed number of cancer cases in each group of persons defined by country, gender, and occupation was compared with the expected number calculated from the age-, gender-, and period-specific person-years and the incidence rates for the national population. The result has been presented as a standardized incidence ratio (SIR), defined as the observed number of cases divided by the expected number and multiplied by 100. In the tables of this report, all the SIR values for which the upper limit of the 95% confidence interval is below 100 are printed in green and all those for which the lower limit of the confidence interval is above 100 are printed in red. For all cancers combined, the study showed a wide variation among the men, from an SIR of 79 for farmers to 159 for waiters. The occupations with the highest SIR values also included seamen and workers producing beverages and tobacco. Among the women the SIR values varied from 83 for gardeners to 129 for tobacco workers. Low SIR values were found for farmers and teachers. Outdoor workers such as fishermen and gardeners had the highest risk of lip cancer, while the lowest risk was found among indoor workers such as physicians and artistic workers. Almost all pleural cancers are associated with asbestos exposure. Accordingly, plumbers, welders, mechanics, and seamen were the occupations with the highest risk. There was also an excess risk of pleural cancer in the occupational group of technical, chemical, physical, and biological workers, including, among others, engineers and chemists potentially exposed to asbestos. The wood workers included in the present study had the highest risk of nasal cancer. Most studies of nasal cancer have shown increased risks associated with exposure to wood dust, both for those in furniture making and for those exposed exclusively to soft wood. Nickel refinery workers are also known for their high risk of nasal cancer. In the present study they were included in the occupational group of smelting workers. Lung cancer was the most frequent cancer among men in the present study. Tobacco smoking is the major risk factor for this disease, but occupational exposures also play an important role. Waiters and tobacco workers had the highest risk of lung cancer. Miners and quarry workers also had a high risk of lung cancer, which may be related to.

 

 

Kjaerheim K, Martinsen JI, Lynge E, Gunnarsdottir HK, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. Effects of occupation on risks of avoidable cancers in the Nordic countries. Eur J Cancer. 2010 Sep;46(14):2545-54. doi: 10.1016/j.ejca.2010.07.038.

Knowledge of cancer risk according to occupational affiliation is an essential part of formatting preventive actions aimed at the adult population. Herein, data on 10 major cancer sites amenable by life style exposures from the Nordic Occupational Cancer Study (NOCCA) are presented. All subjects aged 30-64 years participating in one or more national censuses in Denmark, Finland, Iceland, Norway, or Sweden between 1960 and 1990 were included in the cohort and followed up for cancer from inclusion until 2003/2005 via a linkage with the national cancer registries, and standardised incidence ratios (SIRs) were computed. Variation in risk across occupations was generally larger in men than in women. In men, the most consistent cluster with high risk of numerous cancer types included waiters, cooks and stewards, beverage workers, seamen, and chimney sweeps. Two clusters of occupations with generally low cancer risks were seen in both men and women. The first one comprised farmers, gardeners, and forestry workers, the second one included groups with high education, specifically those in health and pedagogical work. Although cancer risk varies by occupation, only a smaller part of the variation can be attributed to occupational exposures in the strict sense. Preventive measures at the work place are important to avoid established and new occupational health hazards. This study also indicates that the work place in addition should be seen as a useful arena for reaching groups of adults with more or less similar habits and attitudes for general health promotion.

Reijula J, Kjaerheim K, Lynge E, Martinsen JI, Reijula K, Sparén P, Tryggvadottir L, Weiderpass E, Pukkala E. Cancer incidence among waiters: 45 years of follow-up in five Nordic countries. Scand J Public Health. 2015 Mar;43(2):204-11. doi: 10.1177/1403494814565130. Epub 2015 Jan 6.

We identified a cohort of 16,134 male and 81,838 female waiters from Denmark, Finland, Iceland, Norway and Sweden. During the follow-up period from 1961 to 2005, we found that 19,388 incident cancer cases were diagnosed. Standardised incidence ratio (SIR) was defined as the observed number of cancer cases divided by the expected number, based on national age, time period and gender-specific cancer incidence rates in the general population.The SIR of all cancers in waiters, in the five countries combined, was 1.46 (95% CI 1.41-1.51) in men and 1.09 (1.07-1.11) in women. In male waiters, the SIR decreased from 1.79 (1.63-1.96) in 1961-1975, to 1.33 (1.26-1.40) in 1991-2005, but remained stable among women. The SIR among male waiters was highest for cancers in the pharynx (6.11; 95% CI 5.02-7.37), oral cavity (4.91; 95% CI 3.81-6.24) and tongue (4.36; 95% CI 3.13-5.92); and in female waiters, in the larynx (2.17; 95% CI 1.63-2.82), oral cavity (1.96; 95% CI 1.60-2.34) and lung (1.89; 95% CI 1.80-1.99).The risk of cancer among waiters was higher than in the general population. The elevated incidence in some cancer sites can likely be explained by higher alcohol consumption, the prevalence of smoking and occupational exposure to tobacco smoke. Hopefully, the incidence of cancer among waiters will decrease in the future, due to the banning of tobacco smoking in restaurants and bars in the Nordic countries.

Tarvainen L, Suojanen J, Kyyronen P, Lindqvist C, Martinsen JI, Kjaerheim K, Lynge E, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. Occupational Risk for Oral Cancer in Nordic Countries. Anticancer Res. 2017 Jun;37(6):3221-3228.

 

To evaluate occupational risk for cancer of the tongue, oral cavity or pharynx after adjustment for alcohol and tobacco use.The data covered 14.9 million people and 28,623 cases of cancer of the tongue, oral cavity and pharynx in the Nordic countries 1961-2005. Alcohol consumption by occupation was estimated based on mortality from liver cirrhosis and incidence of liver cancer. Smoking by occupation was estimated based on the incidence of lung cancer.Only few occupations had relative risks of over 1.5 for cancer of the tongue, oral cavity and pharynx. These occupations included dentists, artistic workers, hairdressers, journalists, cooks and stewards, seamen and waiters.Several occupational categories, including dentists, had an increased relative risk of tongue cancer. This new finding remains to be explained but could be related to occupational chemical exposures, increased consumption of alcohol and tobacco products, or infection with human papilloma virus.

Kjaerheim K, Andersen A. Incidence of cancer among male waiters and cooks: two Norwegian cohorts. Cancer Causes Control. 1993 Sep;4(5):419-26.

Previous occupational survey studies have identified ‘waiter’ and ‘cook’ as possible high risk occupations for cancer. However, few cohort studies have been performed among persons in the restaurant business, and we therefore have analyzed cancer incidence in two cohorts of Norwegian waiters and cooks. The cohorts consisted of skilled male workers, 1,463 waiters and 2,582 cooks, who received their craft certificate between 1958 and 1983. The cohorts were followed from 1959 through 1991. The standardized incidence ratio (SIR) for all causes of cancer was 1.4 (95 percent confidence interval [CI] = 1.2-1.7] for waiters, and 1.1 (CI = 0.9-1.4) for cooks. Cancers of the tongue, mouth, pharynx, larynx, esophagus, and liver were grouped together as alcohol-associated cancers. SIR for these cancers combined was 5.1 (CI = 3.4-7.4) for waiters and 4.2 (CI = 2.2-7.2) for cooks. For lung cancer, SIR was 2.0 (CI = 1.3-2.9) for waiters and 0.7 (CI = 0.2-1.7) for cooks. For alcohol-associated cancers, the analysis carried out according to number of years since first employment showed a larger number of cases than expected for both occupations in all time-periods. The excess of lung cancer cases among waiters appeared after 30 years or more of employment. The study shows that waiters and cooks are at high risk of cancers associated with alcohol consumption, and that waiters, in addition, show high rates for lung cancer. The hypothesis of an occupational lung-cancer risk in cooks was not supported by this study.

 

Kjaerheim K, Martinsen JI, Lynge E, Gunnarsdottir HK, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. Effects of occupation on risks of avoidable cancers in the Nordic countries. Eur J Cancer. 2010 Sep;46(14):2545-54. doi: 10.1016/j.ejca.2010.07.038.

Knowledge of cancer risk according to occupational affiliation is an essential part of formatting preventive actions aimed at the adult population. Herein, data on 10 major cancer sites amenable by life style exposures from the Nordic Occupational Cancer Study (NOCCA) are presented. All subjects aged 30-64 years participating in one or more national censuses in Denmark, Finland, Iceland, Norway, or Sweden between 1960 and 1990 were included in the cohort and followed up for cancer from inclusion until 2003/2005 via a linkage with the national cancer registries, and standardised incidence ratios (SIRs) were computed. Variation in risk across occupations was generally larger in men than in women. In men, the most consistent cluster with high risk of numerous cancer types included waiters, cooks and stewards, beverage workers, seamen, and chimney sweeps. Two clusters of occupations with generally low cancer risks were seen in both men and women. The first one comprised farmers, gardeners, and forestry workers, the second one included groups with high education, specifically those in health and pedagogical work. Although cancer risk varies by occupation, only a smaller part of the variation can be attributed to occupational exposures in the strict sense. Preventive measures at the work place are important to avoid established and new occupational health hazards. This study also indicates that the work place in addition should be seen as a useful arena for reaching groups of adults with more or less similar habits and attitudes for general health promotion.

Medicine (Baltimore). 2016 Jul;95(27):e4140. doi: 10.1097/MD.0000000000004140.

The effect of individual and neighborhood socioeconomic status on esophageal cancer survival in working-age patients in Taiwan.

Wu CC1, Chang CM, Hsu TW, Lee CH, Chen JH, Huang CY, Lee CC.

Esophageal cancer is the sixth leading cause of cancer mortality. More than 90% of patients with esophageal cancer in Taiwan have squamous cell carcinoma. Survival of such patients is related to socioeconomic status (SES). We studied the association between SES (individual and neighborhood) and the survival of working-age patients with esophageal cancer in Taiwan. A population-based study was conducted of 4097 patients diagnosed with esophageal cancer between 2002 and 2006. Each was traced for 5 years or until death. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income and dichotomized into advantaged or disadvantaged. Multilevel logistic regression was used to compare the survival rates by SES group after adjustment for possible confounding and risk factors. Hospital and neighborhood SES were used as random effects in multilevel logistic regression. In patients younger than 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjustment for patient characteristics, esophageal cancer patients with high individual SES had a 39% lower risk of mortality than those with low individual SES (odds ratio 0.61, 95% confidence interval 0.48-0.77). Patients living in disadvantaged areas with high individual SES were more likely to receive surgery than those with low SES (odds ratio 1.45, 95% confidence interval 1.11-1.89). Esophageal cancer patients with low individual SES have the worst 5-year survival, even with a universal healthcare system. Public health, education, and social welfare programs should address the inequality of esophageal cancer survival.

 

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Singh PKChandra GBogra JGupta RKumar VJain A, et al. Association of interleukin-6 genetic polymorphisms with risk of OSCC in Indian population. Meta Gene 2015;4:142-51

Sivridis A, Giatromanolaki M, Koukourakis I. Proliferating fibroblasts at the invading tumour edge of colorectal adenocarcinomas are associated with endogenous markers of hypoxia, acidity, and oxidative stress. J Clin Pathol 2005;58:1033–38.

Skrinjar IBrailo VVidovic-Juras DVucicevic-Boras VMilenovic A. Evaluation of pretreatment serum interleukin-6 and tumour necrosis factor alpha as a potential biomarker for recurrence in patients with oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal 2015;20:e402-7.

Slavin S, Yeh CR, Da J, Yu S, Miyamoto H, Messing EM, et al. Estrogen receptor α in cancer-associated fibroblasts suppresses prostate cancer invasion via modulation of thrombospondin 2 and matrix metalloproteinase 3. Carcinogenesis 2014;35:1301-19.

Stamatiou R, Paraskeva E, Papagianni M, Paschalis Adam Molyvdas PA, Hatziefthimiou A. The mitogenic effect of testosterone and 17β-estradiol on airway smooth muscle cells Steroids 2011;76:400–8.

Suba ZMaksa GMihályi STakács D. Role of hormonal risk factors in oral cancer development. Orv Hetil 2009;150:791-9.

Tiwari ASwamy SGopinath KSKumar A. Genomic amplification upregulates estrogen-related receptor alpha and its depletion inhibits oral squamous cell carcinoma tumors in vivo. Sci Rep 2015 ;5:17621.

Torre, L.A., Bray, F., Siegel, R.L., Ferlay, J., Lortet-Tieulent, J., Jemal, A., 2015. Globalcancer statistics. 2012. Cancer Epidemiol Biomarkers Prev 2016; 25(1):16-27.

Tsai CC, Chen CC, Lin CC, Chen CH, Lin TS, Shieh TY.Interleukin-1 beta in oral submucous fibrosis, verrucous hyperplasia and squamous cell carcinoma tissues.Kaohsiung J Med Sci 1999;15(9):513-9.

Tuohimaa P,  Niemi M, The effect of testosterone on cell renewal and mitotic cycles in sex accessory glands of castrated mice Acta Endocrinol 1968; 58: 696-704.

Van Zyl A, Bunn BK. Clinical features or oral cancer. SADJ 2012;67: 566-9.

Vucicevic Boras V, Cikes N, Lukac J, Virag M, Cekic-Arambasin A. Salivary and serum interleukin 6 and basic fibroblast growth factor levels in patients with oral squamous cell carcinoma. Minerva Stomatol 2005; 54:569-73.

Won HS, Kim YA, Lee JS, Jeon EK, An HJ, Sun DS, et al. Soluble interleukin-6 receptor is a prognostic marker for relapse-free survival in estrogen receptor-positive breast cancer. Cancer Invest 2013;31:516-21.

Wu TF, Luo FJ, Chang YL, Huang CM, Chiu WJ, Weng CF, et al. The oncogenic role of androgen receptors in promoting the growth of oral squamous cell carcinoma cells Oral Dis. 2015;21(3):320-7.

Yoo HJ, Sepkovic DW, Bradlow HL, Yu GP, Sirilian HV, Schantz SP.  Estrogen metabolism as a risk factor for head and neck cancer. Otolaryngol Head Neck Surg 2001;124: 241-7.

Youssef NS, Hakim SA. Association of Fascin and matrix metalloproteinase-9 expression with poor prognostic parameters in breast carcinoma of Egyptian women. Diagn Pathol.  2014;4:136.

Zheng WY, Zhang DT, Yang SY, Li H. Elevated Matrix Metalloproteinase-9 Expression Correlates With Advanced Stages of Oral Cancer and Is Linked to Poor Clinical Outcomes. J Oral Maxillofac Surg 2015;73:2334-42.

Alam MS, Siddiqui SA, Perween R. Epidemiological profile of head and neck cancer patients in Western Uttar Pradesh and analysis of distributions of risk factors in relation to site of tumor. J Cancer Res Ther. 2017 Jul-Sep;13(3):430-435. doi: 10.4103/0973-1482.180687.

Head and neck cancers (HNCs) are a major form of cancers in India. The spectrum varies from place to place within the country because of significant diversified risk factors.To study, epidemiology and risk factors of HNC patients from Western Uttar Pradesh and to find out the correlation between risk factors and different anatomical regions involved.All patients with histologically confirmed diagnoses of HNC between January 2011 and December 2013 were selected from hospital records. Data regarding age, gender, addiction habits, site of tumor, and other details were obtained from their clinical records, and statistical analysis was done.HNC accounts for 21.2% of total body malignancy and 47% of all malignancies in males and 2.5% in females. Squamous cell carcinoma was the most common histological type (97%). Maximum incidence of HNC (>60%) was in 40-60 year of age. Male:female ratio was 16:1. Oral cancers were most common HNC in patients below 40 year age group, whereas carcinoma oropharynx and larynx were more common in patients above 40 year age group. Tobacco smoking was a most prevalent risk factor for carcinoma oropharynx, larynx, and hypopharynx. Tobacco chewing was a most prevalent risk factor in females, young males, and carcinoma buccal mucosa patients. Habit of tobacco consumption in HNC patients was much higher than their normal counterpart. Alcohols drinking alone was observed in <1% patient as a risk factor. In oral tongue cancer, smoking and tobacco chewing were equally prevalent. Habit of tobacco chewing and alcohol were significantly higher in carcinoma buccal mucosa than other HNC suggesting synergistic effect specific to this site.

