Occupational dust exposure and head and neck squamous cell carcinoma risk in a population-based case-control study conducted in the greater Boston area

Hypermethylation of nc886 in HPV-positive oropharyngeal cancer and its clinical implications: An epigenome-wide association study

The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased rapidly in the United States, driven by rising human papillomavirus (HPV) infections in the U.S. population. HPV-positive OPSCC patients have a better prognosis than HPV-negative patients. To gain insights into the unique biology of HPV(+) OPSCC that may contribute to its clinical behaviors, we performed a multi-stage epigenome-wide methylation profiling of leukocyte and tumor DNA in OPSCC patients and compared the methylation levels of CpG sites between HPV(+) and HPV(-) OPSCC patients. We identified and validated a significantly differentially methylated region (DMR) of 1,355 bp encompassing non-coding RNA 886 (nc886) gene and its promoter region. Nc886 is hypermethylated in both leukocytes and tumor DNA of HPV(+) OPSCC patients. Homozygous knockout of nc886 by CRISPR-Cas9 in head and neck cell lines was lethal, but nc886 could be knocked out on the background of protein kinase R (PKR) knockout. Our data suggest that HPV induces nc886 hypermethylation, and nc886 acts as both a viral sensor and a tumor sensor in OPSCC patients and contribute to the better prognosis of HPV(+) OPSCC patients. Nc886 may become a therapeutic target in OPSCC.

[Advances in risk factors and genetic risk of head and neck squamous cell carcinoma]

With the incidence of head and neck squamous cell carcinoma increasing year by year and the epidemiological trend changes, the research on risk factors of head and neck squamous cell carcinoma and its primary prevention has attracted more and more attention. At present, many risk factors of head and neck squamous cell carcinoma have been studied, which can be divided into genetic factors and non-genetic factors. Among the non-genetic factors, viral infection （HPV virus, Epstein-Barr virus）, lifestyle （smoking, drinking, diet, chewing betel nut）, social behavior factors, immunosuppression, occupational exposure, and other factors are closely related to HNSCC incidence. In this paper, the research progress of HNSCC related risk factors is reviewed to provide evidence for the identification of the risk of head and neck squamous cell carcinoma and reduce the risk behaviors to reduce the incidence of head and neck squamous cell carcinoma.

Tetraspanin CD9: A friend or foe of head and neck cancer (Review)

Head and neck cancers are diverse and complex diseases characterised by unregulated growth of tumour cells in various parts of the head and neck region, such as in the buccal mucosa, floor of the mouth, tongue, oropharynx, hypopharynx, oesophagus, nasopharynx and salivary glands. Partial or total glossectomy, radiation or chemotherapy greatly affect patient quality of life. However, even following treatment, patients may relapse. Nicotine-derived nitrosamines and alcohol are the major etiological factors underlying this deadly disease. These compounds induce DNA damage that may lead to mutation in crucial genes, such as p53 and p21, which are important to regulate cell proliferation, thus leading to cancer. CD9 is a tetraspanin, which are a group of transmembrane proteins that have a role in cell motility and adhesion. The present review aimed to explore the role of CD9 in head and neck cancer. Epidermal growth factor receptor activity and cell proliferation are regulated by the CD9-integrin/CD9-transforming growth factor interaction. Hence, CD9 can play a dual role in various types of cancer.

Firefighter occupation is associated with increased risk for laryngeal and hypopharyngeal squamous cell carcinoma among men from the Greater Boston area

OBJECTIVE

Firefighters are exposed to a wide variety of carcinogens during the line of duty, including several associated with head and neck cancer. Existing studies assessing head and neck cancer risk with firefighting have predominately included occupational cohorts or registry data, which are limited by inability to adjust for smoking and alcohol consumption-major risk factors for head and neck cancer. Our objective was to assess the risk of head and neck cancer among men with an occupational history as a firefighter.

METHODS

This work was conducted using male subjects from a large population-based case-control study of head and neck cancer from the greater Boston area using self-reported occupational history (718 cases and 905 controls).

RESULTS

An occupational history as a firefighter was reported for 11 cases and 14 controls. Although no significant association was observed overall, we observed substantial increased risk for hypopharyngeal and laryngeal squamous cell carcinoma among professional municipal firefighters who had a light or no smoking history (OR=8.06, 95% CI 1.74 to 37.41), with significantly increasing risk per decade as a firefighter (OR=2.10, 95% CI 1.06 to 4.14).

CONCLUSION

Professional municipal firefighters may be at increased risk for hypopharyngeal and laryngeal squamous cell carcinoma due to carcinogenic exposures encountered during the line of duty.

