Effects of smoking cessation on the risk of laryngeal cancer: An overview of published studies

doi:10.1016/j.oraloncology.2006.02.008

Oral Oncology

Volume 42, Issue 9, October 2006, Pages 866-872

https://doi.org/10.1016/j.oraloncology.2006.02.008 Get rights and content

Summary

Epidemiological studies showed that stopping smoking substantially decreases the risk of lung cancer. With reference to laryngeal cancer, at least four cohort studies and 15 case-control studies reported information on smoking cessation. These studies indicated that the risk of laryngeal cancer is considerably reduced in ex-smokers as compared to current smokers. The relative risk steeply decreases with time since stopping smoking, with reductions by about 60% after 10–15 years since cessation, and even larger after 20 years. The favorable effect of stopping smoking is already evident within few years after cessation, thus suggesting that smoking has a relevant impact on the late stage of laryngeal carcinogenesis. However, several years after stopping smoking, ex-smokers still have elevated risks of laryngeal cancer as compared to never smokers. In conclusion, the epidemiological evidence clearly indicates that cessation of smoking is the best measure to reduce laryngeal cancer risk, the beneficial effect being evident within a few years after cessation, and steadily increasing with passing time since cessation.

Introduction

Several studies have considered the effect of smoking cessation on the risk of lung cancer, and have shown that the absolute risk (incidence) tends to level off around the value reached at the time of stopping.1, 2 Thus, although former smokers have higher relative risks (RR) than never smokers, they also have a substantial reduction in the RR as compared to continuous smokers, the RR declining with increasing time since smoking cessation.³ More limited data exists on smoking cessation and the risk of laryngeal cancer.

The epidemiological evidence on the risk of laryngeal cancer after smoking cessation is reviewed in this paper. All cohort and case-control studies published before December 2005 were identified through Medline and by searching the references of the retrieved studies.

Section snippets

Cohort studies

At least four cohort studies have reported data on laryngeal cancer in relation to smoking cessation (Table 1). These studies gave the risk for former smokers overall, since they collected information only once at the enrolment of the study subjects, and not on lifetime smoking habits. They reported markedly lower risk of laryngeal cancer in former than in current smokers, although the risk was still elevated compared to never smokers.

Thus, in the Life Span Study including over 60,000 atomic

Case-control studies

At least 15 case-control studies reported information on laryngeal cancer risk after smoking cessation, and analyzed the time course of the change in risk after stopping smoking (Table 2).

In an investigation from the USA including 314 cases,⁸ the risk of laryngeal cancer significantly decreased after 6 years since smoking cessation, but the odds ratio (OR) was still fourfold increased as compared to never smokers 16 years after cessation. In this study, there was also indication that the average

Discussion

A large number of epidemiological studies indicates that the risk of laryngeal cancer is substantially reduced in ex-smokers as compared to subjects who continue to smoke. The favorable effect of stopping smoking is evident already within few years after cessation. The similar or even higher risk among recent quitters as compared to current smokers reported in a few studies,8, 9, 16, 18, 21, 22 is likely due to the fact that some cases could have stopped smoking because of early symptoms of the

Acknowledgments

This work was conducted with the contribution of the Italian Association for Cancer Research, Milan, and the Italian League against Cancer. The authors thank Mrs MP Bonifacino for editorial assistance.

References (24)

R. Doll
The age distribution of cancer: implications for models of carcinogenesis
J R Stat Soc A
(1971)
R. Peto et al.
Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies
BMJ
(2000)
International Agency for Research on Cancer
Tobacco Smoke and Involuntary Smoking
(2004)
S. Akiba
Analysis of cancer risk related to longitudinal information on smoking habits
Environ Health Perspect
(1994)
J.K. McLaughlin et al.
Smoking and cancer mortality among US veterans: a 26-year follow-up
Int J Cancer
(1995)
S.H. Jee et al.
Smoking and cancer risk in Korean men and women
Cancer Causes Control
(2004)
R. Doll et al.
Mortality from cancer in relation to smoking: 50 years observations on British doctors
Br J Cancer
(2005)
E.L. Wynder et al.
Environmental factors in cancer of the larynx: a second look
Cancer
(1976)
A.J. Tuyns et al.
Cancer of the larynx/hypopharynx, tobacco and alcohol: IARC international case-control study in Turin and Varese (Italy), Zaragoza and Navarra (Spain), Geneva (Switzerland) and Calvados (France)
Int J Cancer
(1988)
R.T. Falk et al.
Effect of smoking and alcohol consumption on laryngeal cancer risk in coastal Texas
Cancer Res
(1989)

S. Franceschi et al.

Smoking and drinking in relation to cancers of the oral cavity, pharynx, larynx, and esophagus in northern Italy

Cancer Res

(1990)

C. La Vecchia et al.

Type of cigarettes and cancers of the upper digestive and respiratory tract

Cancer Causes Control

(1990)

