Alcoholism and cancer of the larynx: a case-control study in western Washington (United States)

Impact of Dietary Intake and Habits on Subjective Voice and Laryngeal Mucosal Diseases: Analysis From Korean National Health and Nutritional Examination Survey Between 2008 and 2021

OBJECTIVES

Dysphonia negatively affects social communication, leading to reduced quality of life. Comprehensive research on dysphonia and laryngeal mucosal diseases using large-scale epidemiological data is lacking. Therefore, we investigated how dietary and habitual factors influence dysphonia and laryngeal mucosal diseases using data from the Korean National Health and Nutritional Examination Survey.

STUDY DESIGN

A population-based cross-sectional study.

METHODS

The study included individuals aged 19 years and older who both underwent laryngoscopic examinations and completed a dysphonia survey. Dietary and habitual factors and results of the laryngoscopic examinations were collected. Risk factors for dysphonia and laryngeal mucosal diseases were identified.

RESULTS

The weighted frequency of dysphonia and laryngeal mucosal diseases was 6.4% and 6.0%, respectively. In univariable analyses for dysphonia, sex, body weight change, alcohol ingestion, and various minerals and vitamins showed statistically significant associations. However, in the multivariable analysis, only age, body weight, female sex, and vitamin A intake were significantly associated with dysphonia. Age, body weight, body mass index, sex, smoking, amount of sodium intake, and alcohol intake were associated with laryngeal mucosal diseases in the univariable analyses, but in the multivariable analysis, only age, smoking, and amount of niacin intake were significant factors.

CONCLUSIONS

In this large-scale epidemiological analysis, subjective dysphonia and laryngeal mucosal diseases had different frequencies and risk factors. Age was a risk factor for both dysphonia and mucosal diseases, but smoking was only a risk factor for laryngeal mucosal diseases. Diet types, calories, and water and alcohol intake were not significant risk factors for either laryngeal mucosal diseases or dysphonia.

Duodenal Contents Reflux-Induced Laryngitis in Rats: Possible Mechanism of Enhancement of the Causative Factors in Laryngeal Carcinogenesis

Objectives:

The main factors considered responsible for the onset of laryngeal cancer are tobacco smoking and alcohol abuse. Recently, gastroesophageal reflux has also been implicated as a causative factor in several laryngeal disorders, including laryngeal cancer. However, the significance of gastroesophageal reflux in laryngeal cancer is controversial.

Methods:

We investigated the histologic features of the esophagus and larynx in a rat model of reflux of the duodenal contents. Cell proliferation was also evaluated in laryngeal samples by detection of Ki67 antigen.

Results:

In this reflux model, laryngitis with infiltration of inflammatory cells and proliferation of small mucous glands was evident from 10 weeks after operation, and basal cell hyperplasia around the epiglottis and hyperplastic changes in the larynx were detected at 30 weeks. No dysplastic or malignant lesions were detected in the laryngeal samples within the duration of the experiment, in spite of detection of malignancy in 31.3% of lesions in esophageal samples at 30 weeks. The Ki67 index at each week was significantly higher than that of the control animals.

Conclusions:

Previous studies have shown smoking and alcohol abuse to have refluxogenic effects. Reflux of duodenal contents causes laryngitis. Reflux does not appear to be an independent risk factor for laryngeal carcinogenesis, but it may enhance the acknowledged etiologic risk factors, namely, smoking and alcohol abuse, by promoting cell proliferation.

A Population-Based Cross-Sectional Study of Alcohol Consumption and Risk of Benign Laryngeal Disease in Korean Adults

OBJECTIVE

Studies on alcohol consumption and benign laryngeal disease (BLD) in the general population are rare. The aim of this study was to investigate the relationship between alcohol consumption and BLD in the Korean general population.

STUDY DESIGN

This was a cross-sectional study of a national health survey.

MATERIALS AND METHODS

Subjects were 3141 noninstitutionalized civilian adults older than 19 years (1313 men and 1828 women) who completed the laryngeal examination of the Korea National Health and Nutrition Examination Survey of 2008. Frequency of drinking was classified into less than once per week, two to three times per week, and more than four times per week. Binge drinking was defined as five or more drinks (≥61 g of alcohol) per episode for men and as four or more drinks (≥41 g of alcohol) per episode for women. Poisson regression analyses were conducted to examine the relationship between alcohol drinking and BLD.