Chrysotile fibers in tissue adjacent to laryngeal squamous cell carcinoma in cases with a history of occupational asbestos exposure

Asbestos describes a group of naturally occurring fibrous silicate mineral compounds that have been associated with a number of respiratory maladies, including mesothelioma and lung cancer. In addition, based primarily on epidemiologic studies, asbestos has been implicated as a risk factor for laryngeal and pharyngeal squamous cell carcinoma (SCC). The main objective of this work was to strengthen existing evidence via empirical demonstration of persistent asbestos fibers embedded in the tissue surrounding laryngeal and pharyngeal SCC, thus providing a more definitive biological link between exposure and disease. Six human papillomavirus (HPV)-negative laryngeal (n = 4) and pharyngeal (n = 2) SCC cases with a history working in an asbestos-exposed occupation were selected from a large population-based case-control study of head and neck cancer. A laryngeal SCC case with no history of occupational asbestos exposure was included as a control. Tissue cores were obtained from adjacent nonneoplastic tissue in tumor blocks from the initial primary tumor resection, and mineral fiber analysis was performed using a scanning electron microscope equipped with an energy dispersive X-ray analyzer (EDXA). Chrysotile asbestos fiber bundles were identified in 3/6 of evaluated cases with a history of occupational asbestos exposure. All three cases had tumors originating in the larynx. In addition, a wollastonite fiber of unclear significance was identified one of the HPV-negative pharyngeal SCC cases. No mineral fibers were identified in adjacent tissue of the case without occupational exposure. The presence of asbestos fibers in the epithelial tissue surrounding laryngeal SCC in cases with a history of occupational asbestos exposure adds a key line of physical evidence implicating asbestos as an etiologic factor.

Risk factors for head and neck cancer in the World Trade Center Health Program General Responder Cohort: results from a nested case-control study

OBJECTIVES

Head and neck cancers (HNCs) may be among the health consequences of involvement in the World Trade Center (WTC) response on and after 11 September 2001. We conducted a nested case-control study of WTC Health Program (WTCHP) general responders to examine the effects of WTC exposures and behavioural risk factors on HNC.

METHODS

We enrolled 64 cases and 136 controls, matched on age, sex and race/ethnicity within risk sets. We assessed tobacco and alcohol use, sexual activity, and occupational exposures prior to, during and after WTC exposure until case diagnosis via questionnaire. We obtained WTC exposure information (duration (first to last day), total days and location of work) from the WTCHP General Responder Data Center. We assessed associations with HNC, and interaction among exposures, using conditional logistic regression.

RESULTS

Responders in protective services versus other occupations had increased odds (OR: 2.51, 95% CI 1.09 to 5.82) of HNC. Among those in non-protective services occupations, arriving to the WTC effort on versus after 11 September 2001 was significantly associated with HNC (OR: 3.77, 95% CI 1.00 to 14.11). Duration of work was not significantly associated with HNC. Lifetime and post-WTC years of cigarette smoking and post-WTC number of sex partners were positively and significantly associated with HNC, while alcohol consumption was not.

CONCLUSIONS

These findings suggest opportunities for HNC risk factor mitigation (eg, smoking cessation, human papillomavirus vaccination) and contribute to a risk factor profile which may assist WTCHP clinicians with identifying high-risk responders and improve detection and treatment outcomes in this population.

Occupations and the Risk of Head and Neck Cancer: A Pooled Analysis of the International Head and Neck Cancer Epidemiology (INHANCE) Consortium

OBJECTIVE

To investigate the associations between head and neck cancer (HNC) risk and occupations.

METHODS

We harmonized data on occupations in a pooled analysis of 8839 HNC cases and 13,730 controls in International Head and Neck Cancer Epidemiology (INHANCE) consortium. Logistic regression was used to estimate odds ratios (ORs) for associations of occupations and HNC risk. Population attributable fraction (PAF) for occupations was calculated using the formula PEC × (OR - 1)/OR.

RESULTS

Trend of increasing HNC risk was found with increasing duration of employment for many occupations, including cooks (OR = 1.36; 95% confidence interval [CI] 1.09 to 1.68), cleaners (OR = 1.38; 95% CI 1.13 to 1.69), painters (OR = 1.82; 95% CI 1.42 to 2.35). The PAF for a priori occupations was 14.5% (95% CI 7.1% to 21.9%) for HNC.

CONCLUSIONS

We found associations between certain occupations and HNC risks, including for subsites, with a duration-response relationship.

Head and neck cancer and occupational exposure to leather dust: results from the ICARE study, a French case-control study

BACKGROUND

Leather dust is an established carcinogen of the sinonasal cavities; however, evidence is lacking regarding its association with other head and neck cancers (HNC). To date, few studies have been conducted on the association between occupational leather dust exposure and the risk of oral, pharyngeal, and laryngeal cancers. The objective of this study was to investigate the association between the risk of HNC and occupational exposure to leather dust.

