The relationship between tobacco and alcohol consumption and the development of additional primary cancers of the upper alimentary tract is reviewed. The chance of developing a second primary is dependent principally on the intensity (i.e., quantity and duration) of the smoking and drinking habit prior to the onset of the first neoplasm. However, results conflict regarding the effect exerted by the continuation of these habits after the first diagnosis. While tobacco smoking is considered the primary risk factor associated with cancers in this area, its interaction with alcohol creates a powerful carcinogenic effect. It is agreed that multiple primaries are selective on a site-specific basis and that risk varies with anatomic location of the first primary.
During a retrospective case-control study of recent laryngeal cancer patients, several associated factors were studied to determine possible changes in the epidemiology of laryngeal cancer between 1956 and 1974. The large sex difference noted in the early survey (male: female ratio of 14.9:1) diminished considerably in the present sample (4.6:1) because more women are cigarette smokers in the cancer age group today than was the case 20 years ago. Laryngeal cancer patients tended to be less educated than the controls and included a smaller proportion of Jews and more Catholics than the control group. The risk for developing laryngeal cnacer was considerably lower for exsmokers and long-term (10+ years) filter cigarette smokers as compared with non-filter smokers. At each level of alcohol consumption, the risk increased as exposure to tobacco increased. Occupations associated with wood exposure were found to affect the development of laryngeal cancer, independently of smoking status. Future studies should include an extensive study of nutritional deficiencies associated with alcoholism to determine if a correlation exists between such deficiencies, socioeconomic status, and an increased risk of laryngeal cnacer.
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