RESULTS

Adjusting for covariates (age, sex, income, level of education, occupation, and cigarette smoking), it was found that those who drank more than four times a week, compared with those who drank less than once per week, were more likely to have BLD (risk ratio = 2.15, 95% confidence interval: 1.01-4.59, P < 0.05). However, the amount of alcohol consumed was not associated with BLD.

CONCLUSIONS

Frequent drinking (ie, more than four times a week) was found to be a risk factor for BLD.

Uso de substâncias psicoativas, alterações vocais e qualidade de vida em usuários de drogas lícitas e ilícitas

OBJETIVOS:investigar a qualidade de vida e voz, além das principais alterações perceptivo-auditivas e as medidas acústicas jitter, shimmer e Glottal Noise Excitation em usuários de substâncias psicoativas lícitas e/ou ilícitas que buscaram um centro de tratamento para dependência química.MÉTODOS:estudo transversal. Os participantes responderam aos questionários de Mensuração de Qualidade de Vida em Voze World Health Organization Quality of Life Instrument-Bref. Além disso foi realizado, um registro vocal da vogal /a/ e de uma contagem de números de 1 a 20. Os registros vocais foram avaliados por meio da escala GRBAS-I (G - grau global da disfonia, R - rugosidade, B - soprosidade, A - astenia, S - tensão) e a análise acústica (jitter, shimmer, Glottal noise excitation) pelo software VoxMetria.RESULTADOS:avaliaram-se 29 protocolos e registros de voz; na amostra, 19 (65,5%) eram homens; a idade média da amostra foi de 37,8 anos. Os escores de ambos os questionários não apresentaram diferenças entre os usuários de drogas lícitas e os de drogas ilícitas. Na análise perceptiva por meio da GRBAS-I, eles mostraram predominância de alterações discretas e moderadas nos itens grau geral da disfonia, rugosidade e instabilidade para usuárias de drogas ilícitas. A medida acústica jitter e o shimmerestavam alterados para homens e mulheres, e o desvio padrão da frequência fundamental também estava alterado.CONCLUSÃO:alterações de qualidade de vida e voz foram identificadas em ambos os usuários. A maioria dos usuários apresentou alterações nas medidas de jittere shimmer.Usuários de drogas ilícitas apresentaram mais alterações de Glottal Noise Excitation e desvio padrão da frequência fundamental.

Expression of CBY and methylation of CBY at promoter region in human laryngeal squamous cell carcinoma

AIMS AND BACKGROUND

Chibby (CBY), a β-catenin binding partner, inhibits Wnt/β-catenin-mediated transcriptional activation by competing with Tcf/Lef factors for β-catenin binding and promoting the export of β-catenin from nucleus to cytoplasm. The regulatory effect of CBY in this signaling pathway suggests its biological importance as a potential tumor suppressor gene. The purposes of this study were to determine whether the expression of CBY was downregulated in human laryngeal squamous cell carcinoma (LSCC) samples, the CpG sites of CBY at the promoter region were methylated in these tumor samples, and reduced expression of CBY was induced by methylation of CBY promoters.

METHODS

CBY expression was investigated by quantitative real-time PCR and immunohistochemistry in samples from 36 LSCC patients. The methylation status of the CBY promoter was detected by methylation-specific PCR.

RESULTS

Compared with normal laryngeal mucosa, the expression of CBY was downregulated in LSCC samples. The reduced CBY expression rate was 58.33% (21/36) at the mRNA and 66.67% (24/36) at the protein level. The promoters of CBY were methylated in 12/36 tumor samples, partially methylated in 5, and unmethylated in 19 samples. The methylation rate including incomplete methylation was 47.22% (17/36) in tumor samples, while no methylation was detected in normal laryngeal squamous epithelium. Compared with the unmethylated group, the expression of CBY was significantly different in the methylated group (p&lt;0.05) but similar in the partially methylated group (p&gt;0.05).

CONCLUSIONS

Our data indicate that CBY expression was downregulated in LSCC, which may be partially caused by methylation of CBY promoters.

Laryngeal pathologies in older Korean adults and their association with smoking and alcohol consumption

OBJECTIVES/HYPOTHESIS

This study's objectives were to assess the prevalence rate of laryngeal pathologies in the Korean elderly, and to examine the association of smoking and alcohol consumption with laryngeal diseases.

STUDY DESIGN

Cross-sectional study.

