Scanty data are available on familial risk in oral and pharyngeal cancer. The relationship between oral and pharyngeal cancer and family history of cancer in first-degree relatives was investigated using data from a multicentric case-control study conducted in Italy and Switzerland between 1992 and 2005 on 956 cases aged less than 79 years, with histologically confirmed incident oral and pharyngeal cancer, and 2362 controls admitted to hospital for acute, nonneoplastic conditions. Logistic regression models conditioned on sex, age, study centre, and including terms for education, tobacco smoking, alcohol drinking, and number of siblings were used to estimate the odds ratios (OR) of oral and pharyngeal cancer. The multivariate ORs were similar for a family history of oral and pharyngeal cancer (2.6, 95% confidence interval, CI, 1.5-4.5) and laryngeal cancer (3.8, 95% CI, 2.0-7.2). The OR was 3.1 (95% CI, 2.0-4.8) for oral and pharyngeal cancer and laryngeal cancer combined. The OR was 7.1 (95% CI, 1.3-37.2) for subjects with 2 or more first-degree relatives with oral and pharyngeal/laryngeal cancers. Significant increases in risk were also observed for a family history of melanoma (OR 5 5.8; 95% CI, 1.3-26.4) and lung cancer (OR 5 1.4; 95% CI, 1.0-2.0). Compared to subjects without family history, nonsmokers, and non or moderate drinkers, the OR was 42.6 for current smokers, heavy drinkers with family history. History of oral and pharyngeal cancer and laryngeal cancer is a strong determinant of oral and pharyngeal cancer risk, independent from tobacco and alcohol. ' 2007 Wiley-Liss, Inc.Key words: oral neoplasms; familial risk; tobacco; alcohol drinking; risk factors Incidence and mortality from oral and pharyngeal cancer vary widely across the world. 1,2 This variation depends mostly on differences in exposure to tobacco and alcohol, the 2 major risk factors for oral and pharyngeal cancer. However, genetic factors may also contribute to explain the observed differences in rates. 2 Only a few epidemiologic studies have assessed familial risks in oral and pharyngeal cancer. A case-control study from the United States on 487 cases found odds ratios (OR) of 1.2 (95% confidence interval (CI), 0.7-2.3) in subjects with a family history of oral and pharyngeal cancer, and of 1.6 (95% CI, 0.7-3.8) for a family history of cancers of the esophagus and larynx. 3 Another case-control study from Puerto Rico on 342 oral and pharyngeal cancers showed ORs of 2.5 (95% CI, 0.8-8.0) in subjects reporting a first-degree relative with oral and pharyngeal cancer, and of 2.6 (95% CI, 1.4-4.8) in those reporting upper aerodigestive tract cancers. 4 A record-linkage study on the Utah Population Database, which includes 1 million individuals, found a standardized incidence ratio of oral and pharyngeal cancer of 1.8 (95%, 0.5-4.0) for subjects with a first-degree relative with cancer at the same site (8 observed versus 4.4 expected cases). 5 The familial aggregation of oral and pharyngeal cancers, however, may have different genetic and en...