Longitudinal study of smoking patterns in relation to the development of smoking‐related secondary primary tumors in patients with upper aerodigestive tract malignancies

Abstract

BACKGROUNDThe authors set out to assess the correlation between smoking‐related second primary tumor (SPT) development and cigarette smoking habits after diagnosis and definitive treatment in patients with early‐stage head and neck squamous cell carcinoma who were enrolled in a placebo‐controlled randomized chemoprevention trial of 13‐cis‐retinoic acid.METHODSLongitudinal data collected for 10 years after the index diagnosis are presented for 1190 patients. Cox proportional hazards regression models were used to examine the effects of changes in smoking behavior on smoking‐related SPT development.RESULTSOne‐third of all patients who quit smoking within 12 months before randomization experienced recurrence, compared with 6.9% and 10.4% of all never‐smokers and former smokers, respectively. Approximately 16% of all current smokers stopped smoking, and nearly 22% of current smokers developed SPTs, compared with 14.5%, 13.2%, and 8.8% of all recent smokers, former smokers, and never‐smokers, respectively. The probability of developing a smoking‐related SPT was highest among patients who were current smokers at randomization. These patients, regardless of whether they ceased smoking during follow‐up, were nearly three times more likely than patients who had never smoked to develop a smoking‐related SPT. In contrast, former smokers and recent quitters who continued to abstain from smoking during follow‐up were approximately 1.5 times more likely to develop an SPT compared with patients who had never smoked.CONCLUSIONSPatients who continue to smoke after the successful treatment of their index head and neck malignancies have a substantially higher risk of developing smoking‐related SPTs. Cancer 2004. © 2004 American Cancer Society.

Evaluation of glutathione S‐transferase polymorphisms and mutagen sensitivity as risk factors for the development of second primary tumors in patients previously diagnosed with early‐stage head and neck cancer

“…The low-dose 13cRA treatment, as reported by Do et al, 9 did not significantly reduce the occurrence of SPTs. The results indicate that the GST-M1 genotype is an influential risk factor for the development of SPTs in patients who are treated successfully for an index head and neck cancer.…”

“…Do et al, 7,9 in their analysis of the same population, reported similar results and also implicated continued alcohol use after diagnosis as an additional risk factor. Our current results, in a subset of the same population, support the implication of age (PϽ.001) and smoking status (P ϭ .06) as risk factors for the development of SPTs of the head and neck.…”

A Randomized Trial of an Intervention to Increase Fruit and Vegetable Intake in Curatively Treated Patients with Early-Stage Head and Neck Cancer

“…To date, no chemopreventive agent has been identified that consistently reduces the second primary cancer rate (5,6). Tobacco and alcohol use are wellknown risk factors for head and neck cancer and continued smoking following diagnosis has been associated with an increased risk of second primary cancers (7) and patients are advised to modify these behaviors following diagnosis of head and neck cancer.…”

Curcumin Inhibits Carcinogen and Nicotine-Induced Mammalian Target of Rapamycin Pathway Activation in Head and Neck Squamous Cell Carcinoma

“…Ninety percent to 95% of diagnosed head and neck malignancies are tobacco-related (4,5). Tobacco use at HNSCC diagnosis is a recognized risk factor for second primary tumors (SPTs), and current smokers are 3 times more likely than never-smokers to develop smoking-related SPT (6), indicating a need for chemopreventive agents among tobacco users. One promising agent is curcumin.…”