METHODS

Data were from the 2008 Korea National Health and Nutritional Examination Survey. Subjects were 663 elderly persons (261 men and 402 women) between the ages of 65 and 84 years who completed the laryngoscopic examination. Weighted prevalence of laryngeal pathologies was compared by demographic characteristics, smoking, alcohol drinking, body mass index, and self-reported voice problems. Multiple logistic regression analyses were conducted to examine the independent as well as combined influence of smoking and alcohol consumption on laryngeal lesions.

RESULTS

The prevalence of laryngeal pathologies in the Korean elderly between the ages of 65 and 84 years was 8.1%. The prevalence of laryngeal lesions increased with age and was higher among men, middle school and high school graduates, manual workers, current smokers, current alcohol drinkers, and those with self-reported voice problems. Adjusting for covariates, current smokers, compared with nonsmokers, were more likely to have laryngeal pathologies (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.01-4.67). Current alcohol drinking was not independently associated with laryngeal diseases. Concurrent smoking and alcohol drinking, however, were associated with a significantly higher risk of laryngeal pathologies (OR, 3.29; 95% CI, 1.22-8.88).

CONCLUSIONS

Smoking and alcohol consumption may increase the risk of laryngeal diseases in later life.

Riscos ocupacionais para o câncer de laringe: um estudo caso-controle

O tabagismo e o consumo de álcool são os fatores de risco mais bem estabelecidos para o câncer de laringe. Com relação aos fatores ocupacionais, o único carcinógeno estabelecido é a exposição a névoas de ácidos inorgânicos fortes. Entretanto, asbesto, pesticidas, tintas, gases de combustão de gasolina e diesel e poeiras, entre outros, aparecem na literatura como agentes ocupacionais que aumentam o risco de câncer de laringe. Um estudo caso-controle de base hospitalar foi conduzido para investigar fatores de risco ocupacionais para câncer de laringe. Foram coletadas informações detalhadas sobre tabagismo, consumo de álcool e história ocupacional de 122 casos de câncer de laringe e 187 controles pareados por freqüência (segundo sexo e idade). Encontrou-se risco aumentado de câncer de laringe nos indivíduos com exposição à sílica cristalina livre respirável (OR = 1,83; IC95%: 1,00-3,36), à fuligem (de carvão mineral, coque, madeira, óleo combustível) (OR = 1,78; IC95%: 1,03-3,03), a fumos em geral (OR = 2,55; IC95%: 1,14-5,67) e a animais vivos (OR = 1,80; IC95%: 1,02-3,19).

PC cell-derived growth factor overexpression promotes proliferation and survival of laryngeal carcinoma

PC cell-derived growth factor is a novel growth factor for tumor formation and progression. No comprehensive literature concerning PC cell-derived growth factor expression status and its biological function in squamous cell carcinoma, especially in the larynx, is, however, available. The target of this study is to evaluate the clinical significance of PC cell-derived growth factor and the potential of small interfering RNA-induced genetic silencing of PC cell-derived growth factor as a supplementary therapeutic way for laryngeal squamous cell carcinoma. A total of 146 primary laryngeal cancer, 108 adult laryngeal papilloma and 41 laryngeal leukoplakia samples, as well as 10 normal larynx tissues were investigated. The PC cell-derived growth factor mRNA level was examined by real-time polymerase chain reaction and protein localization by immunohistochemistry. The biological function of PC cell-derived growth factor was assessed by transfection of small interfering RNA PC cell-derived growth factor construction. The PC cell-derived growth factor protein levels and mRNA levels of the laryngeal squamous cell carcinomas were significantly higher than those of normal laryngeal tissues (P<0.001). Simultaneously, the difference in the levels of mRNA and protein between those of laryngeal precancerous lesions (papilloma/leukoplakia) and those of normal tissues was significant (P<0.05, P<0.05), whereas those of laryngeal precancerous lesions (papilloma/leukoplakia) were significantly lower than those of laryngeal squamous cell carcinomas (P<0.05, P<0.05). Strong PC cell-derived growth factor expression was associated with lymph node metastases in laryngeal squamous cell carcinoma (P<0.05). Functional studies on Hep-2 cell lines demonstrated that the attenuation of PC cell-derived growth factor expression levels led to diminished cell proliferation rates (P<0.001), anchorage-independent growth in vitro (P<0.001), tumor forming in vivo (P<0.01) and resistance to apoptosis (P<0.001). PC cell-derived growth factor is a pivotal autocrine growth factor in the tumorigenesis of laryngeal squamous cell carcinoma. Our findings also indicate that PC cell-derived growth factor is a logical and potential target for early diagnosis, specific therapy and prognosis of laryngeal squamous cell carcinoma.

