Current theories for the development of nonsmoking and nondrinking laryngeal carcinoma

Our plain-English summary of Current theories for the development of nonsmoking and nondrinking laryngeal carcinoma, by R. Wight, V. Paleri, P. Arullendran (Current Opinion in Otolaryngology & Head and Neck Surgery, 2003).

The study

• Authors: R. Wight, V. Paleri, P. Arullendran
• Journal: Current Opinion in Otolaryngology & Head and Neck Surgery
• Published: 2003;11(2):73-7
• Type of article: Review
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The pivotal risk of smoking and alcohol in laryngeal cancer has meant that evidence for alternate cofactors has been indicative to date. A number of case series, however, contain a few patients who are life-long nondrinkers and nonsmokers and question what other cofactors may contribute. Gastroesophageal reflux disease makes a small but significant contribution to the causal development of laryngeal cancer; however, what remains to be understood is the mechanism of its action. Bile reflux appears to be an additional causative factor in achlorhydrics. After controlling for the effects of alcohol and tobacco, exposure to oncogenic types of human papilloma virus is associated with an increased risk of laryngeal carcinoma. Evidence does not support asbestos exposure itself as increasing the relative risk of laryngeal cancer. A dietary increase in vegetables and fruit may confer an advantage in reducing the laryngeal cancer incidence. Inherited differences in cell cycle control systems, DNA repair systems, and carcinogen-metabolizing enzymes can increase the risk for laryngeal cancer, but as yet, no causal mechanism has been demonstrated.

In plain English

This narrative review covered possible causes of laryngeal (voice box) cancer other than smoking and drinking. It reported no new data and gave no search methods. The authors discussed reflux, viruses, workplace exposures including asbestos, diet and genetics. On asbestos, which they noted causes mesothelioma, they summarized a French case-control study, a meta-analysis and a systematic review. The case-control study found a nonsignificant increase in laryngeal cancer risk overall (odds ratio 1.24; CI 0.83 to 1.90) but a higher risk in the epilarynx (odds ratio 2.22; CI 1.05 to 4.71). The meta-analysis reported metastandardized mortality ratios of 157 with and 133 without latency of exposure, found no dose response using mesothelioma deaths as a proxy for dose, and concluded the association was weak. The systematic review found that only two of 17 retrospective studies showed a significantly increased risk. The authors concluded that evidence does not support asbestos exposure itself increasing the relative risk of laryngeal cancer. They left open whether inhaled dusts might act as a cofactor. They noted few studies recorded smoking and alcohol.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published literature (no original data; search methods not described)
• Who was studied: Published studies on risk factors for laryngeal cancer, with a focus on patients who never smoked or drank; the number of studies reviewed and the search methods are not stated
• Exposure: Possible cofactors including gastroesophageal reflux, bile reflux, human papilloma virus, occupational exposures (asbestos, metal working fluids, diesel fumes, rubber, bitumen, meat industry), diet and genetic factors; asbestos fiber types not specified
• Main results:
  • A cited French case-control study found a nonsignificant increase in risk of laryngeal carcinoma at all sites (odds ratio 1.24; CI 0.83 to 1.90) but higher risk in the epilarynx (odds ratio 2.22; CI 1.05 to 4.71)
  • A cited meta-analysis reported metastandardized mortality ratios for laryngeal cancer of 157 with latency of exposure and 133 without latency of exposure
  • Using deaths from mesothelioma as a proxy for dose, that meta-analysis found no dose response in laryngeal cancer and concluded there was a weak association between laryngeal cancer and asbestos
  • A cited systematic review found that of 24 prospective studies with a standardized mortality ratio, nine had an SMR at or below unity, and that of 17 retrospective studies only two showed a significantly increased risk ratio
  • The authors stated that evidence does not support asbestos exposure itself increasing the relative risk of laryngeal cancer, but that it remains unanswered whether inhaled dusts acting as a repetitive irritant could be a cofactor
  • In a cited veterans case-control study, gastroesophageal reflux disease was associated with an adjusted odds ratio of 2.4 (CI 2.15 to 2.69) for laryngeal cancer
  • After controlling for alcohol and tobacco, exposure to oncogenic types of human papilloma virus was associated with an increased risk of laryngeal carcinoma (odds ratio 3.0) in a cited study
• The authors' conclusion: The authors concluded that several potential cofactors (reflux, bile reflux, viral infection, diet, genetic susceptibility) may contribute to laryngeal cancer in nonsmokers and nondrinkers, but that exact causal mechanisms have not been established; asbestos was not among the cofactors they listed
• Limitations the authors state:
  • Few of the asbestos studies included details of smoking and alcohol intake
  • Evidence on occupational exposures is inconsistent, and changes in work practices over the decades make comparisons difficult

Topics

The National Library of Medicine indexes this study under subjects our site covers: Throat and laryngeal cancer.

Medical terms in this study, explained in our Lexicon: Carcinoma, Laryngeal Cancer, Asbestos Exposure, Relative Risk.

Related studies

• Asbestosis, laryngeal carcinoma, and malignant peritoneal mesothelioma in an insulation worker — A. Fischbein, J.C. Luo, et al. (1991)
• Asbestos and laryngeal carcinoma — P.M. Stell, T. McGill (1973)
• Exposure to asbestos and laryngeal carcinoma — P.M. Stell, T. McGill (1975)
• Metastatic laryngeal carcinoma mimicking pleural mesothelioma — M. Huncharek, J. Muscat (1991)
• Occupational risk factors for laryngeal carcinoma: Connecticut, 1975-1980 — R.T. Zagraniski, J.L. Kelsey, et al. (1986)
• The history, aetiology and epidemiology of laryngeal carcinoma — M.A. Rafferty, J.E. Fenton, et al. (2001)

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