McCarthy CE, Field JK, Marcus MW. Age at menopause and hormone replacement therapy as risk factors for head and neck and oesophageal cancer (Review). Oncol Rep. 2017 Oct;38(4):1915-1922. doi: 10.3892/or.2017.5867.

There were ~986,000 cases of head and neck cancer (HNC) and oesophageal cancer diagnosed worldwide in 2012. The incidence of these types of cancer is much higher in males than females, although this disparity decreases in the elderly population, suggesting a role for hormones as a risk factor. This systematic review investigates the potential role of female hormones [age at menopause and use of hormone replacement therapy (HRT)] as risk factors for HNC/oesophageal squamous cell carcinoma (SCC). The electronic databases MEDLINE, Web of Science, EMBASE and Cochrane were searched. Only studies with at least 50 cases of HNC/oesophageal SCC, with data on age at menopause, smoking, alcohol, age and socioeconomic status or educational attainment, were included. The Newcastle Ottawa Scale was used for assessing risk of bias. Eight studies met the inclusion criteria (5 oesophageal SCC, 2 HNC and 1 combined oesophageal SCC and HNC). HRT was shown to reduce the risk of HNC (HR, 0.78; 95% CI, 0.61-0.99) in one study. Our results showed that earlier age at menopause is a risk factor for oesophageal SCC, with women entering menopause at <45 years having double the risk of those entering menopause at age >50 years. Similar, but less striking, results were observed for HNC. HRT was found to reduce the risk of HNC/oesophageal SCC, but the evidence is inconclusive. We, therefore, recommend that consideration should be given to collecting data on reproductive factors and exposure to HRT, as routine practice, in future epidemiological and clinical studies of these cancers. The concept of oestrogen deficiency as a risk for HNC/oesophageal SCC deserves further exploration in future laboratory and clinical studies.

Hashim D, Sartori S, Vecchia C, Serraino D, Maso LD, Negri E, Smith E, Levi F, Boccia S, Cadoni G, Luu HN, Lee YA, Hashibe M, Boffetta P. Hormone factors play a favorable role in female head and neck cancer risk. Cancer Med. 2017 Aug;6(8):1998-2007. doi: 10.1002/cam4.1136.

Due to lower female incidence, estimates of exogenous and endogenous hormonal factors in head and neck cancers (HNCs, comprising cancers of the oral cavity, oropharynx, hypopharynx, and larynx) among women have been inconsistent and unable to account for key HNC risk factors. We pooled data from 11 studies from Europe, North America, and Japan. Analysis included 1572 HNC female cases and 4343 controls. Pooled odds ratios (ORs) estimates and their 95% confidence intervals (CIs) were calculated using multivariate logistic regression models adjusting for tobacco smoking and alcohol drinking. Lower risk was observed in women who used hormone replacement therapy (HRT) (OR = 0.58; 95% CI: 0.34-0.77). Pregnancy (OR = 0.61; 95% CI: 0.42-0.90) and giving birth (OR = 0.59; 95% CI: 0.38-0.90) at <35 years of age were inversely associated with HNCs. An inverse association with HNC was observed with age at start of HRT use (OR = 0.59; 95% CI: 0.39-0.90) for each additional 10 years and with duration of use (OR = 0.87; 95% CI: 0.76-0.99 for every 3 years). Exogenous female hormone use is associated with a nearly twofold risk reduction in female HNCs. The lower female HNC incidence may, in part, be explained by endogenous and exogenous estrogen exposures.

Tarvainen L, Suojanen J, Kyyronen P, Lindqvist C, Martinsen JI, Kjaerheim K, Lynge E, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. Occupational Risk for Oral Cancer in Nordic Countries. Anticancer Res. 2017 Jun;37(6):3221-3228.

To evaluate occupational risk for cancer of the tongue, oral cavity or pharynx after adjustment for alcohol and tobacco use.The data covered 14.9 million people and 28,623 cases of cancer of the tongue, oral cavity and pharynx in the Nordic countries 1961-2005. Alcohol consumption by occupation was estimated based on mortality from liver cirrhosis and incidence of liver cancer. Smoking by occupation was estimated based on the incidence of lung cancer. Only few occupations had relative risks of over 1.5 for cancer of the tongue, oral cavity and pharynx. These occupations included dentists, artistic workers, hairdressers, journalists, cooks and stewards, seamen and waiters.Several occupational categories, including dentists, had an increased relative risk of tongue cancer. This new finding remains to be explained but could be related to occupational chemical exposures, increased consumption of alcohol and tobacco products, or infection with human papilloma virus.

Nowosielska-Grygiel J, Owczarek K, Bielińska M, Wacławek M, Olszewski J. Analysis of risk factors for oral cavity and oropharynx cancer in the authors’ own material. Otolaryngol Pol. 2017 Apr 30;71(2):23-28. doi: 10.5604/01.3001.0009.8411.

 

The aim of the study was to analyse the risk factors for oral cavity and oropharynx cancer in peopled examined under the Head and Neck Cancer Awareness Week in 2016, Lodz.In Lodz, 21st September 2016, under the Head and Neck Cancer Awareness Week, 106 people, including 67 women aged 29-77 and 39 men aged 23-84, underwent preventive examinations in the hospital department. Prior to the laryngological examination, the patients were asked to answer questions that referred to their education, medical case history, symptoms, smoking habits with the number of cigarettes per day, alcohol intake, the number of lifetime sexual partners, oral sex engagement, incidents of head and neck cancer in the family history.The major part of the examined patients were women and men with the secondary and high level of education, 47,76% and 35,82%, and 58,97% and 35,91% respectively. The patients were informed by mass media about the planned preventive medical examinations – 80,60% women and 79,49% men. The most common symptoms reported by women were: hoarse voice in 61,19% cases, dysphagia in 32,84% cases and burning sensation and/or pain in the oral cavity in 29,85% cases. The examined male patients mainly showed hoarse voice (46,15%), other symptoms (43,59%) and dysphagia (25,64%). 28,35% women and 28,20% men smoked cigarettes, while passive smokers were 22,38% and 25,64% respectively. Alcohol consumption was reported by 67,16% women and 82,05% men, rather occasionally. Having oral sex was noted in 25,37% women and 38,46% men, mostly with multiple sexual partners. Among the studied patients, 13,43% women and 5,12% men suffered from malignant cancer, including 2,98% women and 2,56% men who reported head and neck carcinoma in the medical interview. On the basis of the interview and ENT examination, 11,94% women and 17,94% men were qualified for the extended oncological diagnostics. Conclussion. The Fourth Head and Neck Cancer Awareness Week shows the increased interest in preventive screening, especially oncological screening, and thus the necessity of such preventive activities in the future.

Javadi P, Sharma A, Zahnd WE, Jenkins WD. Evolving disparities in the epidemiology of oral cavity and oropharyngeal cancers. Cancer Causes Control. 2017 Jun;28(6):635-645. doi: 10.1007/s10552-017-0889-8.

Incidence rates of head and neck cancers (HNC) associated with human papillomavirus (HPVa) infection are increasing while non-HPV-associated (non-HPVa) HNC cancer rates are decreasing. As nearly all sexually active individuals will acquire an HPV infection, it is important to understand epidemiologic trends of HNCs associated with this sexually transmitted disease. We analyzed SEER 9 (1973-2012) and 18 data (2000-2012) for HPVa HNCs (oropharynx area; OP) and non-HPVa (oral cavity area; OC). Incidence rates were examined by gender, race, rurality, geographic location, and time. Joinpoint regression analyses assessed temporal variations. From 1973 to 2012, OC incidence decreased while OP increased, with changes largely driven by males (whose OP rate increased 106.2% vs female decrease of 10.3%). Males consistently had higher rates of both cancer groups across each registry except Alaska, OP rates among blacks changed from significantly above whites to below, and trend analysis indicated significant differences in rates over time by gender, race, and geography. Analysis of SEER 18 found that rates discordantly varied by group and gender across the 18 registries, as did the male/female rate ratio with overall means of 4.7 for OP versus 1.7 for OC (only Alaska and Georgia having overlapping ranges). Our findings indicate that much of the HPVa rate increases were driven by rate increases among males and that there were changing differences in risk between genders, race, and geographic location. The epidemiology of HNCs is complex, with locally relevant factors requiring further research for elucidation of demographic disparities in incidence.

Xu C, Chen YP, Liu X, Tang LL, Chen L, Mao YP, Zhang Y, Guo R, Zhou GQ, Li WF, Lin AH, Sun Y, Ma J. Socioeconomic factors and survival in patients with non-metastatic head and neck squamous cell carcinoma. Cancer Sci. 2017 Jun;108(6):1253-1262. doi: 10.1111/cas.13250.

The effect of socioeconomic factors on receipt of definitive treatment and survival outcomes in non-metastatic head and neck squamous cell carcinoma (HNSCC) remains unclear. Eligible patients (n = 37 995) were identified from the United States Surveillance, Epidemiology and End Results (SEER) database between 2007 and 2012. Socioeconomic factors (i.e., median household income, education level, unemployment rate, insurance status, marital status and residence) were included in univariate/multivariate Cox regression analysis; validated factors were used to generate nomograms for cause-specific survival (CSS) and overall survival (OS), and a prognostic score model for risk stratification. Low- and high-risk groups were compared for all cancer subsites. Impact of race/ethnicity on survival was investigated in each risk group. Marital status, median household income and insurance status were included in the nomograms for CSS and OS, which had higher c-indexes than the 6th edition TNM staging system (all P < 0.001). Based on three disadvantageous socioeconomic factors (i.e., unmarried status, uninsured status, median household income <US $65 394), the prognostic score model generated four risk subgroups with scores of 0, 1, 2 or 3, which had significantly separated CSS/OS curves (all P < 0.001). Low-risk patients (score 0-1) were more likely to receive definitive treatment and obtain better CSS/OS than high-risk patients (score 2-3). Chinese and non-Hispanic black patients with high-risk socioeconomic status had best and poorest CSS/OS, respectively. Therefore, marital status, median household income and insurance status have significance for predicting survival outcomes. Low-risk socioeconomic status and Chinese race/ethnicity confer protective effects in HNSCC.

Perloy A, Maasland DHE, van den Brandt PA, Kremer B, Schouten LJ. Intake of meat and fish and risk of head-neck cancer subtypes in the Netherlands Cohort Study. Cancer Causes Control. 2017 Jun;28(6):647-656. doi: 10.1007/s10552-017-0892-0.

To date, the role of meat and fish intake in head-neck cancer (HNC) etiology is not well understood and prospective evidence is limited. This prompted us to study the association between meat, fish, and HNC subtypes, i.e., oral cavity cancer (OCC), oro- and hypopharyngeal cancer (OHPC), and laryngeal cancer (LC), within the Netherlands Cohort Study (NLCS).In 1986, 120,852 participants (aged 55-69 years) completed a baseline 150-item food frequency questionnaire (FFQ), from which daily meat and fish intake were calculated. After 20.3 years of follow-up, 430 HNC overall (134 OCC, 90 OHPC and 203 LC) cases and 4,111 subcohort members were found to be eligible for case-cohort analysis. Multivariate hazard ratios were calculated using Cox’s proportional hazards model within quartiles of energy-adjusted meat and fish intake.Processed meat intake, but not red meat intake, was positively associated with HNC overall [HR(Q4 vs. Q1) = 1.46, 95% CI 1.06-2.00; ptrend = 0.03]. Among HNC subtypes, processed meat was positively associated with OCC, while no associations were found with OHPC and LC. Fish intake was not associated with HNC risk. Tests for interaction did not reveal statistically significant interaction between meat, fish, and alcohol or smoking on HNC overall risk.In this large cohort study, processed meat intake was positively associated with HNC overall and HNC subtype OCC, but not with OHPC and LC.

 

Bakhtiari S, Mortazavi H, Mehdipour M, Jafarian N, Ranjbari N, Rahmani S. Frequency of Head and Neck Squamous Cell Carcinomas and Related Variables in Southern Iran (Ahvaz City): 10-Year Retrospective Study. Asian Pac J Cancer Prev. 2017 Feb 1;18(2):375-379.

Objective: Squamous cell carcinoma (SCC) is a life threatening lesion but there has been only limited research about its frequency in Iran. The aim of this study was to evaluate the frequency of squamous cell carcinoma of the head and neck in the records of the pathology department of Imam Khomeini hospital in Ahvaz between 2005 and 2015. Methods: The retrospective and cross-sectional study was conducted using 55,708 medical records of cancer throughout the body, accumulated in the pathology department of Imam Khomeini in Ahvaz in the designated period. Information about age, gender, site of involvement, histological characteristics, status of lymph node metastasis, smoking habit, family history, job and education level was extracted and data were analyzed with the Chi-square test with SPSS version 22. Result: Of the total of 55,708 records, 582 patients (1.04%) had head and neck squamous cell carcinomas. The male to female ratio was 2.85. The frequencies in the head, mouth and neck were 28.7%, 22% and 49.3% respectively. Significant relationships between being male and location (neck) (p = 0.002), age (60 to 80 years old) and being a farmer (p = 0.001) was observed. The most important correlated risk factors were: smoking, sunlight exposure, rural residence, job and education level. Conclusion: Head and neck squamous cell carcinomas were found to account for 1.04% of all cancers in Ahvaz, one of the southern provinces of Iran.

Peterson CE, Khosla S, Jefferson GD, Davis FG, Fitzgibbon ML, Freels S, Johnson TP, Hoskins K, Joslin CE. Measures of economic advantage associated with HPV-positive head and neck cancers among non-Hispanic black and white males identified through the National Cancer Database. Cancer Epidemiol. 2017 Jun;48:1-7. doi: 10.1016/j.canep.2017.02.011.

National trends show dramatic increases in the incidence of HPV-related head and neck squamous cell carcinomas (HNSCCs) among black and white males. Using cases identified through the National Cancer Data Base, we assessed factors associated with HPV 16- or 16/18 positive HNSCCs among non-Hispanic black and white males diagnosed in the U.S. between 2009 and 2013.This sample included 21,524 HNSCCs with known HPV status. Adjusted relative risks (RRs) and 95% confidence intervals (CIs) were estimated using log-binomial regression.Compared to those with HPV-negative tumors, male patients diagnosed with HPV-positive HNSCCs were non-Hispanic white, younger at diagnosis, lived in zip-code areas with higher median household income and higher educational attainment, had private health insurance and no reported comorbidities at diagnosis. Although the risk of HPV-positive HNSCCs increased with measures of higher area-level socioeconomic status, the effect was stronger for non-Hispanic black males (RRAdjusted=1.76, 95% CI 1.49-2.09) than for whites (RRAdjusted=1.12, 95% CI 1.08-1.16). The peak age for diagnosis of HPV-positive HNSCCs occurred in those diagnosed at 45-49 years (RRAdjusted=1.57, 95% CI 1.42-1.73). Oropharyngeal tumors were strongly associated with HPV-positivity (RRAdjusted=4.32, 95% CI 4.03-4.63). In the analysis restricted to oropharyngeal anatomic sites, similar patterns persisted.In our analysis, measures of economic advantage were associated with an increased risk of HPV-positive HNSCCs. In order to develop effective interventions, greater understanding of the risk factors for HPV-positive HNSCCs is needed among both high-risk males and their healthcare providers.

Getz KR, Rozek LS, Peterson LA, Bellile EL, Taylor JMG, Wolf GT, Mondul AM. Family history of cancer and head and neck cancer survival. Laryngoscope. 2017 Aug;127(8):1816-1820. doi: 10.1002/lary.26524.