Gastroesophageal reflux and laryngeal cancer: causation or association? A critical review

Gastroesophageal reflux disease has been implicated as a causative factor in several laryngeal disorders. Its involvement in laryngeal cancer is of interest not only from a clinicopathologic aspect, but also from a public health perspective. However, despite a number of studies, a causal relationship with laryngeal cancer is uncertain. In this article, we address the current literature in a critical manner to facilitate the understanding of this subject and evaluate the relationship between gastroesophageal reflux disease and laryngeal carcinoma.

Alcohol consumption and risk of laryngeal cancer

Epidemiological studies consistently showed that alcohol drinking increases the risk of laryngeal cancer. This risk increases with the amount of alcohol consumed: in recent studies conducted in North America, Europe, Japan and Korea the multivariate relative risks for the highest levels of consumption ranged between 2 and 10, and were 1.94 for 50 g/day and 3.95 for 100 g/day in a meta-analysis of 20 studies. Further, the risk increases by concomitant tobacco smoking, each agent approximately multiplying the effect of the other. In the absence of smoking the risks are small for moderate alcohol consumption. After stopping drinking, some fall in risk becomes apparent in the long term. The role of age at starting and stopping drinking is still unclear. In various studies, the most commonly used alcoholic beverage appears to be the most associated with laryngeal cancer risk, suggesting that no meaningful difference exists for different types of alcoholic beverages. The supraglottis is more closely related to alcohol consumption, as compared to the glottis/subglottis. Alcohol drinking may influence laryngeal cancer risk particularly through its direct contact or solvent action, perhaps by enhancing the effects of tobacco or other environmental carcinogens.

Larynx squamous cell carcinoma: concepts and future directions

The larynx is one of the most important structures in the upper aerodigestive tract. Functional impairment of the larynx is a bur-den to patients who suffer from laryngeal carcinoma, the second most common cancer of the head and neck region after the oral cavity.

Derivation of tolerable upper alcohol intake levels in Germany: a systematic review of risks and benefits of moderate alcohol consumption

BACKGROUND

The objective of this study is to weigh the risks of moderate alcohol consumption against its benefits and, as a result, to derive tolerable upper alcohol intake levels (TUALs) for the German adult population.

METHODS

Human studies assessing the effects of moderate alcohol consumption (< or = 40 g/day) on coronary heart disease, stroke, blood pressure, diseases of the liver, gallbladder, bile duct, and pancreas, cancer of the mouth/pharynx/larynx/oesophagus, stomach, colon/rectum, and breast, foetal alcohol syndrome/foetal alcohol effects, as well as all-cause mortality, published in the 10-15 years before 1999, have been systematically reviewed. The quality of studies has been evaluated using a self-constructed evaluation scheme. As a result of comparing the critical endpoints of alcohol intake related to morbidity and mortality, the TUALs have been derived.

RESULTS

The TUALs have been set at 10-12 g/day for healthy women and 20-24 g/day for healthy men of the adult population (18 years and older). Additional guidelines on alcohol use have been defined, taking into account further important aspects like alcohol consumption patterns and high-risk groups.

CONCLUSIONS

The TUALs are not intended to be recommended intake levels. However, if the TUALs and the additional guidelines are followed, a relation of alcohol consumption to an increased risk of alcohol-associated diseases is unlikely for the majority of the population.

Gastroesophageal reflux disease is a risk factor for laryngeal and pharyngeal cancer

OBJECTIVE

Gastroesophageal reflux disease (GERD) is a proposed risk factor for developing laryngeal and pharyngeal cancers. No controlled study has examined this association.

METHODS

A case-control-study was performed using the computerized hospitalization and outpatient databases of the US Department of Veterans Affairs. All patients, who were veterans, had been identified as being hospitalized with laryngeal or pharyngeal during 1991 to 1997. In addition, all persons diagnosed with laryngeal or pharyngeal cancer in 1999 in the outpatient files were identified. From the same patient populations, four nonmatched control subjects were randomly assigned for each case. The medical history for cases and controls was retrospectively searched for GERD diagnoses, tobacco use, and alcohol dependence. Multivariable logistic regression analyses were performed to assess the risk factors for laryngeal and pharyngeal cancers.