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Reduced tobacco consumption in the population has not been associated with reduced incidence rates of head and neck cancer in several countries.
To explore the associations between HNC and sociodemographic characteristics and lifestyle of former smokers from three Brazilian cancer centers.
A multicenter case-control study was conducted with 229 former smokers diagnosed with squamous cell carcinoma of the oral cavity, oropharynx, larynx, and 318 controls (former smokers without head and neck cancer). Bivariate and multiple logistic regression analyses were conducted to estimate odds ratios (ORs) with a 95% confidence interval (CI).
11–20 years after smoking cessation showed significant impact on HNC reduction (OR 0.22, 95% CI, 0.12–0.39), which reached 82% (95% CI, 0.09–0.35) among 20 + former smokers when compared to individuals who had stopped smoking for up to 5 years. A history of high-intensity smoking (>40 pack-years) increased HNC risk by 2.09 times (95% CI 1.13–3.89) when compared to subjects who smoked up to 20 pack-years. Past alcohol consumption (OR 1.99, 95% CI, 1.06–3.82) was also associated with head and neck cancer risk in former smokers when compared to no alcohol consumption. There was a decreased head and neck cancer risk in former smokers who had high school level of education (OR 0.38, 95% CI, 0.16–0.91) compared to illiterate former smokers; and former smokers with moderate intake of vegetables (OR 0.49, 95% CI, 0.28–0.85) and fruits (OR 0.43, 95% CI, 0.25–0.73) compared to those with low intake.
Head and neck cancer risk in former smokers decreases after 11 years after smoking cessation, former smokers with past alcohol consumption showed an increased risk of HNC. High school level of education and moderate intake of vegetables and fruits reduced HNC risk among former smokers.
Discovery of de novo concurrent vocal fold dysplasia in a nonagenarian man and his octogenarian wife
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After 10–15 years of cessation, an almost 60% decrease in relative risk was observed. Although the risk remains elevated as compared to never-smokers, long-term cessation does appear to confer a risk decline [5]. Apart from smoking, the impact of other environmental factors has yet to be fully elucidated.
This case report describes an unusual case of a 92-year-old man with chronic dysphonia with more recent worsening and his 88-year-old wife who developed new-onset hoarseness within 6 months of her husband's surgical treatment.
Retrospective review of 2 cases.
Flexible laryngovideostroboscopy showed very similar exophytic hemorrhagic-appearing lesions. The pathology reports for both husband and wife were nearly identical: inflamed polypoid granulation tissue with high-grade dysplastic epithelium. No organisms were found on Periodic acid-Schiff (PAS) stain. The patients did not recall any environmental exposure in the home, dietary changes, or illnesses requiring antibiotics. Neither had prior history of vocal fold dysplasia or other vocal fold pathology.
An elderly couple presented with nearly identical vocal fold pathology – containing polypoid granulation tissue with high-grade dysplasia. The coincidence may be related to age as a risk factor; although, shared environmental or dietary factors should be taken into consideration.
Combined treatment for at-risk drinking and smoking cessation among Puerto Ricans: A randomized clinical trial
2017, Addictive Behaviors
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At-risk drinking, as defined by the Institute of Medicine and the National Institute on Alcohol Abuse and Alcoholism, is characterized by engaging in chronic moderate or high levels of use and/or frequent binge drinking, and is related to numerous negative health and social consequences (NIAAA, 1995; National Institute of Health, 2004; Institute of Medicine, 1990). Fortunately, the risk for various diseases and other negative health consequences declines following smoking cessation and the reduction of alcohol use (Hayes, Bravo-Otero, Kleinman, et al., 1999; Bosetti, Garavello, Gallus, & La Vecchia, 2006; Bjartveit & Tverdal, 2009). Thus, a critical strategy for chronic disease prevention is to reduce the use of these two substances.
Tobacco and alcohol use are linked behaviors that individually and synergistically increase the risk for negative health consequences. This study was a two-group, randomized clinical trial evaluating the efficacy of a behavioral intervention, “Motivation And Problem Solving Plus” (MAPS +), designed to concurrently address smoking cessation and the reduction of at-risk drinking. Targeted interventions may promote coaction, the likelihood that changing one behavior (smoking) increases the probability of changing another behavior (alcohol use). Puerto Ricans (N = 202) who were smokers and at-risk drinkers were randomized to standard MAPS treatment focused exclusively on smoking cessation (S-MAPS), or MAPS +, focused on cessation and at-risk drinking reduction. Drinking outcomes included: number of at-risk drinking behaviors, heavy drinking, binge drinking, and drinking and driving. MAPS + did not have a significant main effect on reducing at-risk drinking relative to S-MAPS. Among individuals who quit smoking, MAPS + reduced the number of drinking behaviors, the likelihood of meeting criteria for heavy drinking relative to S-MAPS, and appeared promising for reducing binge drinking. MAPS + did not improve drinking outcomes among individuals who were unsuccessful at quitting smoking. MAPS + showed promise in reducing at-risk drinking among Puerto Rican smokers who successfully quit smoking, consistent with treatment enhanced coaction. Integrating an alcohol intervention into cessation treatment did not reduce engagement in treatment, or hinder cessation outcomes, and positively impacted at-risk drinking among individuals who quit smoking. Findings of coaction between smoking and drinking speak to the promise of multiple health behavior change interventions for substance use treatment and chronic disease prevention.
Reformed smokers have survival benefits after head and neck cancer
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Citation Excerpt :
However, reformed smokers have higher risks than non-smokers, though they also have substantially lower risks than those who continue to smoke, the difference in risk being greater the earlier they stopped smoking. The favourable effects of stopping smoking are evident within just a few years after cessation.1,9–12 Bosetti et al11 in their epidemiological study stated that the men who stopped smoking at around 40 years of age avoided about 80% of the possible excess risk of developing cancer over the men who continued to smoke.
Smoking tobacco is the main risk factor for head and neck cancer, is proportional to the number of pack years (number of packs smoked/day x number of years of smoking), and is reduced when the patient stops smoking. Current molecular evidence has suggested that tobacco-related cancers could be clinically more aggressive than cancers in non-smokers, particularly in the head and neck. However, clinical studies have not uniformly reproduced the relation between survival and tobacco, possibly because they ignore the health benefit that reformed smokers obtain during the period between giving up smoking and the diagnosis of cancer, which is not shared by those who continue to smoke and develop cancer. We have investigated the survival of reformed smokers, non-smokers, and continuing smokers after a diagnosis of head and neck cancer. The data of patients with head and neck cancer from 1992 -2013 from the Cancer Genome Atlas database were analysed using a multivariate Cox's regression model for survival, and Kaplan-Meier curves were produced for smoking history. A total of 521 patients were treated for head and neck cancer, and there was a significant difference in survival between reformed and non-smokers on the one hand, and current smokers on the other (p = 0.02). The significance increased when reformed smokers were grouped according to their duration of abstinence and time of diagnosis of cancer (>15 and ≤15 years, p < 0.01). Smoking history was a significant prognostic factor in the multivariate Cox's regression model when analysed with age, stage, grade, and site. We conclude that reformed smokers have a survival benefit in head and neck cancer.
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Because the molecular mechanisms underlying the development of laryngeal cancer are not well understood, we conducted a case–control study to determine the association between eight common SNPs in NER pathway genes and risk of laryngeal cancer, and the association between genetic polymorphisms and environmental factors. A 1:1 matched case–control study of 176 cases and 176 controls was conducted. Laryngeal cancer cases were more likely to smoke and drink (all P values < 0.05). Subjects with the ERCC1 rs11615 CC genotype and C allele had an increased risk of laryngeal cancer. Similarly, individuals with the ERCC5 rs17655 GG genotype and G allele had an increased risk of laryngeal cancer. Gene–gene interaction analysis showed that subjects carrying ERCC1 rs11615 C allele and XPG/ERCC5 rs17655 G allele had a greatly increased risk of breast cancer. Stratified analysis revealed that the interaction between polymorphisms of ERCC1 rs11615 and ERCC5 rs17655 and smoking on cancer risk was statistically significant, and ERCC1 rs11615 polymorphisms also had a significant interaction with drinking habit. In conclusion, our study suggests that ERCC1 rs11615 and ERCC5 rs17655 polymorphisms are associated with increased risk of laryngeal cancer, and that they confer more risk among smokers and drinkers.
Adult Laryngotracheal Surgery
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REVIEWEffects of smoking cessation on the risk of laryngeal cancer: An overview of published studies