Patients with a family history of cancer may be genetically predisposed to carcinogenesis. This could affect risk of recurrence, second primary tumors, and overall outcomes after treatment of a primary cancer. We evaluated the association between family history of cancer and disease-specific survival in a cohort of patients with primary head and neck squamous carcinoma (HNSCC).

Six hundred and forty-three incident HNSCC patients recruited through the University of Michigan Specialized Program of Research Excellence were followed for up to 5 years for survival. Participants were interviewed about personal and family cancer history, demographic information, and behavioral habits.Cox proportional hazards models were used to estimate the association between family history of cancer in a first-degree relative and disease-specific survival.After multivariable adjustment, we found a nonsignificant inverse association between family history and HNSCC mortality (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.57-1.35). This association was stronger and statistically significant among patients who currently both drank alcohol and smoked cigarettes at diagnosis (HR = 0.46, 95% CI = 0.22-0.97); no association was observed among participants who did not both drink and smoke at the time of diagnosis (HR = 1.14, 95% CI = 0.68-1.91; p-interaction = 0.046).Results from this study suggest that having a family history of cancer may be associated with improved disease-specific survival in patients who use tobacco and alcohol. Additional large studies, particularly in populations including nonwhites and women, are needed to confirm or refute the association and to elucidate the genetic factors that may underlie this potential association.

Yakin M, Gavidi RO, Cox B, Rich A. Oral cancer risk factors in New Zealand. N Z Med J. 2017 Mar 3;130(1451):30-38.

Oral cancer constitutes the majority of head and neck cancers, which are the fifth most common malignancy worldwide, accounting for an estimated 984,430 cases in 2012. Between 2000 and 2010, there were 1,916 cases of OSCC in New Zealand with a male to female ratio of 1.85:1, and an age-standardised incidence rate of 42 persons per 1,000,000 population. This article presents an overview of the main risk factors for oral and oropharyngeal cancers and their prevalence in New Zealand. Alcohol consumption is the most prevalent risk factor in New Zealand, followed by tobacco. Given the high prevalence of these two risk factors and their synergistic effect, it is important for doctors and dentists to encourage smoking cessation in smokers and to recommend judicious alcohol intake. Research is needed to determine the prevalence of use of oral preparations of tobacco and water-pipe smoking in New Zealand, especially due to changing demography and increases in migrant populations. UV radiation is also an important risk factor. Further investigations are also needed to determine the prevalence of oral and oropharyngeal cancers attributable to oncogenic HPV infection.

Fakhry C, Westra WH, Wang SJ, van Zante A, Zhang Y, Rettig E, Yin LX, Ryan WR, Ha PK, Wentz A, Koch W, Richmon JD, Eisele DW, D’Souza G. The prognostic role of sex, race, and human papillomavirus in oropharyngeal and nonoropharyngeal head and neck squamous cell cancer. Cancer. 2017 May 1;123(9):1566-1575. doi: 10.1002/cncr.30353.

Human papillomavirus (HPV) is a well-established prognostic marker for oropharyngeal squamous cell cancer (OPSCC). Because of the limited numbers of women and nonwhites in studies to date, sex and racial/ethnic differences in prognosis have not been well explored. In this study, survival differences were explored by the tumor HPV status among 1) patients with OPSCCs by sex and race and 2) patients with nonoropharyngeal (non-OP) head and neck squamous cell cancers (HNSCCs).This retrospective, multi-institution study included OPSCCs and non-OP HNSCCs of the oral cavity, larynx, and nasopharynx diagnosed from 1995 to 2012. Race/ethnicity was categorized as white non-Hispanic, black non-Hispanic, Asian non-Hispanic, and Hispanic of any race. Tumors were centrally tested for p16 overexpression and the presence of HPV by HPV16 DNA and high-risk HPV E6/E7 messenger RNA in situ hybridization. Kaplan-Meier and Cox proportional hazards models were used to evaluate overall survival (OS).The study population included 239 patients with OPSCC and 621 patients with non-OP HNSCC with a median follow-up time of 3.5 years. After adjustments for the tumor HPV status, age, current tobacco use, and stage, the risk of death was lower for women versus men with OPSCC (adjusted hazard ratio, 0.55; P = .04). The results were similar with p16. In contrast, for non-OP HNSCCs, HPV positivity, p16 positivity, and sex were not associated with OS.For OPSCC, there are differences in survival by sex, even after the tumor HPV status has been taken into account. For non-OP HNSCC, the HPV status and the p16 status are not of prognostic significance. Cancer 2017;123:1566-1575. © 2017 American Cancer Society.

Kouyoumdjian FG, Pivnick L, McIsaac KE, Wilton AS, Lofters A, Hwang SW. Cancer prevalence, incidence and mortality in people who experience incarceration in Ontario, Canada: A population-based retrospective cohort study. PLoS One. 2017 Feb 22;12(2):e0171131. doi: 10.1371/journal.pone.0171131. eCollection 2017.

Evidence suggests that many risk factors for cancer are overrepresented in people who experience incarceration, and data on cancer epidemiology are limited for this population. We aimed to describe cancer prevalence, incidence and mortality in adults admitted to provincial custody in Ontario, Canada in 2000.We linked data on 48,166 adults admitted to provincial custody in Ontario in 2000 with Ontario Cancer Registry data to 2012. We calculated cancer prevalence in the 10 years prior to admission to custody in 2000, incidence between 2000 and 2012 and mortality between 2000 and 2011. Standardized for age, we calculated incidence and mortality ratios by sex compared to the general population of Ontario.The 10-year cancer prevalence was 0.4% in men and 0.6% in women at admission to provincial custody in 2000. Between 2000 and 2012, 2.6% of men and 2.8% of women were diagnosed with new cancer. The standardized incidence ratio for cancer was 1.0 (95% CI 0.9-1.0) for men and 0.9 (95% CI 0.7-1.0) for women compared to the general population, and was significantly increased for cervical, head and neck, liver and lung cancers. The standardized mortality ratio was 1.6 (95% CI 1.4-1.7) in men and 1.4 (95% CI 1.0-1.9) in women, and was significantly increased for head and neck, liver, and lung cancers.There is an excess burden of cancer in people who experience incarceration. Cancer prevention should include people who experience incarceration, and the period of incarceration may offer an opportunity for intervention.

Dwojak S, Bhattacharyya N. Racial disparities in preventable risk factors for head and neck cancer. Laryngoscope. 2017 May;127(5):1068-1072. doi: 10.1002/lary.26203.

To demonstrate racial differences in preventable risk behaviors/practices that contribute to head and neck cancer (HNCA).

The Behavioral Risk Factor Surveillance System for 2013 was analyzed. Demographic data were extracted, including age, sex, and race. Social habits considered risk factors for HNCA were also extracted, including alcohol consumption, smoking, and human papillomavirus (HPV) vaccination status. Statistical comparisons were conducted according to race for each risk factor, and additional comparisons were conducted within the American Indian population subgroup for risk factors according to sex.A total of 238.6 million Americans were surveyed. American Indians reported higher rates of binge drinking (19.0%) than whites (17.3%), blacks (12.4%), and Asian Americans (13.1%; P < .001). This rate was significantly higher for American Indian males (23.5%) versus females (13.7%; P < .001). Mean total drinks per month was higher for whites and American Indians (13.5 and 13.5; P < .001). American Indians reported the highest rates of current smoking (28.1%), followed by blacks (20.1%), whites (18.3%), and Asians (10.2%; P < .001). American Indians also reported the highest rates of every day smoking (18.2%), versus whites (13.3%), blacks (13.1%), and Asians (6.1%; P < .001). Rates of HPV vaccination were lowest for American Indians (11.7%), compared to whites (14.6%), blacks (13.6%), and Asians (12%; P = 0.618).There are striking racial disparities in the prevalence of preventable risk factors for HNCA. These data highlight the need for targeted education and prevention programs in particular racial groups.

Meyers TJ, Chang SC, Chang PY, Morgenstern H, Tashkin DP, Rao JY, Cozen W, Mack TM, Zhang ZF. Case-control study of cumulative cigarette tar exposure and lung and upper aerodigestive tract cancers. Int J Cancer. 2017 May 1;140(9):2040-2050. doi: 10.1002/ijc.30632.

The development of comprehensive measures for tobacco exposure is crucial to specify effects on disease and inform public health policy. In this population-based case-control study, we evaluated the associations between cumulative lifetime cigarette tar exposure and cancers of the lung and upper aerodigestive tract (UADT). The study included 611 incident cases of lung cancer; 601 cases of UADT cancers (oropharyngeal, laryngeal and esophageal cancers); and 1,040 cancer-free controls. We estimated lifetime exposure to cigarette tar based on tar concentrations abstracted from government cigarette records and self-reported smoking histories derived from a standardized questionnaire. We analyzed the associations for cumulative tar exposure with lung and UADT cancer, overall and according to histological subtype. Cumulative tar exposure was highly correlated with pack-years among ever smoking controls (Pearson coefficient = 0.90). The adjusted odds ratio (95% confidence limits) for the estimated effect of about 1 kg increase in tar exposure (approximately the interquartile range in all controls) was 1.61 (1.50, 1.73) for lung cancer and 1.21 (1.13, 1.29) for UADT cancers. In general, tar exposure was more highly associated with small, squamous and large cell lung cancer than adenocarcinoma. With additional adjustment for pack-years, positive associations between tar and lung cancer were evident, particularly for small cell and large cell subtypes. Therefore, incorporating the composition of tobacco carcinogens in lifetime smoking exposure may improve lung cancer risk estimation. This study does not support the claim of a null or inverse association between “low exposure” to tobacco smoke and risk of these cancer types.

Adoga AA, Silas OA, Yaro JP, Okwori ET, Iduh AA, Mgbachi CJ. Assessment of the sociodemographic characteristics and efficacy of screening for oral, head and neck potential malignant lesions in apparently healthy adults in Jos Nigeria. Indian J Cancer. 2016 Apr-Jun;53(2):252-255. doi: 10.4103/0019-509X.197713.

This study aims to review our experience with a free oral, HNC-screening program to determine the sociodemographic characteristics of the participants and the effectiveness of this program to improve future programs.In the years of screening, 135 participants presented aged between 21 and 83 years (mean = 47.0; ±15.6) with a male to female ratio of 1.2:1. 32.6% consumed alcohol, and 17.8% were smokers. Smoking (P = 0.04) and alcohol use (P = 0.05) were associated with higher rates of suspicious malignant symptoms. There was no statistical correlation between symptom prevalence and the number of participants requiring immediate consultation for oral, HNC (r = 0.47), and those referred for routine follow-up (r = 0.34). Premalignant and malignant lesions were diagnosed in 5 males aged 44-72 years. 83.7% found the screening program beneficial in increasing their awareness of the disease.This hospital-based screening demonstrates improved awareness among people about oral, HNCs, and survival outcomes on a small scale. A community-based screening with health education to target a larger high-risk population is recommended to encourage individuals to modify high-risk factors and improve outcomes.

Carton M, Barul C, Menvielle G, Cyr D, Sanchez M, Pilorget C, Trétarre B, Stücker I, Luce D; ICARE Study Group. Occupational exposure to solvents and risk of head and neck cancer in women: a population-based case-control study in France. BMJ Open. 2017 Jan 9;7(1):e012833. doi: 10.1136/bmjopen-2016-012833.

Investigation of occupational and environmental CAuses of REspiratory cancers (ICARE), a French population-based case-control study, included 296 squamous cell carcinomas of the head and neck (HNSCC) in women and 775 female controls. Lifelong occupational history was collected. Job-exposure matrices allowed to assess exposure to 5 chlorinated solvents (carbon tetrachloride; chloroform; methylene chloride; perchloroethylene; trichloroethylene), 5 petroleum solvents (benzene; special petroleum product; gasoline; white spirits and other light aromatic mixtures; diesel, fuels and kerosene) and 5 oxygenated solvents (alcohols; ketones and esters; ethylene glycol; diethyl ether; tetrahydrofuran). OR and 95% CIs, adjusted for smoking, alcohol drinking, age and geographical area, were estimated with logistic models.Elevated ORs were observed among women ever exposed to perchloroethylene (OR=2.97, 95% CI 1.05 to 8.45) and trichloroethylene (OR=2.15, 95% CI 1.21 to 3.81). These ORs increased with exposure duration (OR=3.75, 95% CI 0.64 to 21.9 and OR=4.44, 95% CI 1.56 to 12.6 for 10 years or more, respectively). No significantly increased risk of HNSCC was found for occupational exposure to the other chlorinated, petroleum or oxygenated solvents.These findings suggest that exposure to perchloroethylene or trichloroethylene may increase the risk of HNSCC in women. In our study, there is no clear evidence that the other studied solvents are risk factors for HNSCC.

Butler C, Lee YA, Li S, Li Q, Chen CJ, Hsu WL, Lou PJ, Zhu C, Pan J, Shen H, Ma H, Cai L, He B, Wang Y, Zhou X, Ji Q, Zhou B, Wu W, Ma J, Boffetta P, Zhang ZF, Dai M, Hashibe M. Diet and the risk of head-and-neck cancer among never-smokers and smokers in a Chinese population. Cancer Epidemiol. 2017 Feb;46:20-26. doi: 10.1016/j.canep.2016.10.014.

Few studies have been conducted in China to investigate the association between diet and the risk of head-and-neck cancer (HNC). The aim of this study was to determine the relationship between diet and HNC risk in the Chinese population and to examine whether smoking status has any effect on the risk.Our multicenter case-control study included 921 HNC cases and 806 controls. We obtained information on the frequency of both animal- and plant-based food consumption. Unconditional logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (95%CIs).The risk of HNC increased with more frequent consumption of processed meat and fermented foods but decreased with frequent consumption of fruits and vegetables. There was a significant increasing P for trend of 0.006 among smokers who consumed meat and an increased OR among smokers who consumed processed meat (OR 2.95, 95%CI 1.12-7.75). Protective odds ratios for vegetable consumption were observed among smokers only. We also observed protective odds ratios for higher egg consumption among never-smokers (P for trend=0.0.003).Reduced HNC risks were observed for high fruit and vegetable intake, a finding consistent with the results of previous studies. Processed meat intake was associated with an increased risk. The role of dietary factors in HNC in the East Asian population is similar to that in European populations.

Schnelle C, Whiteman DC, Porceddu SV, Panizza BJ, Antonsson A. Past sexual behaviors and risks of oropharyngeal squamous cell carcinoma: a case-case comparison. Int J Cancer. 2017 Mar 1;140(5):1027-1034. doi: 10.1002/ijc.30519.

The incidence of oropharyngeal squamous cell carcinomas (SCCs) is increasing and is believed to reflect changing sexual practices in recent decades. For this case-case comparative study, we collected medical and life-style information and data on sexual behavior from 478 patients treated at the head and neck clinic of a tertiary hospital in Brisbane, Australia. Patients were grouped as (i) oropharyngeal SCC (n = 96), (ii) oral cavity, larynx and hypopharynx SCC (“other HNSCCs,” n = 96), (iii) other SCCs (n = 141), and (iv) other diagnoses (n = 145). We fitted multivariable logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) associated with lifestyle factors and sexual behaviors. Compared to the other three patient groups, the oropharyngeal SCC patients had overall more sexual lifetime partners (kissing, oral sex and sexual intercourse). Oropharyngeal SCC patients were significantly more likely to have ever given oral sex compared to the other three patient groups-93% of oropharyngeal SCC patients, 64% of other HNSCC patients, and 58% of patients with other SCC or other diagnoses. Oropharyngeal SCC patients were significantly more likely to have given oral sex to four or more partners when compared to patients with other HNSCC (odds ratio [OR] 11.9; 95% CI 3.5-40.1), other SCC (OR 16.6; 95% CI 5.3-52.0) or patients with other diagnoses (OR 25.2; 95% CI 7.8-81.7). The very strong associations reported here between oral sex practices and risks of oropharyngeal SCC support the hypothesis that sexually transmitted HPV infections cause some of these cancers.