METHODS

Lifestyle habits and occupational history were collected for 2161 patients with squamous cell carcinoma of oral cavity, pharynx, and larynx, and 3555 controls, using a standardized questionnaire. Occupational exposure to leather dust was assessed using a job-exposure matrix. Odds ratios (OR) and 95% confidence intervals (CI) for HNC globally and by subsite were estimated using multivariate unconditional, and polytomous logistic regressions, respectively.

RESULTS

Cumulative lifetime exposure to leather dust < 6 mg/m³-years was associated with an increased risk of laryngeal cancer (OR = 2.26, 95% CI: 1.07-4.76); higher levels were not related to elevated risks of HNC. Some tasks performed and the use of some glues were associated with elevated, although non-significant, risks of HNC. No dose-response relationships were observed.

CONCLUSION

Our study did not provide enough evidence for an increased risk of HNC related to occupational exposure to leather dust. Further studies are needed to understand the risks of specific tasks in the leather industry.

Excess HPV-related head and neck cancer in the world trade center health program general responder cohort

The World Trade Center (WTC) attacks exposed rescue and recovery workers to a complex mix of toxicants, including carcinogens. our study compared site-specific cancer incidence of head and neck cancers (HNC) from 2003 through 2012 among 33,809 consented WTC General Responder Cohort (GRC) members to the New Jersey State Cancer Registry, using standardized incidence ratios (SIRs). HNC grouped using SEER ICD-O-3 codes into HPV-related (oropharyngeal) and non-related (other oral-nasal; laryngeal) tumors based on anatomical site. For the 73 GRC members identified with HNC, proportional hazard regression assessed the relationship between WTC exposure and other socio-demographic characteristics. An overall excess of HNC was not observed (SIR = 1.00, 95% CI: 0.78, 1.25) but excess cancer was seen in the latest observation period (2009-2012: SIR = 1.4; 95% CI: 1.01, 1.89). A similar temporal pattern was seen for HPV-related oropharyngeal cancer and laryngeal cancer, but not for non-HPV-related sites (oral-nasal cancer). HNC was significantly associated with increasing age (8% per year, 95% CI: 5%, 12%), non-Hispanic white ethnic group-ethnicity (hazard ratio (HR) = 3.51, 95 CI: 1.49, 8.27); there was a borderline association with the 9/11 occupation of military/protective services vs. others (HR = 1.83 95% CI: 0.99, 3.38; p = 0.0504). Caution is needed in interpreting these results given the small number of cases, potential for surveillance bias, and long latency for most cancers. Our findings highlight the need to examine the potentially carcinogenic effects of WTC exposure in the context of other strong risk factors, and the need for continued medical monitoring of WTC responders.

Systematic screening for occupations and occupational exposures in head and neck squamous cell carcinoma patients

PURPOSE

The importance of occupational exposures in patients with head and neck squamous cell carcinomas (HNSCC) has received little attention.

METHODS

In a single-center study, we prospectively characterized occupational exposures in 154 HNSCC cancer patients in a systematic occupational consultation and examined the association between most frequent exposures, HNSCC stage and localization.

RESULTS

Patients occupied a mean of 3.3 different positions during their working life. The prevalence of asbestos, the most frequent exposure (46 patients; 29.9%) was higher than in the French population > 50 years. Other frequent exposures were solvents (n = 26; 16.9%) and silica (n = 19; 12.3%). For 37 patients (24%) a possible link was identified between occupational exposures and HNSCC. Duration of asbestos exposure was significantly higher (p = 0.04) in patients with hypopharyngeal and laryngeal cancer compared to other localizations.

CONCLUSIONS

Occupational exposures are frequent in patients with HNSCC and should receive increased attention by physicians.

May the change of platelet to lymphocyte ratio be a prognostic factor for T3-T4 laryngeal squamous cell carcinoma: A retrospective study

Background

Many blood markers have been shown to predict the recurrence and survival of various malignancies, but the effects of surgery on the body's inflammatory levels may cause changes in these inflammatory markers. Therefore, in this study, we assessed the relationship between changes in platelet to lymphocyte ratio (PLR) and survival and recurrence in patients with T3-T4 laryngeal squamous cell carcinoma (LSCC).

Methods

Data of patients with T3-T4 HSCC were reviewed. Continuous variables were expressed as mean ± SD and were compared using t test or Mann-Whitney U test. The covariate distributions were compared by Chi-square test. Survival curve was estimated by Kaplan-Meier analysis, and Log-Rank test were performed to estimate the survival curve and significance of the difference in survival distribution between groups, respectively. The prognostic value was uncovered by univariate and multivariate Cox hazards analysis.