RESULTS

A total of 8,228 hospitalized patients with laryngeal cancers and 1,912 with pharyngeal cancers were compared to 32,912 and 7,648 hospitalized controls, while 9,292 outpatients with laryngeal cancer and 2,769 outpatients with pharyngeal cancer were compared with 37,168 and 11,076 outpatient controls without cancer. Among hospitalized persons, the prevalence of GERD was higher among patients with laryngeal cancer (8.9 vs 4.0%, p < 0.0001) and pharyngeal cancer (6.2 vs 3.8%, p < 0.0001). In a multivariable logistic regression analysis that was controlled for age, gender, ethnicity, smoking, and alcohol, GERD was associated with an adjusted odds ratio (OR) of 2.40 for laryngeal cancer among hospitalized patients (95% CI 2.15-2.69, p < 0.0001) and an adjusted OR of 2.38 (95% CI 1.87-3.02, p < 0.0001) for pharyngeal cancer. For outpatients, GERD was associated with an adjusted OR = 2.31 (95% CI 2.10-2.53) for laryngeal cancer and adjusted OR = 1.92 (95% CI 1.72-2.15).

CONCLUSIONS

Among US veterans, the risk for laryngeal or pharyngeal cancers is modestly increased in the presence of GERD. This effect seems to be independent of age, gender, smoking, and alcohol intake.

Current options in management of head and neck cancer patients

Head and neck cancer, particularly squamous cell carcinoma (SCC) of the upper aerodigestive tract, poses difficult diagnostic and therapeutic challenges to the clinician. A methodical approach, including complete visualization of mucosal surfaces, appropriate imaging, and tissue diagnosis whenever possible, gives patients the best opportunity for early intervention. A treatment program of surgery, radiation, or chemotherapy is best developed by a devoted head and neck oncologic team, involving surgeons, radiation and medical oncologists, and rehabilitative specialists with significant experience in the care of head and neck oncologic patients. Despite new advancements in the treatment of patients with advanced stage SCC of the head and neck, little progress has been made in overall survival. Several new avenues of investigation are currently being explored, one of which may ultimately provide the answer for this devastating disease.

Smoking tobacco, oral snuff, and alcohol in the etiology of squamous cell carcinoma of the head and neck: a population-based case-referent study in Sweden

BACKGROUND

This case-referent study was conducted to elucidate the role of selected exogenous agents in the etiology of head and neck cancer. The factors studied were tobacco smoking, alcohol intake, the use of moist oral snuff, dietary factors, occupational exposures, and oral hygiene. In this first report, the authors discuss the impact of tobacco smoking, the use of oral snuff, and alcohol consumption.

METHODS

The study base was approximately 2 million person-years at risk and consisted of Swedish males age 40-79 years living in 2 geographic regions during the years 1988-1990. A total of 605 cases were identified in the base, and 756 controls were selected by stratified random sampling from population registries covering the base.

RESULTS

Among those who were tobacco smokers at the time of the study, the relative risk of head and neck cancer was 6.5% (95% confidence interval, 4.4-9.5%). After cessation of smoking, the risk gradually declined, and no excess risk was found after 20 years. The relative risk associated with alcohol consumption of 50 grams or more per day versus less than 10 grams per day was 5.5% (95% confidence interval, 3.1-9.6%). An almost multiplicative effect was found for tobacco smoking and alcohol consumption.

CONCLUSIONS

Tobacco smoking and alcohol intake had a strong interactive effect on the risk of squamous cell carcinoma of the head and neck. Moderate alcohol intake (10-19 grams per day) had little or no effect among nonsmokers. No increased risk was found for the use of Swedish oral snuff.

Epidemiology of laryngeal cancer

Laryngeal cancer is the second most common respiratory cancer after lung cancer. Its incidence is increasing over time in much of the world and this increase is generally accepted to be related to changes in tobacco and alcohol consumption. It is a relatively common cancer in men, but rarer in women. Moreover, interesting new issues have been raised recently about the influence of other possible risk factors. Evidence from epidemiological studies which supports the involvement of new risk factors in the aetiology of larynx cancer, as well as new perspectives in therapy, must be taken into consideration in order to realise primary and tertiary prevention. However, it remains clear that, even as new evidence continues to amass about a wide range of risk factors, primary prevention of the great majority of laryngeal cancers could be achieved by elimination of tobacco smoking and reduction of consumption of alcoholic beverages. With an additional contribution from adoption of a diet rich in fruits and vegetables, the great majority of laryngeal cancer appears to be preventable within our current epidemiological knowledge.