 

Condon JR, Zhang X, Dempsey K, Garling L, Guthridge S. Trends in cancer incidence and survival for Indigenous and non-Indigenous people in the Northern Territory. Med J Aust. 2016 Nov 21;205(10):454-458.

Age-adjusted incidence rates; rate ratios comparing incidence in NT Indigenous and non-Indigenous populations with that for other Australians; 5-year survival; multivariable Poisson regression of excess mortality.The incidence of most cancers in the NT non-Indigenous population was similar to that for other Australians. For the NT Indigenous population, the incidence of cancer at several sites was much higher (v other Australians: lung, 84% higher; head and neck, 325% higher; liver, 366% higher; cervix, 120% higher). With the exception of cervical cancer (65% decrease), incidence rates in the Indigenous population did not fall between 1991-1996 and 2007-2012. The incidence of several other cancers (breast, bowel, prostate, melanoma) was much lower in 1991-1996 than for other Australians, but had increased markedly by 2007-2012 (breast, 274% increase; bowel, 120% increase; prostate, 116% increase). Five-year survival was lower for NT Indigenous than for NT non-Indigenous patients, but had increased for both populations between 1991-2000 and 2001-2010.The incidence of several cancers that were formerly less common in NT Indigenous people has increased, without a concomitant reduction in the incidence of higher incidence cancers (several of which are smoking-related). The excess burden of cancer in this population will persist until lifestyle risks are mitigated, particularly by reducing the extraordinarily high prevalence of smoking.

 

Shaw R, Beasley N. Aetiology and risk factors for head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016 May;130(S2):S9-S12.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It discusses the aetiology and risk factors for head and neck cancer and the recommended interventions appropriate for each risk factor. Recommendations • Recent evidence synthesis from National Institute for Health and Care Excellence suggests that the following brief interventions for smoking cessation work should be used: ○ Ask smokers how interested they are in quitting (R) ○ If they want to stop, refer them to an intensive support service such as National Health Service Stop Smoking Services (R) ○ If they are unwilling or unable to accept a referral, offer a stop smoking aid, e.g. pharmacotherapy. (R) • Brief interventions are effective for hazardous and harmful drinking. (R) • Specialist interventions are effective in people with alcohol dependence. (R) • Most people with alcohol dependence can undergo medically assisted withdrawal safely at home, after risk assessment. (R) • Management of leukoplakia is not informed by high-level evidence but consensus supports targeted use of biopsy and histopathological assessment. (R) • The management of biopsy proven dysplastic lesions favours: ○ advice to reduce known environmental carcinogens such as tobacco and alcohol (R) ○ surgical excision when the size of the lesions and the patient’s function allows (R) ○ long-term surveillance. (R) • Fanconi anaemia patients should: ○ be followed up in a multidisciplinary specialist Fanconi anaemia clinic (G) ○ have quarterly screening for head and neck squamous cell carcinoma and an aggressive biopsy policy (G) ○ receive prophylactic vaccination against high risk human papilloma virus (G) ○ receive treatment for head and neck squamous cell carcinoma with surgery alone where possible. (G).

Wu YH, Yen CJ, Hsiao JR, Ou CY, Huang JS, Wong TY, Tsai ST, Huang CC, Lee WT, Chen KC, Fang SY, Wu JL, Hsueh WT, Lin FC, Yang MW, Chang JY, Liao HC, Wu SY, Lin CL, Wang YH, Weng YL, Yang HC, Chen YS, Chang JS. A Comprehensive Analysis on the Association between Tobacco-Free Betel Quid and Risk of Head and Neck Cancer in Taiwanese Men. PLoS One. 2016 Oct 25;11(10):e0164937. doi: 10.1371/journal.pone.0164937. eCollection 2016.

Although betel quid (BQ) is an established risk factor of head and neck cancer (HNC), insufficiencies exist in the literature regarding the dose-response, BQ types, HNC sites, and BQ cessation. The current study was conducted to fill these insufficiencies.A hospital-based case-control study was conducted to evaluate the association between BQ and HNC. In-person interview was conducted to collect data on BQ chewing. The current analysis included 487 men newly diagnosed with HNC and 617 male controls who were frequency-matched to the cases by age. The association between BQ and HNC was assessed using multivariable unconditional logistic regression. Ever BQ chewing was associated with an increased HNC risk regardless of the BQ types. A non-linear positive association between BQ and HNC was observed, with a steep rise in HNC risk for the first 5 pack-years or 200,000 minutes of BQ consumption. Every year of BQ cessation was associated with a 2.9% reduction in HNC risk; however, the risk did not reduce to the level of non-BQ chewers even after 20 years of BQ cessation. Eliminating BQ chewing may prevent 51.6% of HNCs, 62.6% of oral cancers, and 41.3% of pharyngeal cancers in Taiwan.Our results supported the positive association between BQ and HNC. BQ cessation is effective in reducing HNC risk and should be encouraged. Because BQ cessation may not reduce the HNC risk to the level of non-BQ chewers, it is important to prevent the initiation of BQ chewing.

Perdomo S, Martin Roa G, Brennan P, Forman D, Sierra MS4. Head and neck cancer burden and preventive measures in Central and South America. Cancer Epidemiol. 2016 Sep;44 Suppl 1:S43-S52. doi: 10.1016/j.canep.2016.03.012.

Central and South America comprise one of the areas characterized by high incidence rates for head and neck cancer. We describe the geographical and temporal trends in incidence and mortality of head and neck cancers in the Central and South American region in order to identify opportunities for intervention on the major identified risk factors: tobacco control, alcohol use and viral infections.We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. Age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 person-years were estimated.Brazil had the highest incidence rates for oral and pharyngeal cancer in the region for both sexes, followed by Cuba, Uruguay and Argentina. Cuba had the highest incidence and mortality rates of laryngeal cancer in the region for males and females. Overall, males had rates about four times higher than those in females. Most countries in the region have implemented WHO recommendations for both tobacco and alcohol public policy control.Head and neck squamous-cell cancer (HNSCC) incidence and mortality rates in the Central and South America region vary considerably across countries, with Brazil, Cuba, French Guyana, Uruguay and Argentina experiencing the highest rates in the region. Males carry most of the HNSCC burden. Improvement and implementation of comprehensive tobacco and alcohol control policies as well as the monitoring of these factors are fundamental to prevention of head and neck cancers in the region.

Chancellor JA, Ioannides SJ, Elwood JM. Oral and oropharyngeal cancer and the role of sexual behaviour: a systematic review. Community Dent Oral Epidemiol. 2016 Sep 19. doi: 10.1111/cdoe.12255.

Following the PRISMA guidelines, we identified observational and interventional studies reporting associations between several different sexual behaviours and OPC or OCC. Study quality was assessed independently by two reviewers using a validated scoring system.

From 513 papers identified, 21, reporting on 20 studies, fulfilled the inclusion criteria. Two cohort studies were rated as moderate quality. The 18 case-control studies were rated as weak; nine comparing people with OPC or OCC to people without cancer, eight comparing HPV-positive to HPV-negative cancer patients and one comparing OPCs to other head and neck cancers. One study was a pooled analysis of seven of the included studies with some additional information. Twelve sexual behaviours were assessed and 69 associations reported. The studies differed in the comparisons made, the sexual behaviours assessed, and how these were reported and categorized, so no quantitative meta-analyses were appropriate. Most studies combined OPC and OCC. Several significantly increased risks were seen with a high number of lifetime sexual partners (nine studies) and with the practice of oral sex (five studies), although two studies found a significant negative association with OCC and ever performing oral sex. Two cohort studies of men and women in homosexual relationships found increases in oral cancer risk, and a cohort study of men married to women who had a history of cervical cancer also showed an increased risk of oral cancers. Results for other sexual behaviours were limited and inconsistent, and these included the following: younger age at first sexual intercourse, number of lifetime oral sex partners, the practice of oral-anal sex, the number of oral-anal sex partners, and ever performing anal sex. Only one study assessed casual sex, never or rare use of a condom and having a sexual partner with a history of genital warts, finding significant associations in the two former behaviours.The current evidence for sexual behaviours being risk factors for oral and oropharyngeal cancer is limited and inconsistent. Evidence suggests that the number of sexual partners and performing oral sex are associated with a greater risk. Furthermore men whose partners have had cervical cancer may have an increased risk. More studies looking at OPC specifically will be useful to determine whether these behaviours are subsite-selective.

Tang L, Hu H, Liu H, Jian C, Wang H, Huang J. Association of nonsteroidal anti-inflammatory drugs and aspirin use and the risk of head and neck cancers: a meta-analysis of observational studies. Oncotarget. 2016 Oct 4;7(40):65196-65207. doi: 10.18632/oncotarget.11239.

Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, have emerged as the potential chemopreventive agents for a number of cancer types, however, previous studies of head and neck cancers (HNC) have yielded inconclusive results. We performed a meta-analysis of observational studies to quantitatively assess the association between NSAIDs use and the risk for HNC.We searched Pubmed, Embase, Google scholar, and Cochrane library for relevant studies that were published in any language, from January 1980 to April 2016. We pooled the odds ratio (OR) from individual studies and performed subgroup, heterogeneity, and publication bias analyses.A total of eleven studies (eight case-control studies and three cohort studies), involving 370,000 participants and 10,673 HNC cases contributed to this meta-analysis. The results of these studies suggested that neither use of overall NSAIDs (OR=0.95; 95% CI, 0.81-1.11), aspirin (OR=0.93; 95% CI, 0.79-1.10), nor nonsteroidal NSAIDs (OR=0.92; 95% CI, 0.76-1.10) were associated with HNC risk. Similar nonsteroidal results were observed when stratified by HNC sites, study design, sample size, and varied adjustment factors. However, we found significant protective effect of ibuprofen (OR=0.85; 95% CI, 0.72-0.99) and long-term aspirin use (≧5years) (OR=0.75; 95% CI, 0.65-0.85) on HNC risk, with low heterogeneity and publication bias.Our meta-analysis results do not support the hypothesis that overall use of NSAIDs significant reduces the risk of HNC. Whereas, we cannot rule out a modest reduction in HNC risk associated with ibuprofen and long-term aspirin use.

Selmer C, Madsen JC, Torp-Pedersen C, Gislason GH, Faber J. Hyponatremia, all-cause mortality, and risk of cancer diagnoses in the primary care setting: A large population study. Eur J Intern Med. 2016 Dec;36:36-43. doi: 10.1016/j.ejim.2016.07.028.

Hyponatremia has been associated with increased all-cause mortality in hospitalized individuals. In this study we examine the risk of all-cause mortality in primary care subjects with hyponatremia, while also exploring the association with subsequent diagnosis of cancer.Retrospective cohort study on subjects who underwent blood tests, consulting their general practitioner 2000-2012 in Copenhagen, Denmark. Reference range for sodium was 135-145mmol/L, and mild, moderate, and severe hyponatremia were defined as 130-135, 125-129, and <125mmol/L, respectively. Primary outcome was all-cause mortality, and secondary outcomes overall and specific types of cancer diagnoses.Among 625,114 included subjects (mean age 49.9 [SD±18.4] years; 43.5% males), 90,926 (14.5%) deaths occurred. All-cause mortality was increased in mild, moderate, and severe hyponatremia (age-adjusted mortality rates [IRs, incidence rates] 26, 30, and 36 per 1000 person-years (py), respectively and incidence rate ratios [IRRs] 1.81 [95% CI: 1.76-1.85], 2.11 [2.00-2.21], and 2.52 [2.26-2.82], respectively) compared with individuals with normonatremia (IR 14 per 1000 py). For the secondary endpoint an increased level-dependent risk was found with lower sodium levels in relation to cancer overall, head and neck cancers, and pulmonary cancer, with severe hyponatremia associated with the highest IRRs (1.77 [1.39-2.24], 5.24 [2.17-12.63]), and 4.99 [3.49-7.15], respectively).All levels of hyponatremia are associated with all-cause mortality in primary care patients and hyponatremia is linked to an increased risk of being diagnosed with any cancer, particularly pulmonary and head and neck cancers.

Alnuaimi AD, Ramdzan AN, Wiesenfeld D, O’Brien-Simpson NM, Kolev SD, Reynolds EC, McCullough MJ. Candida virulence and ethanol-derived acetaldehyde production in oral cancer and non-cancer subjects. Oral Dis. 2016 Nov;22(8):805-814. doi: 10.1111/odi.12565.

To compare biofilm-forming ability, hydrolytic enzymes and ethanol-derived acetaldehyde production of oral Candida isolated from the patients with oral cancer and matched non-oral cancer.Fungal biofilms were grown in RPMI-1640 medium, and biofilm mass and biofilm activity were assessed using crystal violet staining and XTT salt reduction assays, respectively. Phospholipase, proteinase, and esterase production were measured using agar plate method, while fungal acetaldehyde production was assessed via gas chromatography.Candida isolated from patients with oral cancer demonstrated significantly higher biofilm mass (P = 0.031), biofilm metabolic activity (P < 0.001), phospholipase (P = 0.002), and proteinase (P = 0.0159) activity than isolates from patients with non-oral cancer. High ethanol-derived acetaldehyde-producing Candida were more prevalent in patients with oral cancer than non-oral cancer (P = 0.01). In univariate regression analysis, high biofilm mass (P = 0.03) and biofilm metabolic activity (P < 0.001), high phospholipase (P = 0.003), and acetaldehyde production ability (0.01) were significant risk factors for oral cancer; while in the multivariate regression analysis, high biofilm activity (0.01) and phospholipase (P = 0.01) were significantly positive influencing factors on oral cancer.These data suggest a significant positive association between the ability of Candida isolates to form biofilms, to produce hydrolytic enzymes, and to metabolize alcohol to acetaldehyde with their ability to promote oral cancer development.

Emanuelli E, Alexandre E, Cazzador D, Comiati V, Volo T, Zanon A, Scapellato ML, Carrieri M, Martini A, Mastrangelo G. A case-case study on sinonasal cancer prevention: effect from dust reduction in woodworking and risk of mastic/solvents in shoemaking. J Occup Med Toxicol. 2016 Jul 21;11:35. doi: 10.1186/s12995-016-0124-7. eCollection 2016.

Sinonasal cancers (SNCs) are rare neoplasms, accounting for about 3 % of head and neck cancers, with squamous cell carcinoma (SCC) and adenocarcinoma (ADC) as the most common subtypes. ADCs present strong associations with occupational wood dust exposure. Preventive measures have progressively reduced wood dust concentrations in workplaces but no study has evaluated the effectiveness of such interventions. Few studies indicate associations between ADC and exposure to solvents, which is common in the shoe industry, but this hypothesis still needs confirmation.In a case-case study, we contrasted 32 ADCs against 21 Non-Adenocarcinoma Epithelial Tumors (NAETs) – all recruited from the same clinical setting (Padua’s University Hospital; period 2004-2015) – using questionnaires and clinical records to collect information on potential predictors. Non-occupational factors were age, sex, smoking, allergy and chronic sinusitis. Occupational factors were intensity and frequency of wood dust exposure, protection from wood dust, type of wood (in woodworking); frequency of exposure to leather dust or mastic/solvent (in shoemaking). Odds-ratio (OR), 95 % confidence interval (95 % CI) and two-tail p-values were obtained through stepwise backward logistic regression for each industry, always using as reference patients never employed in either trade and adjusting for non-occupational risk factors.Adjusted OR was 22.5 (95 % CI = 3.50-144; p = 0.001) and 9.37 (95 % CI = 1.29-67.6; p = 0.026), respectively, in patients with low or high degree of protection against wood dust. In the shoe industry, adjusted OR was 1 and 18.8 (95 % CI = 1.29-174; p = 0.030), respectively, in patients with low or high exposure to only mastic/solvent; and 1 and 22.5 (95 % CI = 2.07-244; p = 0.011), respectively, in patients with low or high exposure to only leather dust.The questionnaire used was able to estimate with simple algorithms past exposures in wood and footwear industries. The case-case design considerably increased the validity of this small study. Results in this study were always consistent with the extant literature; this could support reliability of novel findings. In woodworking, respiratory protective equipment and local exhaust ventilation reduced the risk of occupational SNC; in footwear manufacture, where preventive interventions were seldom adopted, SNC risk was significantly greater for high exposure from mastic/solvent and leather dust.