Results

The 413 consecutive patients with LSCC were reviewed. Of these, 362 patients who met the criteria were selected, multi-factor analysis found that pathological T classification(hazard ratio [HR] = 1.878; 95% confidence interval [CI] = 1.342–3.023; P<0.001), pathological N classification (HR = 1.212; 95% CI = 0.867–2.125; P< 0.001) and change of PLR (HR = 2.158; 95% CI = 1.332–2.889; P = 0.004) associated with postoperative recurrence of T3-T4 LSCC. In addition, the pathological T classification (HR = 1.901; 95% CI = 1.255–2.999; P<0.001), pathological N classification (HR = 1.244; 95% CI = 0.810–2.212; P<0.001) and change of PLR (HR = 2.011; 95% CI = 1.354–2.753; P = 0.001) associated with postoperative survival in patients with T3-T4 LSCC.

Conclusions

Results demonstrate that change in PLR may serve as a useful prognostic predictor for patients with T3-T4 LSCC.

Head and Neck Cancer in World Trade Center Responders: A Case Series

OBJECTIVE

The aim of this study was to report on cases of head and neck cancer (HNC) among World Trade Center (WTC) responders participating in the WTC Health Program and seen at Rutgers WTC Center of Clinical Excellence.

METHODS

Medical records were abstracted by two clinical reviewers and discrepancies resolved. Cases were defined as WTC responders diagnosed with HNC between December 9, 2005, and December 31, 2016.

RESULTS

Sixteen HNC patients met the case definition, most (13) arrived at the WTC location on 9/11 or within the following 2 days, and half worked in law enforcement during the 9/1 response.

CONCLUSION

An association between HNC and WTC exposure is biologically plausible and should be further investigated. Research to enumerate the risk factor profile for these cancers may contribute to understanding mechanisms by which WTC exposure can contribute to carcinogenesis and to prevention and early detection strategies.

Human Papillomavirus Associated Cancers of the Head and Neck: An Australian Perspective

Human papillomavirus (HPV) associated head and neck squamous cell carcinomas (HNSCCs), have become a serious global health problem. Despite decreases in HPV-negative HNSCCs, the prevalence of HPV-positive HNSCCs has significantly increased. HPV-positive cancers are associated with superior survival outcomes when compared to HPV-negative cancers, which appears likely to be associated with differences in the molecular pathogenesis of the two diseases. While therapies are still problematic, the current HPV vaccine programs hold a promise for the primary prevention of HPV-related HNSCCs and since Australia was the first to introduce a nationwide HPV vaccine program, it is in a unique position to observe the effects of the vaccine on HNSCCs. This review discusses the epidemiological trends associated with HPV in HNSCC, with reference to the differences between HPV-positive and HPV-negative HNSCCs and the prevention potential of HPV vaccines.

Obesity and head and neck cancer risk and survival by human papillomavirus serology

PURPOSE

Previous studies examining the association of body mass index (BMI) with risk of and survival from head and neck squamous cell carcinoma (HNSCC) have been inconsistent, although an inverse association has been noted for obesity and risk of HNSCC in several studies. Previous studies have not examined whether these associations differ by human papillomavirus (HPV) status.

METHODS

We utilized the resources of a population-based case-control study of HNSCC from the greater Boston area (959 cases and 1,208 controls were eligible for this analysis). Anthropometric history was collected through personal interviews, and HPV status was assessed using serology. We analyzed the association between BMI (assessed 5 years prior to disease incidence) and disease risk and survival using logistic regression and Cox proportional hazards regression, respectively.

RESULTS

After adjusting for known risk factors, the association between obesity and overall risk of HNSCC was not significant (OR 0.79, 95 % CI 0.60-1.04). However, obesity (BMI ≥30 kg/m(2)) was inversely associated with HNSCC risk among HPV-seronegative cases (OR 0.48, 95 % CI 0.32-0.70), but not among HPV-seropositive cases (OR 0.91, 95 % CI 0.68-1.21). BMI was not associated with survival overall or by HPV status. However, being overweight (BMI 25-29.9 kg/m(2)) was associated with longer survival among HPV-seropositive smokers (HR 0.48, 95 % CI 0.31-0.74).

CONCLUSIONS

Our findings are consistent with previous observations that obesity is inversely associated with the risk of HNSCC; however, this association appears to be confined to HPV-seronegative cases. Overall, obesity was not associated with HNSCC survival overall or by HPV status.

IMPACT

Obesity is associated with risk of non-HPV HNSCC, but not HPV HNSCC.