Summary.-The unusually high relative frequency of cancer in the laryngeal region in males (18% of all histologically diagnosed cancers) and a sex ratio of unity for lung cancer in Northern Thailand were further explored in a hospital-based case-control study in Chiang Mai. This compared patients having cancers of the oral cavity (including oropharynx), larynx, hypopharynx and lung, with controls in relation to smoking and chewing habits. Statistical analysis indicated that chewing betel is strongly associated with the occurrence of oral cancer in both sexes, and with cancer of the laryngeal region in males. No factors were strongly linked to lung cancer in men, but, in women, urban residence and miang cheving were associated with lung cancer. Analysis of smoke from the two main types of cigars smoked in the region showed that both had high tar content, but there were marked differences in pH. Smoking cigars with alkaline smoke and high tar had an increased risk for laryngeal cancer in males, whereas other cigars with acid smoke and high tar together with manufactured cigarettes had increased risks for lung cancer. These increased risks were not, however, statistically significant.MENAKANIT, Muir and Jain (1971) demonstrated a very high relative frequency (18 4%/ ) of cancer's of the laryngopharyngeal region among male cancer cases in Chiang Mai, Northern Thailand. This contrasts with a figure of 3 700 in Bangkok, Central Thailand (Piyaratn, 1959). Although lung cancer has a low relative frequency (< 5%o) in both Chiang Mai and Bangkok, there were far more female cases in Chiang Mai (4-2o% Vs 0 7 o). This is reflected in the male: female ratio of 1-0 in Chiang Mai and 5 0 in Bangkok.The aims of our case-control study were to search for associations between personal habits and cancers of the oral cavity, pharynx, larynx and lung. Attention was focused particularly on smoking, chewing and drinking habits, many of which are different from those in Western populations, especially in older adults. In the laboratory, cigars* from Chiang Mai were compared with Australian-manufactured cigarettes.
SmoklingTwo major groups of hand-rolled cigars are smoked in Northern Thailand around Chiang Mai. A third imported type is not commonlv smoked by the local population.(a) Khii yoo are cigars 14-22 cm in length and 3-8 g in weight, the size and weight varying with the place of purchase. The tobacco is mixed with additives before being wrapped in * A cigar is (lefine(d as tobacco wrappe( in a (lrie(1 leaf or similar material, in contrast to a cigarette, (lefine(l as a paper-wrappe(l roll of finely ciut tobacco.