Wu CC, Chang CM, Hsu TW, Lee CH, Chen JH, Huang CY, Lee CC. The effect of individual and neighborhood socioeconomic status on esophageal cancer survival in working-age patients in Taiwan. Medicine (Baltimore). 2016 Jul;95(27):e4140. doi: 10.1097/MD.0000000000004140.

Esophageal cancer is the sixth leading cause of cancer mortality. More than 90% of patients with esophageal cancer in Taiwan have squamous cell carcinoma. Survival of such patients is related to socioeconomic status (SES). We studied the association between SES (individual and neighborhood) and the survival of working-age patients with esophageal cancer in Taiwan. A population-based study was conducted of 4097 patients diagnosed with esophageal cancer between 2002 and 2006. Each was traced for 5 years or until death. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income and dichotomized into advantaged or disadvantaged. Multilevel logistic regression was used to compare the survival rates by SES group after adjustment for possible confounding and risk factors. Hospital and neighborhood SES were used as random effects in multilevel logistic regression. In patients younger than 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjustment for patient characteristics, esophageal cancer patients with high individual SES had a 39% lower risk of mortality than those with low individual SES (odds ratio 0.61, 95% confidence interval 0.48-0.77). Patients living in disadvantaged areas with high individual SES were more likely to receive surgery than those with low SES (odds ratio 1.45, 95% confidence interval 1.11-1.89). Esophageal cancer patients with low individual SES have the worst 5-year survival, even with a universal healthcare system. Public health, education, and social welfare programs should address the inequality of esophageal cancer survival.

Sterba KR, Garrett-Mayer E, Carpenter MJ, Tooze JA, Hatcher JL, Sullivan C, Tetrick LA, Warren GW, Day TA, Alberg AJ, Weaver KE. Smoking status and symptom burden in surgical head and neck cancer patients. Laryngoscope. 2017 Jan;127(1):127-133. doi: 10.1002/lary.26159.

Head and neck squamous cell carcinoma (HNSCC) patients who smoke are at risk for poor treatment outcomes. This study evaluated symptom burden and clinical, sociodemographic, and psychosocial factors associated with smoking in surgical patients to identify potential targets for supportive care services.Individuals with HNSCC of the oral cavity, larynx, or pharynx were recruited from two cancer centers and completed questionnaires assessing smoking status (never, former, current/recent), patient characteristics, and symptoms before surgery.

Of the 103 patients enrolled, 73% were male, 52% were stage IV, 41% reported current/recent smoking, and 37% reported former smoking. Current/recent smokers were less likely than former smokers to have adequate finances (53% vs. 89%, P = .001) and be married/partnered (55% vs. 79%, P = .03). Current/recent smokers were also more likely than both former and never smokers to be unemployed (49% vs. 40% and 13%, respectively, all P = .02) and lack health insurance (17% vs. 5% and 13%, respectively, all P ≤.04). Fatalistic beliefs (P = .03) and lower religiosity (P =.04) were more common in current/recent than never smokers. In models adjusted for sociodemographic/clinical factors, current/recent smokers reported more problems than former and never smokers with swallowing, speech, and cough (P ≤.04). Current/recent smokers also reported more problems than never smokers with social contact, feeling ill, and weight loss (P ≤ .02).HNSCC patients reporting current/recent smoking before surgery have high-risk clinical and sociodemographic features that may predispose them to poor postoperative outcomes. Unique symptoms in HNSCC smokers may be useful targets for patient-centered clinical monitoring and intervention.

 

Koyanagi YN, Matsuo K, Ito H, Wakai K, Nagata C, Nakayama T, Sadakane A, Tanaka K, Tamakoshi A, Sugawara Y, Mizoue T, Sawada N, Inoue M, Tsugane S, Sasazuki S; Research Group for the Development and Evaluation of Cancer Prevention Strategies in Japan, Sasazuki S, Tsugane S, Inoue M, Iwasaki M, Otani T, Sawada N, Shimazu T, Yamaji T, Tsuji I, Tsubono Y, Nishino Y, Tamakoshi A, Matsuo K, Ito H, Wakai K, Nagata C, Mizoue T, Tanaka K, Nakayama T, Sadakane A; Research Group for the Development and Evaluation of Cancer Prevention Strategies in Japan. Cigarette smoking and the risk of head and neck cancer in the Japanese population: a systematic review and meta-analysis. Jpn J Clin Oncol. 2016 Jun;46(6):580-95. doi: 10.1093/jjco/hyw027.

Although cigarette smoking is a well-established risk factor for head and neck cancer, the impact of smoking on head and neck cancer might vary among geographic areas. To date, however, no systematic review of cigarette smoking and head and neck cancer in the Japanese population has yet appeared.We conducted a systematic review of previous epidemiological studies for cigarette smoking and head and neck cancer among Japanese. Evaluation of associations was based on the strength of evidence (‘convincing’, ‘probable’, ‘possible’ or ‘insufficient’) and the magnitude of association (‘strong’, ‘moderate’, ‘weak’ or ‘no association’), together with biological plausibility as previously evaluated by the International Agency for Research on Cancer. A meta-analysis was conducted to obtain summary estimates for the overall magnitude of association.We identified five cohort studies and 12 case-control studies. Four of five cohort studies and 11 of 12 case-control studies showed a strong positive association between cigarette smoking and head and neck cancer. Nine of 12 studies indicated a dose-response relationship between cigarette smoking and the risk of head and neck cancer. Meta-analysis of 12 studies indicated that the summary relative risk for ever smokers relative to never smokers was 2.43 (95% confidence interval: 2.09-2.83). Summary relative risks for current and former smokers relative to never smokers were 2.68 (2.08-3.44) and 1.49 (1.05-2.11), respectively.Cigarette smoking is a convincing risk factor for head and neck cancer in the Japanese population.

Woto-Gaye G, M’Farrej MK, Doh K, Thiam I, Touré S, Diop R, Dial C. Human papilloma viruses: other risk factor of head and neck carcinoma. Bull Soc Pathol Exot. 2016 Aug;109(3):160-4. doi: 10.1007/s13149-016-0500-7.

 

Head and neck carcinoma (HNC) occupy the sixth place as the most frequent type of cancer worldwide. Next to alcohol and tobacco intoxication, other risk factors (RF) are suspected, including the human papilloma viruses (HPVs). The aim of this study was to highlight the prevalence of HPVs and histo-epidemiological characteristics of HNC HPV+ in Senegal. This is a prospective, multicenter preliminary study of 18 months (January 1, 2012-June 30, 2014). The cases of HNC histologically confirmed in Senegal were then sent to the bio-pathology department of the Curie Institute in Paris to search HPVs. In the 90 included cases, the PCR technique was successful in 54 cases (60%). HPVs were found in seven cases, that is, a prevalence of 13%. HPVs were associated with 5 cases of hypopharyngeal carcinoma and 2 cases of carcinoma of the oral cavity. Patients with HNC HPV+ had a median age of 42 years against 49 years for HPV-patients. Three patients (42.8%) with HPV+ carcinomas were smokers. Of the 47 HPV-patients, 40 patients (87.1%) had alcohol intoxication and/or smoking. The concept of oral sex was refuted by all our patients. Squamous cell carcinoma was the only histological type found. HPV+ cell carcinoma showed no specific histological appearance. HPVs are another certain RF of HNC in Senegal. The major therapeutic and prognostic impact of HPVinduced cancers requires the systematic search of the viruses by the PCR technique.

Lee PN, Thornton AJ, Hamling JS. Epidemiological evidence on environmental tobacco smoke and cancers other than lung or breast. Regul Toxicol Pharmacol. 2016 Oct;80:134-63. doi: 10.1016/j.yrtph.2016.06.012.

We reviewed 87 epidemiological studies relating environmental tobacco smoke (ETS) exposure to risk of cancer other than lung or breast in never smoking adults. This updates a 2002 review which also considered breast cancer. Meta-analysis showed no significant relationship with ETS for nasopharynx cancer, head and neck cancer, various digestive cancers (stomach, rectum, colorectal, liver, pancreas), or cancers of endometrium, ovary, bladder and brain. For some cancers (including oesophagus, colon, gall bladder and lymphoma) more limited data did not suggest a relationship. An increased cervix cancer risk (RR 1.58, 95%CI 1.29-1.93, n = 17 independent estimates), reducing to 1.29 (95%CI 1.01-1.65) after restriction to five estimates adjusting for HPV infection or sexual activity suggests a causal relationship, as do associations with nasosinus cancer observed in 2002 (no new studies since), and less so kidney cancer (RR 1.33, 95%CI 1.04-1.70, n = 6). A weaker association with total cancer (RR 1.13, 95%CI 1.03-1.35, n = 19) based on heterogeneous data is inconclusive. Inadequate confounder control, recall bias, publication bias, and occasional reports of implausibly large RRs in individual studies contribute to our conclusion that the epidemiological evidence does not convincingly demonstrate that ETS exposure causes any of the cancers studied.

Zaoui K, Doll J, Stiebi P, Federspil P, Plinkert PK, Hess J. Diabetes mellitus as a prognostic marker in oropharyngeal and laryngeal squamous cell carcinoma. HNO. 2016 Jul;64(7):479-86. doi: 10.1007/s00106-016-0177-z.

Recent experimental and clinical studies have provided compelling evidence that diabetes mellitus (DM) is an important risk factor in various cancers, and may affect both pathogenesis and prognosis. Additionally, antidiabetic agents such as metformin exhibit an antitumorigenic effect. However, to date there is insufficient knowledge about the role of DM in the pathogenesis and prognosis of head and neck squamous cell carcinoma (HNSCC).In a retrospective monocentric study including 424 patients with SCC of the oropharynx (OPSCC) or larynx (LaSCC), the impact of DM on clinical and histopathologic parameters was investigated. The authors found a rising incidence of DM among LaSCC patients (<10 % until 2005 and 20 % since 2006) and a significant association between DM and clinical and histopathologic features (age, gender, tumor size, and pathologic grading), which depended on the anatomic site. Moreover, a clear trend toward unfavorable progression-free and overall survival of HNSCC patients with DM upon current treatment modalities was evident.The presented data support a relative increase in patients with DM, particularly for LaSCC. This might have a sustained influence on treatment decisions and management, and should be considered in future clinical trials. A better understanding of the cellular and molecular traits of HNSCC in DM could pave the way for innovative therapeutic strategies in terms of personalized medicine.

Vlastarakos PV, Vassileiou A, Delicha E, Kikidis D, Protopapas D, Nikolopoulos TP. Dietary consumption patterns and laryngeal cancer risk. Ear Nose Throat J. 2016 Jun;95(6):E32-8.

We conducted a case-control study to investigate the effect of diet on laryngeal carcinogenesis. Our study population was made up of 140 participants-70 patients with laryngeal cancer (LC) and 70 controls with a non-neoplastic condition that was unrelated to diet, smoking, or alcohol. A food-frequency questionnaire determined the mean consumption of 113 different items during the 3 years prior to symptom onset. Total energy intake and cooking mode were also noted. The relative risk, odds ratio (OR), and 95% confidence interval (CI) were estimated by multiple logistic regression analysis. We found that the total energy intake was significantly higher in the LC group (p < 0.001), and that the difference remained statistically significant after logistic regression analysis (p < 0.001; OR: 118.70). Notably, meat consumption was higher in the LC group (p < 0.001), and the difference remained significant after logistic regression analysis (p = 0.029; OR: 1.16). LC patients also consumed significantly more fried food (p = 0.036); this difference also remained significant in the logistic regression model (p = 0.026; OR: 5.45). The LC group also consumed significantly more seafood (p = 0.012); the difference persisted after logistic regression analysis (p = 0.009; OR: 2.48), with the consumption of shrimp proving detrimental (p = 0.049; OR: 2.18). Finally, the intake of zinc was significantly higher in the LC group before and after logistic regression analysis (p = 0.034 and p = 0.011; OR: 30.15, respectively). Cereal consumption (including pastas) was also higher among the LC patients (p = 0.043), with logistic regression analysis showing that their negative effect was possibly associated with the sauces and dressings that traditionally accompany pasta dishes (p = 0.006; OR: 4.78). Conversely, a higher consumption of dairy products was found in controls (p < 0.05); logistic regression analysis showed that calcium appeared to be protective at the micronutrient level (p < 0.001; OR: 0.27). We found no difference in the overall consumption of fruits and vegetables between the LC patients and controls; however, the LC patients did have a greater consumption of cooked tomatoes and cooked root vegetables (p = 0.039 for both), and the controls had more consumption of leeks (p = 0.042) and, among controls younger than 65 years, cooked beans (p = 0.037). Lemon (p = 0.037), squeezed fruit juice (p = 0.032), and watermelon (p = 0.018) were also more frequently consumed by the controls. Other differences at the micronutrient level included greater consumption by the LC patients of retinol (p = 0.044), polyunsaturated fats (p = 0.041), and linoleic acid (p = 0.008); LC patients younger than 65 years also had greater intake of riboflavin (p = 0.045). We conclude that the differences in dietary consumption patterns between LC patients and controls indicate a possible role for lifestyle modifications involving nutritional factors as a means of decreasing the risk of laryngeal cancer.

Peterson CE, Khosla S, Chen LF, Joslin CE, Davis FG, Fitzgibbon ML, Freels S, Hoskins K. Racial differences in head and neck squamous cell carcinomas among non-Hispanic black and white males identified through the National Cancer Database (1998-2012). J Cancer Res Clin Oncol. 2016 Aug;142(8):1715-26. doi: 10.1007/s00432-016-2182-8.

Head and neck squamous cell carcinoma (HNSCC) incidence is increasing, and evidence suggests survival disparities between non-Hispanic (nH) black and white males. However, temporal changes in HNSCCs and factors contributing to survival differences have not been examined at the national level.National Cancer Database (NCDB) cases were used to evaluate temporal trends in HNSCC anatomical sites and site groupings (i.e., oral cavity, oropharyngeal, non-oropharyngeal), and to estimate incidence ratios (IRs) comparing nH black and white males in demographic and clinical characteristics.Between 1998 and 2012, 18,443 (11 %) nH black males and 145,611 (89 %) nH white males were diagnosed with HNSCCs. Cases rose from 9094 diagnosed in 1998 to 13,838 in 2012, driven by increases in oropharyngeal tumors, particularly tumors of the tonsil and tongue. Annual percent changes in nH black males and nH white males were 1.93 and 3.17, respectively. Additionally, nH black males had higher incidence of the more aggressive non-oropharyngeal tumors (p < .0001) and distant-stage tumors (76 vs. 64 %, p < .0001). However, nH white males had higher incidence of high-risk HPV types (IRs range from 1.68, 95 % CI 1.50-1.88 in oropharyngeal tumors to 3.03, 95 % CI 1.11-8.25 in non-oropharyngeal tumors).Incidence of oropharyngeal tumors has risen in both nH black and white males. However, nH white males have higher incidence of HPV, and nH black males have higher incidence of more aggressive and advanced HNSCCs. Racial differences in clinical characteristics associated with poorer survival exist, and future studies should determine factors associated with these differences.