Summary

Introduction

Section snippets

Cohort studies

Case-control studies

Discussion

Acknowledgments

The age distribution of cancer: implications for models of carcinogenesis

J R Stat Soc A

Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies

BMJ

Tobacco Smoke and Involuntary Smoking

Analysis of cancer risk related to longitudinal information on smoking habits

Environ Health Perspect

Smoking and cancer mortality among US veterans: a 26-year follow-up

Int J Cancer

Smoking and cancer risk in Korean men and women

Cancer Causes Control

Mortality from cancer in relation to smoking: 50 years observations on British doctors

Br J Cancer

Environmental factors in cancer of the larynx: a second look

Cancer

Cancer of the larynx/hypopharynx, tobacco and alcohol: IARC international case-control study in Turin and Varese (Italy), Zaragoza and Navarra (Spain), Geneva (Switzerland) and Calvados (France)

Int J Cancer

Effect of smoking and alcohol consumption on laryngeal cancer risk in coastal Texas

Cancer Res

Smoking and drinking in relation to cancers of the oral cavity, pharynx, larynx, and esophagus in northern Italy

Cancer Res

Type of cigarettes and cancers of the upper digestive and respiratory tract

Cancer Causes Control

REVIEW
Effects of smoking cessation on the risk of laryngeal cancer: An overview of published studies