 

Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, Keadle SK, Arem H, Berrington de Gonzalez A, Hartge P, Adami HO, Blair CK, Borch KB, Boyd E, Check DP, Fournier A, Freedman ND, Gunter M, Johannson M, Khaw KT, Linet MS, Orsini N, Park Y, Riboli E, Robien K, Schairer C, Sesso H, Spriggs M, Van Dusen R, Wolk A, Matthews CE, Patel AV. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016 Jun 1;176(6):816-25. doi: 10.1001/jamainternmed.2016.1548.

Leisure-time physical activity has been associated with lower risk of heart-disease and all-cause mortality, but its association with risk of cancer is not well understood.To determine the association of leisure-time physical activity with incidence of common types of cancer and whether associations vary by body size and/or smoking.We pooled data from 12 prospective US and European cohorts with self-reported physical activity (baseline, 1987-2004). We used multivariable Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals for associations of leisure-time physical activity with incidence of 26 types of cancer. Leisure-time physical activity levels were modeled as cohort-specific percentiles on a continuous basis and cohort-specific results were synthesized by random-effects meta-analysis. Hazard ratios for high vs low levels of activity are based on a comparison of risk at the 90th vs 10th percentiles of activity. The data analysis was performed from January 1, 2014, to June 1, 2015.Leisure-time physical activity of a moderate to vigorous intensity. A total of 1.44 million participants (median [range] age, 59 [19-98] years; 57% female) and 186 932 cancers were included. High vs low levels of leisure-time physical activity were associated with lower risks of 13 cancers: esophageal adenocarcinoma (HR, 0.58; 95% CI, 0.37-0.89), liver (HR, 0.73; 95% CI, 0.55-0.98), lung (HR, 0.74; 95% CI, 0.71-0.77), kidney (HR, 0.77; 95% CI, 0.70-0.85), gastric cardia (HR, 0.78; 95% CI, 0.64-0.95), endometrial (HR, 0.79; 95% CI, 0.68-0.92), myeloid leukemia (HR, 0.80; 95% CI, 0.70-0.92), myeloma (HR, 0.83; 95% CI, 0.72-0.95), colon (HR, 0.84; 95% CI, 0.77-0.91), head and neck (HR, 0.85; 95% CI, 0.78-0.93), rectal (HR, 0.87; 95% CI, 0.80-0.95), bladder (HR, 0.87; 95% CI, 0.82-0.92), and breast (HR, 0.90; 95% CI, 0.87-0.93). Body mass index adjustment modestly attenuated associations for several cancers, but 10 of 13 inverse associations remained statistically significant after this adjustment. Leisure-time physical activity was associated with higher risks of malignant melanoma (HR, 1.27; 95% CI, 1.16-1.40) and prostate cancer (HR, 1.05; 95% CI, 1.03-1.08). Associations were generally similar between overweight/obese and normal-weight individuals. Smoking status modified the association for lung cancer but not other smoking-related cancers.Leisure-time physical activity was associated with lower risks of many cancer types. Health care professionals counseling inactive adults should emphasize that most of these associations were evident regardless of body size or smoking history, supporting broad generalizability of findings.

Seijas-Tamayo R, Fernández-Mateos J, Adansa Klain JC, Mesía R, Pastor Borgoñón M, Pérez-Ruiz E, Vázquez Fernández S, Salvador Coloma C, Rueda Domínguez A, Taberna M, Martínez-Trufero J, Bonfill Abella T, Vázquez Estévez S, Pollán M, Del Barco Morillo E, Cruz-Hernández JJ. Epidemiological characteristics of a Spanish cohort of patients diagnosed with squamous cell carcinoma of head and neck: distribution of risk factors by tumor location. Clin Transl Oncol. 2016 Nov;18(11):1114-1122.

Head and neck cancer is a highly heterogeneous disease comprising a large number of tumors located in the cervicofacial area. This study aimed to determine the epidemiological characteristics of squamous-cell carcinomas of the head and neck in the Spanish population, and the distribution of risk factors based on tumor locations.A cohort of 459 patients (75 oral cavity, 167 oro-/hypopharyngeal and 217 laryngeal cancers) recruited in 19 hospitals participating in the Spanish head and neck cancer cooperative group were included over 3 years (2012-2014). Epidemiological parameters and risk factors were obtained from a self-administered questionnaire, and tumor characteristics were obtained from clinical records. Multivariate multinomial logistic regression was used to assess factors associated with tumor location.Most patients were males (88.4 %), smokers (95 %) and drinkers (76.5 %). Relative to laryngeal cancer, pharyngeal cancer and oral cancer were more common in women than men (OR 3.58, p = 0.003 and 4.33, p = 0.001, respectively); pharyngeal cancer was more associated with rural environment (OR 1.81, p = 0.007) and weekly alcohol intake (10-140 g: OR 2.53, p = 0.012; 141-280 g: OR 2.47, p = 0.023; >280 g: OR 3.20, p = 0.001) and less associated with pack-years of smoking (21-40 packs: OR 0.46, p = 0.045; 41-70 packs: OR 0.43, p = 0.023; ≥71 packs: OR 3.20, p = 0.015).The distribution of these tumors differs between the sexes, with a higher proportion of oral cavity and pharyngeal tumors in women than in men. Oro-/hypopharyngeal cancers were more strongly associated with rural areas and with alcohol consumption, although less strongly associated with smoking than laryngeal tumors.

Maasland DH, Schouten LJ, Kremer B, van den Brandt PA. Toenail selenium status and risk of subtypes of head-neck cancer: The Netherlands Cohort Study. Eur J Cancer. 2016 Jun;60:83-92. doi: 10.1016/j.ejca.2016.03.003.

There is limited prospective data on the relationship between selenium status and the risk of head-neck cancer (HNC) and HNC subtypes (i.e., oral cavity cancer [OCC], oro-/hypopharyngeal cancer [OHPC] and laryngeal cancer [LC]). Therefore, we investigated the association between toenail selenium, reflecting long-term selenium exposure, and HNC risk within the Netherlands Cohort Study.At baseline, 120,852 participants completed a self-administered questionnaire about diet and other cancer risk factors and were asked to provide toenail clippings. After 20.3 years of follow-up, 294 cases of HNC (95 OCC, 62 OHPC, two oral cavity/pharynx unspecified or overlapping and 135 LC) and 2,164 subcohort members were available for case-cohort analysis using Cox proportional hazards models.Toenail selenium status was statistically significantly associated with a decreased risk of HNC overall (multivariate RR for quartile four versus one: 0.55, 95% confidence interval [CI] 0.37-0.82, P trend = 0.001). The association between toenail selenium and risk of HNC overall was stronger among men than women, but no statistically significant interaction with sex was found. Toenail selenium level was also associated with a decreased risk of all HNC subtypes, with statistically significant associations in OHPC and LC. No statistically significant interaction was found between toenail selenium level and cigarette smoking or alcohol consumption for HNC overall.In this large cohort study, we found an inverse association between toenail selenium level and HNC risk. Among HNC subtypes, this association was strongest for OHPC and LC. Furthermore, the association of toenail selenium status with HNC risk was stronger among men than women.

Shridhar K, Rajaraman P, Koyande S, Parikh PM, Chaturvedi P, Dhillon PK, Dikshit RP. Trends in mouth cancer incidence in Mumbai, India (1995-2009): An age-period-cohort analysis. Cancer Epidemiol. 2016 Jun;42:66-71. doi: 10.1016/j.canep.2016.03.007.

Despite tobacco control and health promotion efforts, the incidence rates of mouth cancer are increasing across most regions in India. Analysing the influence of age, time period and birth cohort on these secular trends can point towards underlying factors and help identify high-risk populations for improved cancer control programmes.We evaluated secular changes in mouth cancer incidence among men and women aged 25-74 years in Mumbai between 1995 and 2009 by calculating age-specific and age-standardized incidence rates (ASR). We estimated the age-adjusted linear trend for annual percent change (EAPC) using the drift parameter, and conducted an age-period-cohort (APC) analysis to quantify recent time trends and to evaluate the significance of birth cohort and calendar period effects.Over the 15-year period, age-standardized incidence rates of mouth cancer in men in Mumbai increased by 2.7% annually (95% CI:1.9 to 3.4), p<0.0001) while rates among women decreased (EAPC=-0.01% (95% CI:-0.02 to -0.002), p=0.03). APC analysis revealed significant non-linear positive period and cohort effects in men, with higher effects among younger men (25-49 years). Non-significant increasing trends were observed in younger women (25-49 years).APC analyses from the Mumbai cancer registry indicate a significant linear increase of mouth cancer incidence from 1995 to 2009 in men, which was driven by younger men aged 25-49 years, and a non-significant upward trend in similarly aged younger women. Health promotion efforts should more effectively target younger cohorts.

Marur S, Forastiere AA. Head and Neck Squamous Cell Carcinoma: Update on Epidemiology, Diagnosis, and Treatment. Mayo Clin Proc. 2016 Mar;91(3):386-96. doi: 10.1016/j.mayocp.2015.12.017.

Squamous cell carcinoma arises from multiple anatomic subsites in the head and neck region. The risk factors for development of cancers of the oral cavity, oropharynx, hypopharynx, and larynx include tobacco exposure and alcohol dependence, and infection with oncogenic viruses is associated with cancers developing in the nasopharynx, palatine, and lingual tonsils of the oropharynx. The incidence of human papillomavirus-associated oropharyngeal cancer is increasing in developed countries, and by 2020, the annual incidence could surpass that of cervical cancer. The treatment for early-stage squamous cell cancers of the head and neck is generally single modality, either surgery or radiotherapy. The treatment for locally advanced head and neck cancers is multimodal, with either surgery followed by adjuvant radiation or chemoradiation as indicated by pathologic features or definitive chemoradiation. For recurrent disease that is not amenable to a salvage local or regional approach and for metastatic disease, chemotherapy with or without a biological agent is indicated. To date, molecular testing has not influenced treatment selection in head and neck cancer. This review will focus on the changing epidemiology, advances in diagnosis, and treatment options for squamous cell cancers of the head and neck, along with data on risk stratification specific to oropharyngeal cancer, and will highlight the direction of current trials.

Al-Jaber A, Al-Nasser L, El-Metwally A. Epidemiology of oral cancer in Arab countries. Saudi Med J. 2016 Mar;37(3):249-55. doi: 10.15537/smj.2016.3.11388.

To review the oral cancer (OC) studies that were conducted in Arab countries with regard to epidemiology, risk factors, and prognosis.A computer-based PubMed literature search was performed to retrieve studies conducted in the Arab world on epidemiology of OC. After screening for exclusion criteria, cross-referencing, and searching local journals, a total of 19 articles were included.Eight prevalence studies found an OC prevalence ranging from 1.8 to 2.13 per 100,000 persons. Oral cancer patients were mostly in their fifth to sixth decade of life, and the incidence in younger age was reported in some Arab countries. Yemenis have an alarming high prevalence of OC among people younger than 45 years. Eleven studies explored determinants or prognosis of OC. Behavioral determinants such as smokeless tobacco (Shamma and Qat), and cigarette smoking were strongly associated with OC. Alcohol drinking and solar radiation exposures were cited as possible risk factors. The most affected sites were tongue, floor of the mouth, and lower lip variations in the affected site were attributed to the socio-cultural behavior of the populations under study. Squamous cell carcinoma was the most frequently detected cancer, and usually patients were in late stages (III and IV) at the time of diagnosis.No solid evidence exists regarding the true OC prevalence/incidence in most Arab countries due to the lack of national cancer registries and population-based studies.

Owczarek K, Jałocha-Kaczka A, Bielińska M, Urbaniak J, Olszewski J. Evaluation of risk factors for oral cavity and oropharynx cancers in patients under the week activity program of head and neck cancers prevention in Lodz. Otolaryngol Pol. 2015;69(6):15-21. doi: 10.5604/00306657.1182713.

The aim of the study was to evaluate risk factors for oral cavity and oropharynx cancers in patients under the week activity program of head and neck cancers prevention in Lodz.104 people reported to preventive examinations under the week activity program of head and neck cancers prevention in Lodz (25-th of September, 2015): 33 women aged 21-68 and 38 men aged 23-71. Before ENT examination, subjects completed the questionnaire, which concerned: the degree of education, source of information about preventive examinations, symptoms, smoking, number of smoked cigarettes, alcohol, number of life sexual partners, number of oral sex partners and family history of head and neck cancers.The analysis showed that people who reported to preventive examination were mostly in the age group of 51-60 and over 60, respectively 71,2% of women and 57,9% of men. Patients were at the age, that predispose to oral cavity and oropharynx cancers. In our own material, 15,9% of women and 23,6% of men have smoked. Most of them have smoked 10-20 cigarettes daily. On the other hand, 40,9% of women and 10,5% of men didn’t consume alcohol. In our study, both women and men had, at life, 1-3 sexual partners the most often, respectively 78,9% and 60,5%. The oral sex was cultivated by 45,5% of women and 60,5% of men, the most often with 1-3 partners, respectively 95,8% and 70,0%. Based on complete ENT examination and the presence of risk factors for oral cavity and oropharynx cancers, 14,4% of patients were qualified to further oncological examinations including: videolaryngostroboscopy, neck ultrasound with fine-needle biopsy, neck CT and HPV test.

Tsai CT, Ho MW, Lin D, Chen HJ, Muo CH, Tseng CH, Su WC, Lin MC, Kao CH. Association of Head and Neck Cancers in Chronic Osteomyelitis: A National Retrospective Cohort Study. Medicine (Baltimore). 2016 Jan;95(3):e2407. doi: 10.1097/MD.0000000000002407.

The aim of study is to determine whether chronic osteomyelitis (COM) is linked to an increased risk of head and neck cancer (HNC).We identify 17,033 patients with osteomyelitis and 68,125 subjects without osteomyelitis during 1996 to 2010 periods. Multivariable Cox proportional hazards regression analysis was used to measure the hazard ratio (HR) of head and neck cancer for the osteomyelitis cohort compared with the comparison cohort.A total of 99 patients in the COM and 228 patients in the comparison cohort developed HNC during an average 5.12 years of follow-up period. The incidence rate of HNC in the COM cohort was 1.51-fold (95% confidence interval [CI]: 1.17-1.95) higher than that in the comparison cohort after adjusting gender, age, urbanization level, monthly income, and comorbidities. In subgroup analysis, younger (less than 45 years-old) and patients without comorbidities have greater risks (adjusted HR: 2.29 [95% CI:1.43-3.66] and 1.74 [95% CI:1.28-2.38] respectively).This study results suggested the association between COM and HNC, particularly in younger population and patients without comorbidities.

Michaud DS, Kelsey KT, Papathanasiou E, Genco CA, Giovannucci E. Periodontal disease and risk of all cancers among male never smokers: an updated analysis of the Health Professionals Follow-up Study. Ann Oncol. 2016 May;27(5):941-7. doi: 10.1093/annonc/mdw028.

Periodontal disease has a direct impact on the immune response and has been linked to several chronic diseases, including atherosclerosis and stroke. Few studies have examined the association between periodontal disease and cancer.A total of 19 933 men reported being never smokers (of cigarette, pipes or cigars) in the Health Professionals’ Follow-up Study. Periodontal disease status and teeth number were self-reported at baseline and during follow-up. All cancers were ascertained during 26 years of follow-up. Cox’s proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) adjusting for risk factors.A 13% increase in total cancer was observed among men reporting periodontitis at baseline, and a 45% increase in risk was observed among men with advanced periodontitis (periodontitis with <17 remaining teeth). Periodontitis was not associated with prostate cancer, colorectal cancer or melanoma, the three most common cancers in this cohort of never smokers, but a 33% increase in risk was observed for smoking-related cancers (lung, bladder, oropharnygeal, esophageal, kidney, stomach and liver cancers; HR = 1.33, 95% CI 1.07-1.65). Men with advanced periodontitis had an HR of 2.57 (95% CI 1.56-4.21; P = 0.0002) for smoking-related cancers, compared with men who did not have periodontitis and had 17 teeth or more. Advanced periodontitis was associated with elevated risks of esophageal and head and neck cancers (HR = 6.29, 95% CI 2.13-18.6; based on five cases with advanced periodontitis) and bladder cancer (HR = 5.06, 95% CI 2.32-11.0; based on nine cases with advanced periodontitis).Advanced periodontitis was associated with a 2.5-fold increase in smoking-related cancers among never smokers. Periodontitis may impact cancer risk through system immune dysregulation. Further studies need to examine the immune impact of advanced periodontitis on cancer, especially for cancers known to be caused by smoking.

Faggons CE, Mabedi C, Shores CG, Gopal S. Review: Head and neck squamous cell carcinoma in sub-Saharan Africa. Malawi Med J. 2015 Sep;27(3):79-87.

Review the literature from 1990 to 2013 to determine known anatomic sites, risk factors, treatments, and outcomes of head and neck squamous cell carcinoma (HNSCC) in sub-Saharan Africa.Using a systematic search strategy, literature pertaining to HNSCC in sub-Saharan Africa was reviewed and patient demographics, anatomic sites, histology, stage, treatment, and outcomes were abstracted. The contributions of human immunodeficiency virus (HIV), human papillomavirus (HPV) and behavioural risk factors to HNSCC in the region were assessed.Of the 342 papers identified, 46 were utilized for review, including 8611 patients. In sub-Saharan Africa, the oropharyngeal/oral cavity was found to be the most common site, with 7750 cases (90% of all cases). Few papers distinguished oropharyngeal from oral cavity, making identification of possible HPV-associated oropharyngeal squamous cell carcinoma (SCC) difficult. SCC of the nasopharynx, nasal cavity, or paranasal sinuses was identified in 410 patients (4.8% of all cases). Laryngeal SCC was found in 385 patients (4.5% of all cases), and only 66 patients (0.8% of all cases) with hypopharyngeal SCC were identified. In 862 patients with data available, 43% used tobacco and 42% used alcohol, and reported use varied widely and was more common in laryngeal SCC than that of the oropharyngeal/oral cavity. Toombak and kola nut use was reported to be higher in patients with HNSCC. Several papers reported HIV-positive patients with HNSCC, but it was not possible to determine HNSCC prevalence in HIV-positive compared to negative patients. Reports of treatment and outcomes were rare.The oropharyngeal/oral cavity was by far the most commonly reported site of HNSCC reported in sub-Saharan Africa. The roles of risk factors in HNSCC incidence in sub-Saharan Africa were difficult to delineate from the available studies, but a majority of patients did not use tobacco and alcohol.

Chu KP, Habbous S, Kuang Q, Boyd K, Mirshams M, Liu FF, Espin-Garcia O, Xu W, Goldstein D, Waldron J, O’Sullivan B, Huang SH, Liu G. Socioeconomic status, human papillomavirus, and overall survival in head and neck squamous cell carcinomas in Toronto, Canada. Cancer Epidemiol. 2016 Feb;40:102-12. doi: 10.1016/j.canep.2015.11.010.

Despite universal healthcare in some countries, lower socioeconomic status (SES) has been associated with worse cancer survival. The influence of SES on head and neck cancer (HNC) survival is of immense interest, since SES is associated with the risk and prognostic factors associated with this disease.Newly diagnosed HNC patients from 2003 to 2010 (n=2124) were identified at Toronto’s Princess Margaret Cancer Centre. Principal component analysis was used to calculate a composite score using neighbourhood-level SES variables obtained from the 2006 Canada Census. Associations of SES with overall survival were evaluated in HNC subsets and by p16 status (surrogate for human papillomavirus).SES score was higher for oral cavity (n=423) and p16-positive oropharyngeal cancer (OPC, n=404) patients compared with other disease sites. Lower SES was associated with worse survival [HR 1.14 (1.06-1.22), p=0.0002], larger tumor staging (p<0.001), current smoking (p<0.0001), heavier alcohol consumption (p<0.0001), and greater comorbidity (p<0.0002), but not with treatment regimen (p>0.20). After adjusting for age, sex, and stage, the lowest SES quintile was associated with the worst survival only for OPC patients [HR 1.66 (1.09-2.53), n=832], primarily in the p16-negative subset [HR 1.63 (0.96-2.79)]. The predictive ability of the prognostic models improved when smoking/alcohol was added to the model (c-index 0.71 vs. 0.69), but addition of SES did not (c-index 0.69).SES was associated with survival, but this effect was lost after accounting for other factors (age, sex, TNM stage, smoking/alcohol). Lower SES was associated with greater smoking, alcohol consumption, comorbidity, and stage.

Maasland DH, van den Brandt PA, Kremer B, Schouten LJ. Body mass index and risk of subtypes of head-neck cancer: the Netherlands Cohort Study. Sci Rep. 2015 Dec 4;5:17744. doi: 10.1038/srep17744.

Low body mass index (BMI) has been associated with risk of head-neck cancer (HNC), but prospective data are scarce. We investigated the association between BMI, BMI at age 20 years and change in BMI during adulthood with risk of HNC and HNC subtypes. 120,852 participants completed a questionnaire on diet and other cancer risk factors, including anthropometric measurements, at baseline in 1986. After 20.3 years of follow-up, 411 HNC (127 oral cavity cancer (OCC), 84 oro-/hypopharyngeal cancer (OHPC), and 197 laryngeal cancer (LC)) cases and 3,980 subcohort members were available for case-cohort analysis using Cox proportional hazards models. BMI at baseline was inversely associated with risk of HNC overall, with a multivariate rate ratio of 3.31 (95% CI 1.40-7.82) for subjects with a BMI < 18.5 kg/m(2), compared to participants with a BMI of 18.5 to 25 kg/m(2). Among HNC subtypes, this association was strongest for OCC and OHPC. The association between BMI at age 20 and HNC risk appeared to be positive. In this large prospective cohort study, we found an inverse association between BMI at baseline and HNC risk. For BMI at age 20, however, a positive rather than inverse association was found.

 

Huang YH, Lee YC, Li Q, Chen CJ, Hsu WL, Lou PJ, Zhu C, Pan J, Shen H, Ma H, Cai L, He B, Wang Y, Zhou X, Ji Q, Zhou B, Wu W, Ma J, Boffetta P, Zhang ZF, Dai M, Hashibe M. Family History of Cancer and Head and Neck Cancer Risk in a Chinese Population. Asian Pac J Cancer Prev. 2015;16(17):8003-8.

This case-control study included 921 cases and 806 controls. Recruitment was from December 2010 to January 2015 in eight centers in East Asia. Controls were matched to cases with reference to sex, 5-year age group, ethnicity, and residence area at each of the centers.We observed an increased risk of head and neck cancer due to first degree family history of head and neck cancer, but after adjustment for tobacco smoking, alcohol drinking and betel quid chewing the association was no longer apparent. The adjusted OR were 1.10 (95% CI=0.80-1.50) for family history of tobacco-related cancer and 0.96 (95%CI=0.75-1.24) for family history of any cancer with adjustment for tobacco, betel quid and alcohol habits. The ORs for having a first-degree relative with HNC were higher in all tobacco/ alcohol subgroups.We did not observe a strong association between family history of head and neck cancer and head and neck cancer risk after taking into account lifestyle factors. Our study suggests that an increased risk due to family history of head and neck cancer may be due to shared risk factors. Further studies may be needed to assess the lifestyle factors of the relatives.

Hettmann A, Demcsák A, Decsi G, Bach Á, Pálinkó D, Rovó L, Nagy K, Takács M, Minarovits J. Infectious Agents Associated with Head and Neck Carcinomas. Adv Exp Med Biol. 2016;897:63-80. doi: 10.1007/5584_2015_5005.

In addition to traditional risk factors such as smoking habits and alcohol consumption, certain microbes also play an important role in the generation of head and neck carcinomas. Infection with high-risk human papillomavirus types is strongly associated with the development of oropharyngeal carcinoma, and Epstein-Barr virus appears to be indispensable for the development of non-keratinizing squamous cell carcinoma of the nasopharynx. Other viruses including torque teno virus and hepatitis C virus may act as co-carcinogens, increasing the risk of malignant transformation. A shift in the composition of the oral microbiome was associated with the development of oral squamous cell carcinoma, although the causal or casual role of oral bacteria remains to be clarified. Conversion of ethanol to acetaldehyde, a mutagenic compound, by members of the oral microflora as well as by fungi including Candida albicans and others is a potential mechanism that may increase oral cancer risk. In addition, distinct Candida spp. also produce NBMA (N-nitrosobenzylmethylamine), a potent carcinogen. Inflammatory processes elicited by microbes may also facilitate tumorigenesis in the head and neck region.

Li S, Lee YC, Li Q, Chen CJ, Hsu WL, Lou PJ, Zhu C, Pan J, Shen H, Ma H, Cai L, He B, Wang Y, Zhou X, Ji Q, Zhou B, Wu W, Ma J, Boffetta P, Zhang ZF, Dai M, Hashibe M. Oral lesions, chronic diseases and the risk of head and neck cancer. Oral Oncol. 2015 Dec;51(12):1082-7. doi: 10.1016/j.oraloncology.2015.10.014.

The aim of our study is to explore the role of the history of oral lesions and chronic diseases on the risk of head and neck cancer in a Chinese population.

Our case-control study included 921 head and neck cancer cases and 806 controls. We obtained medical history information by administering questionnaires to both cases and controls. We used unconditional logistic regression to estimate odds ratios for oral lesions and chronic conditions.Oral submucous fibrosis (OR=24.24, 95% CI=7.39-79.52), oral leukoplakia (OR=4.05, 95% CI=2.44-6.71) and repetitive dental ulcers (OR=5.12, 95% CI=3.17-8.28) increased the risk of HNC. Depression was associated with HNC risk when adjusted for several covariates (OR=2.10, 95% CI=1.06-4.15), but the association was not statistically significant after adjusting for smoking and alcohol drinking (OR=1.53, 95% CI=0.72-3.25). Also, the crude OR suggested an association between diabetes and HNC risk (OR=1.51, 95% CI=1.09-2.11), but it was not significant after adjusting for confounders.Our study reported on strong associations between HNC risk and oral leukoplakia, oral submucous fibrosis, which is consistent with prior research. We also observed repetitive dental ulcer to be associated with HNC risk. Future studies may focus on studying the association between depression and HNC, using medical records or psychological evaluation results to get more accurate information about depression, with careful assessment of tobacco and alcohol history.

Radoï L, Menvielle G, Cyr D, Lapôtre-Ledoux B, Stücker I, Luce D; ICARE Study Group. Population attributable risks of oral cavity cancer to behavioral and medical risk factors in France: results of a large population-based case-control study, the ICARE study. BMC Cancer. 2015 Oct 31;15:827. doi: 10.1186/s12885-015-1841-5.

Population attributable risks (PARs) are useful tool to estimate the burden of risk factors in cancer incidence. Few studies estimated the PARs of oral cavity cancer to tobacco smoking alone, alcohol drinking alone and their joint consumption but none performed analysis stratified by subsite, gender or age. Among the suspected risk factors of oral cavity cancer, only PAR to a family history of head and neck cancer was reported in two studies. The purpose of this study was to estimate in France the PARs of oral cavity cancer to several recognized and suspected risk factors, overall and by subsite, gender and age.We analysed data from 689 oral cavity cancer cases and 3481 controls included in a population-based case-control study, the ICARE study. Unconditional logistic regression models were used to estimate odds ratios (ORs), PARs and 95% confidence intervals (95% CI).The PARs were 0.3% (95% CI -3.9%; +3.9%) for alcohol alone, 12.7% (6.9%-18.0%) for tobacco alone and 69.9% (64.4%-74.7%) for their joint consumption. PAR to combined alcohol and tobacco consumption was 74% (66.5%-79.9%) in men and 45.4% (32.7%-55.6%) in women. Among suspected risk factors, body mass index 2 years before the interview <25 kg.m(-2), never tea drinking and family history of head and neck cancer explained 35.3% (25.7%-43.6%), 30.3% (14.4%-43.3%) and 5.8% (0.6%-10.8%) of cancer burden, respectively. About 93% (88.3%-95.6%) of oral cavity cancers were explained by all risk factors, 94.3% (88.4%-97.2%) in men and only 74.1% (47.0%-87.3%) in women.Our study emphasizes the role of combined tobacco and alcohol consumption in the oral cavity cancer burden in France and gives an indication of the proportion of cases attributable to other risk factors. Most of oral cavity cancers are attributable to concurrent smoking and drinking and would be potentially preventable through smoking or drinking cessation. If the majority of cases are explained by recognized or suspected risk factors in men, a substantial number of cancers in women are probably due to still unexplored factors that remain to be clarified by future studies.

 

Schwingshackl L, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis of observational studies. Cancer Med. 2015 Dec;4(12):1933-47. doi: 10.1002/cam4.539.

The aim of the present systematic review and meta-analysis of observational studies was to gain further insight into the effects of adherence to Mediterranean Diet (MD) on overall cancer mortality, incidence of different types of cancer, and cancer mortality risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and EMBASE until 2 July 2015. We included either cohort (for specific tumors only incidence cases were used) or case-control studies. Study specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effect model. The updated review process showed 23 observational studies that were not included in the previous meta-analysis (total number of studies evaluated: 56 observational studies). An overall population of 1,784,404 subjects was included in the present update. The highest adherence score to an MD was significantly associated with a lower risk of all-cause cancer mortality (RR: 0.87, 95% CI 0.81-0.93, I(2) = 84%), colorectal cancer (RR: 0.83, 95% CI 0.76-0.89, I(2) = 56%), breast cancer (RR: 0.93, 95% CI 0.87-0.99, I(2) =15%), gastric cancer (RR: 0.73, 95% CI 0.55-0.97, I(2) = 66%), prostate cancer (RR: 0.96, 95% CI 0.92-1.00, I(2) = 0%), liver cancer (RR: 0.58, 95% CI 0.46-0.73, I(2) = 0%), head and neck cancer (RR: 0.40, 95% CI 0.24-0.66, I(2) = 90%), pancreatic cancer (RR: 0.48, 95% CI 0.35-0.66), and respiratory cancer (RR: 0.10, 95% CI 0.01-0.70). No significant association could be observed for esophageal/ovarian/endometrial/and bladder cancer, respectively. Among cancer survivors, the association between the adherence to the highest MD category and risk of cancer mortality, and cancer recurrence was not statistically significant. The updated meta-analyses confirm a prominent and consistent inverse association provided by adherence to an MD in relation to cancer mortality and risk of several cancer types.

Guercio V, Turati F, La Vecchia C, Galeone C, Tavani A. Allium vegetables and upper aerodigestive tract cancers: a meta-analysis of observational studies. Mol Nutr Food Res. 2016 Jan;60(1):212-22. doi: 10.1002/mnfr.201500587.

To provide updated quantitative overall estimations of the relation between total allium, garlic, and onion intake on the risk of cancer of the upper aerodigestive tract (UADT).We combined data of published observational studies (21 case-control and four cohort studies), using a meta-analytic approach and random effects models. The overall relative risks (RR) and 95% confidence intervals (CIs) for the squamous cell carcinoma of the UADT were 0.79 (95% CI 0.56-1.11) for total allium, 0.74 (95% CI 0.57-0.95) for garlic, and 0.72 (95% CI 0.57-0.91) for onion for the highest versus the lowest consumption. The inverse relation was apparently stronger in case-control studies (RR 0.56, 95% CI 0.38-0.83 for total allium), in Chinese studies (RR 0.67, 95% CI 0.45-0.98 for garlic intake), and for esophageal than for head and neck cancers. Apparently, there was no relation between allium vegetable intake and adenocarcinoma of the esophagus.We found a moderate inverse association between allium vegetable intake and the risk of squamous cell carcinoma of the UADT in case-control studies. The relation was unclear in cohort studies and for adenocarcinoma of the esophagus.

 

Nour A, Joury E, Naja F, Hatahet W, Almanadili A. Diet and the risk of head and neck squamous cell carcinomas in a Syrian population: a case-control study. East Mediterr Health J. 2015 Oct 2;21(9):629-34.

Diet has not been investigated as a potential risk factor for head and neck squamous cell carcinomas in the Syrian Arab Republic. In a hospital-based, unmatched case-control study 108 people with cancer and 105 controls were interviewed about dietary intake using a validated food frequency questionnaire in Arabic. Sociodemographic and health risk behavioural information were collected by a self-completed questionnaire. Adjusting for age, sex, education level, working status and tobacco smoking, the multiple regression analysis showed that low intake of vegetables (OR 3.8; 95% CI: 1.57-9.10), cereal/cereal products (OR 2.6; 95% CI: 1.12-5.99) and high-caffeine beverages (OR 3.2; 95% CI: 1.34-7.43) increased the risk of head and neck squamous cell carcinomas, whereas a low level of fats and oils intake decreased the risk (OR 0.6; 95% CI: 0.24-1.30). These findings should be considered in national health promotion programmes in the Syrian Arab Republic.

Peters ES, Luckett BG, Applebaum KM, Marsit CJ, McClean MD, Kelsey KT. Dairy products, leanness, and head and neck squamous cell carcinoma. Head Neck. 2008 Sep;30(9):1193-205. doi: 10.1002/hed.20846.

As part of a population-based case-control study, we investigated the association of food groups and micronutrients estimated from a validated food frequency questionnaire (FFQ) with the risk of development of head and neck squamous cell carcinoma (HNSCC).Incident cases were accrued through Boston area hospitals from 1999 to 2003, and neighborhood controls were selected and matched by location, age, and sex. There were 504 cases and 717 controls enrolled, who completed the FFQ.We observed a positive association between the consumption of dairy products and HNSCC. The odds of HNSCC in the highest quintile of dairy intake was 1.64 (95% CI: 1.09-2.46), compared with subjects in the lowest quintile. There was a significant association between leanness with HNSCC. The odds of cancer among the leanest subjects was 5.8 (95%CI: 3.2-10.6) compared with a healthy BMI. Finally, intake of animal fat was positively associated with an elevation in cancer risk. The odds of HNSCC for high animal fat intake were 1.50 (0.99-2.27).Our data suggest that consumption of fruits and vegetables is not universally protective for HNSCC and that other food groups and nutrients may influence the risk for developing this disease.

Sapkota A, Hsu CC, Zaridze D, Shangina O, Szeszenia-Dabrowska N, Mates D, Fabiánová E, Rudnai P, Janout V, Holcatova I, Brennan P, Boffetta P, Hashibe M. Dietary risk factors for squamous cell carcinoma of the upper aerodigestive tract in central and eastern Europe. Cancer Causes Control. 2008 Dec;19(10):1161-70. doi: 10.1007/s10552-008-9183-0.

The incidence of squamous cell carcinoma of upper aerodigestive tract (UADT: oral cavity, pharynx, larynx, and esophagus) has been increasing in central and eastern European countries. We investigated the relationship between diet and UADT cancers in these high risk areas.We used data from hospital-based case-control study of 948 UADT cancer cases and 1,228 controls conducted in Romania, Hungary, Poland, Russia, Slovakia, and Czech Republic. Standardized questionnaire were used to collect information on 23 different food items, along with alcohol and tobacco consumptions. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the UADT cancers after adjusting for center, age, sex, tobacco & alcohol intake, and other food groups.Consumption of dairy product was negatively associated with selected UADT cancers: larynx (OR: 0.38, CI: 0.23-0.62) and esophagus (OR: 0.55, CI: 0.33-0.93). While consumption of yellow/orange vegetables were inversely associated with oral/pharyngeal and laryngeal cancer (OR: 0.53, CI: 0.35-0.81 and OR: 0.62, CI: 0.38-1.00, respectively), preserved vegetable was positively associated with oral/pharyngeal and laryngeal cancer risk (p (trend) < 0.01 for both).Specific dietary components may play a role in the development of UADT cancers in the high-risk region of central and eastern Europe.

de Carvalho MF, Dourado MR, Fernandes IB, Araújo CT, Mesquita AT, Ramos-Jorge ML. Head and neck cancer among marijuana users: a meta-analysis of matched case-control studies. Arch Oral Biol. 2015 Dec;60(12):1750-5. doi: 10.1016/j.archoralbio.2015.09.009.

This study performed a systematic review with meta-analysis. Articles were selected from various electronic databases using keywords obtained from the Medical Subject Headings (MeSH). After reading by three reviewers and scoring of methodological quality, six articles (totaling nine case-control studies) were assessed with Comprehensive Meta-Analysis(®) software. The value of effect (odds ratio) was calculated, which represented the chance of developing head and neck cancer between individuals who had smoked marijuana in their lifetime in models controlled for age, gender, race, and tobacco consumption.Approximately 12.6% of cases and 14.3% of controls were marijuana users. The meta-analysis found no association between exposure and disease (OR=1.021; IC 95%=0.912-1.14; p=0.718).

No association between lifetime marijuana use and the development of head and neck cancer was found. The different methods of collection/presentation of results in the selected articles prevented other analyzes from being conducted. Additional studies are needed to assess for long-term effects.

Zhang ZF, Morgenstern H, Spitz MR, Tashkin DP, Yu GP, Marshall JR, Hsu TC, Schantz SP. Marijuana use and increased risk of squamous cell carcinoma of the head and neck. Cancer Epidemiol Biomarkers Prev. 1999 Dec;8(12):1071-8.

Marijuana is the most commonly used illegal drug in the United States. In some subcultures, it is widely perceived to be harmless. Although the carcinogenic properties of marijuana smoke are similar to those of tobacco, no epidemiological studies of the relationship between marijuana use and head and neck cancer have been published. The relationship between marijuana use and head and neck cancer was investigated by a case-control study of 173 previously untreated cases with pathologically confirmed diagnoses of squamous cell carcinoma of the head and neck and 176 cancer-free controls at Memorial Sloan-Kettering Cancer Center between 1992 and 1994. Epidemiological data were collected by using a structured questionnaire, which included history of tobacco smoking, alcohol use, and marijuana use. The associations between marijuana use and head and neck cancer were analyzed by Mantel-Haenszel methods and logistic regression models. Controlling for age, sex, race, education, alcohol consumption, pack-years of cigarette smoking, and passive smoking, the risk of squamous cell carcinoma of the head and neck was increased with marijuana use [odds ratio (OR) comparing ever with never users, 2.6; 95% confidence interval (CI), 1.1-6.6]. Dose-response relationships were observed for frequency of marijuana use/day (P for trend <0.05) and years of marijuana use (P for trend <0.05). These associations were stronger for subjects who were 55 years of age and younger (OR, 3.1; 95% CI, 1.0-9.7). Possible interaction effects of marijuana use were observed with cigarette smoking, mutagen sensitivity, and to a lesser extent, alcohol use. Our results suggest that marijuana use may increase the risk of head and neck cancer with a strong dose-response pattern. Our analysis indicated that marijuana use may interact with mutagen sensitivity and other risk factors to increase the risk of head and neck cancer. The results need to be interpreted with some caution in drawing causal inferences because of certain methodological limitations, especially with regard to interactions.

Berthiller J, Lee YC, Boffetta P, Wei Q, Sturgis EM, Greenland S, Morgenstern H, Zhang ZF, Lazarus P, Muscat J, Chen C, Schwartz SM, Eluf Neto J, Wünsch Filho V, Koifman S, Curado MP, Matos E, Fernandez L, Menezes A, Daudt AW, Ferro G, Brennan P, Hashibe M. Marijuana smoking and the risk of head and neck cancer: pooled analysis in the INHANCE consortium. Cancer Epidemiol Biomarkers Prev. 2009 May;18(5):1544-51. doi: 10.1158/1055-9965.EPI-08-0845.

Marijuana contains carcinogens similar to tobacco smoke and has been suggested by relatively small studies to increase the risk of head and neck cancer (HNC). Because tobacco is a major risk factor for HNC, large studies with substantial numbers of never tobacco users could help to clarify whether marijuana smoking is independently associated with HNC risk.We pooled self-reported interview data on marijuana smoking and known HNC risk factors on 4,029 HNC cases and 5,015 controls from five case-control studies within the INHANCE Consortium. Subanalyses were conducted among never tobacco users (493 cases and 1,813 controls) and among individuals who did not consume alcohol or smoke tobacco (237 cases and 887 controls).The risk of HNC was not elevated by ever marijuana smoking [odds ratio (OR), 0.88; 95% confidence intervals (95% CI), 0.67-1.16], and there was no increasing risk associated with increasing frequency, duration, or cumulative consumption of marijuana smoking. An increased risk of HNC associated with marijuana use was not detected among never tobacco users (OR, 0.93; 95% CI, 0.63-1.37; three studies) nor among individuals who did not drink alcohol and smoke tobacco (OR, 1.06; 95% CI, 0.47-2.38; two studies).Our results are consistent with the notion that infrequent marijuana smoking does not confer a risk of these malignancies. Nonetheless, because the prevalence of frequent marijuana smoking was low in most of the contributing studies, we could not rule out a moderately increased risk, particularly among subgroups without exposure to tobacco and alcohol.

Liang C, McClean MD, Marsit C, Christensen B, Peters E, Nelson HH, Kelsey KT. A population-based case-control study of marijuana use and head and neck squamous cell carcinoma. Cancer Prev Res (Phila). 2009 Aug;2(8):759-68. doi: 10.1158/1940-6207.CAPR-09-0048.

Cannabinoids, constituents of marijuana smoke, have been recognized to have potential antitumor properties. However, the epidemiologic evidence addressing the relationship between marijuana use and the induction of head and neck squamous cell carcinoma (HNSCC) is inconsistent and conflicting. Cases (n = 434) were patients with incident HNSCC disease from nine medical facilities in the Greater Boston, MA area between December 1999 and December 2003. Controls (n = 547) were frequency matched to cases on age (+/-3 years), gender, and town of residence, randomly selected from Massachusetts town books. A questionnaire was adopted to collect information on lifetime marijuana use (decade-specific exposures) and associations evaluated using unconditional logistic regression. After adjusting for potential confounders (including smoking and alcohol drinking), 10 to 20 years of marijuana use was associated with a significantly reduced risk of HNSCC [odds ratio (OR)(10-<20 years versus never users), 0.38; 95% confidence interval (CI), 0.22-0.67]. Among marijuana users moderate weekly use was associated with reduced risk (OR(0.5-<1.5 times versus <0.5 time), 0.52; 95% CI, 0.32-0.85). The magnitude of reduced risk was more pronounced for those who started use at an older age (OR(15-<20 years versus never users), 0.53; 95% CI, 0.30-0.95; OR(> or =20 years versus never users), 0.39; 95% CI, 0.17-0.90; P(trend) < 0.001). These inverse associations did not depend on human papillomavirus 16 antibody status. However, for the subjects who have the same level of smoking or alcohol drinking, we observed attenuated risk of HNSCC among those who use marijuana compared with those who do not. Our study suggests that moderate marijuana use is associated with reduced risk of HNSCC.

Farsi NJ, El-Zein M, Gaied H, Lee YC, Hashibe M, Nicolau B, Rousseau MC. Sexual behaviours and head and neck cancer: A systematic review and meta-analysis. Cancer Epidemiol. 2015 Dec;39(6):1036-46. doi: 10.1016/j.canep.2015.08.010. Epub 2015 Sep 12

Human papillomaviruses (HPV) are associated with head and neck cancers (H&NC). Transmission of HPV to the upper aerodigestive tract occurs plausibly through sexual contact, although epidemiologic evidence on the role of sexual behaviours in H&NC aetiology is inconsistent. We conducted a meta-analysis of studies examining the association between four indicators of sexual behaviours (number of sexual partners and oral sex partners, oral sex practice, and age at first intercourse) and H&NC. Summary odds ratios (OR) and 95% confidence intervals (CI) were estimated using fixed and random effects models for each indicator, contrasting ‘highest’ to ‘lowest’, ‘ever’ to ‘never’, or ‘youngest’ to ‘oldest’ categories. Twenty case-control studies were included out of 3838 identified publications. Using random effects models, summary ORs suggested an increased risk of H&NC for number of sexual partners [OR=1.29, 95% CI: 1.02-1.63] (19 studies) and number of oral sex partners [OR=1.69, 95% CI: 1.00-2.84] (5 studies), whereas no effect was observed with oral sex practice [OR=1.09, 95% CI: 0.88-1.35] (17 studies) and age at first intercourse [OR=1.40, 95% CI: 0.71-2.79] (6 studies). For number of sexual partners and oral sex practice, which were assessed in more studies, we further excluded studies contributing to heterogeneity and those not adjusted for age, sex, smoking, and alcohol consumption. The summary ORs were 0.95 (95% CI: 0.75-1.20) for number of sexual partners and 1.03 (95% CI: 0.84-1.26) for oral sex practice. Our findings highlight that observed associations might be partly attributed to confounding effects of sociodemographic and behavioural factors.

 

 

 

 

 

Heck JE, Berthiller J, Vaccarella S, Winn DM, Smith EM, Shan’gina O, Schwartz SM, Purdue MP, Pilarska A, Eluf-Neto J, Menezes A, McClean MD, Matos E, Koifman S, Kelsey KT, Herrero R, Hayes RB, Franceschi S, Wünsch-Filho V, Fernández L, Daudt AW, Curado MP, Chen C, Castellsagué X, Ferro G, Brennan P, Boffetta P, Hashibe M. Sexual behaviours and the risk of head and neck cancers: a pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. Int J Epidemiol. 2010 Feb;39(1):166-81. doi: 10.1093/ije/dyp350..

We undertook a pooled analysis of four population-based and four hospital-based case-control studies from the International Head 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.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).Sexual behaviours are associated with cancer risk at the head and neck cancer subsites that have previously been associated with HPV infection.

Chancellor JA, Ioannides SJ, Elwood JM. Oral and oropharyngeal cancer and the role of sexual behaviour: a systematic review. Community Dent Oral Epidemiol. 2016 Sep 19. doi: 10.1111/cdoe.12255.

Following the PRISMA guidelines, we identified observational and interventional studies reporting associations between several different sexual behaviours and OPC or OCC. Study quality was assessed independently by two reviewers using a validated scoring system.From 513 papers identified, 21, reporting on 20 studies, fulfilled the inclusion criteria. Two cohort studies were rated as moderate quality. The 18 case-control studies were rated as weak; nine comparing people with OPC or OCC to people without cancer, eight comparing HPV-positive to HPV-negative cancer patients and one comparing OPCs to other head and neck cancers. One study was a pooled analysis of seven of the included studies with some additional information. Twelve sexual behaviours were assessed and 69 associations reported. The studies differed in the comparisons made, the sexual behaviours assessed, and how these were reported and categorized, so no quantitative meta-analyses were appropriate. Most studies combined OPC and OCC. Several significantly increased risks were seen with a high number of lifetime sexual partners (nine studies) and with the practice of oral sex (five studies), although two studies found a significant negative association with OCC and ever performing oral sex. Two cohort studies of men and women in homosexual relationships found increases in oral cancer risk, and a cohort study of men married to women who had a history of cervical cancer also showed an increased risk of oral cancers. Results for other sexual behaviours were limited and inconsistent, and these included the following: younger age at first sexual intercourse, number of lifetime oral sex partners, the practice of oral-anal sex, the number of oral-anal sex partners, and ever performing anal sex. Only one study assessed casual sex, never or rare use of a condom and having a sexual partner with a history of genital warts, finding significant associations in the two former behaviours.The current evidence for sexual behaviours being risk factors for oral and oropharyngeal cancer is limited and inconsistent. Evidence suggests that the number of sexual partners and performing oral sex are associated with a greater risk. Furthermore men whose partners have had cervical cancer may have an increased risk.