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Abstract
OBJECTIVES/HYPOTHESIS To examine expert testimony offered by otolaryngologists in defense of the tobacco industry and to assess whether opinions rendered were congruent with evidence in the scientific literature. METHODS Data sources include publically available expert witness depositions and trial testimony of board-certified otolaryngologists employed by the tobacco industry in defense of lawsuits brought by smokers suffering from head and neck cancer. The cases, adjudicated in Florida between 2009 and 2014, focused on whether smoking caused the plaintiff's cancer. RESULTS The study includes nine legal cases of upper aerodigestive tract cancer involving six otolaryngologists serving as expert witnesses for the tobacco industry. Cancer sites included larynx (5), esophagus (2), mouth (1), and lung (1). Five of the six otolaryngologists consistently, over multiple cases, offered opinions that smoking did not cause the plaintiff's cancer. By highlighting an exhaustive list of potential risk factors, such as human papillomavirus (HPV), alcohol, asbestos, diesel fumes, salted fish, mouthwash, and even urban living, they created doubt in the minds of the jurors as to the role of smoking in the plaintiff's cancer. Evidence shows that this testimony, which was remarkably similar across cases, was part of a defense strategy shaped by tobacco's law firms. CONCLUSIONS A small group of otolaryngologists regularly serve as experts on behalf of the tobacco industry. Examination of their opinions in relation to the scientific literature reveals a systematic bias in interpreting the data relating to the role played by smoking in head and neck cancer causation. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Robert K. Jackler
- Department of Otolaryngology–Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaU.S.A.
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Peng WJ, Mi J, Jiang YH. Asbestos exposure and laryngeal cancer mortality. Laryngoscope 2015; 126:1169-74. [PMID: 26418833 DOI: 10.1002/lary.25693] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVES/HYPOTHESIS Occupational exposure to asbestos occurs in many workplaces and is well known to cause asbestosis, lung cancer, and mesothelioma. However, the link between asbestos exposure and other malignancies was not confirmed. The aim of the current meta-analysis was to provide a summary measure of risk for laryngeal cancer associated with occupational asbestos exposure. STUDY DESIGN Systematic review and meta-analysis. METHODS Electronic databases were searched for studies characterizing the association between asbestos and laryngeal cancer. Standardized mortality rate (SMR) with its 95% confidence interval (CI) of each study was combined using a fixed or random effect model. RESULTS Significantly increased SMR for laryngeal cancer was observed when subjects were exposed to asbestos (SMR = 1.69, 95% CI = 1.45-1.97, P < .001), with little evidence of heterogeneity among studies (Q = 15.39, P = .803, I(2) = 0.0%). Effect estimates were larger for cohorts controlling for male subjects, Europe and Oceania, mining and textile industries, exposure to crocidolite, long study follow-up (>25 years), and SMR for lung cancer > 2.0. Publication bias was not detect by Begg test (P = .910) and Egger test (P = .340). CONCLUSIONS Our study supports the association of exposure to asbestos with an increased risk of laryngeal cancer mortality among male workers. LEVEL OF EVIDENCE NA Laryngoscope, 126:1169-1174, 2016.
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Affiliation(s)
- Wen-Jia Peng
- Department of Epidemiology and Health Statistics, Bengbu Medical College, Bengbu, Anhui, China
| | - Jing Mi
- Department of Epidemiology and Health Statistics, Bengbu Medical College, Bengbu, Anhui, China
| | - Yu-Hong Jiang
- Department of Epidemiology and Health Statistics, Bengbu Medical College, Bengbu, Anhui, China
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Igissinov N, Zatoskikh V, Moore MA, Igissinov S, Toulebaeyev R, Mustafina M, Valieva S, Aldiyarova G, Bukeyeva Z, Venglovskiy A. Epidemiological evaluation of laryngeal cancer incidence in Kazakhstan for the years 1999-2009. Asian Pac J Cancer Prev 2013; 14:3969-74. [PMID: 23886216 DOI: 10.7314/apjcp.2013.14.6.3969] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The purpose was to provide a descriptive epidemiological assessment of the incidence of cancer of the larynx in Kazakhstan and spatial evaluation with gender characteristics. This retrospective study covered all new cases of laryngeal cancer in 11 years (1999-2009). The total number was 4,967 cases, 4,535 (91.3%) in males and 432 (8.7%) in women, with a ratio of 10.5:1. The higher incidence in men compared to women was evident in all age groups, the differences being statistically significant (p<0.05). At the same time revealed a unimodal growth with age, peaking at 70 years and older both sexes. In the dynamics, incidence rates of laryngeal cancer demonstrated a tendency to decrease, in women (T=-6.7%) this being more pronounced than in men (T=-3.3%). Levels were determined to produce cartograms of cancer of the larynx for male and female populations, clear geographical variation being evidenced. The data are discussed with reference to possible risk factors.
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Chen M, Tse LA. Laryngeal cancer and silica dust exposure: a systematic review and meta-analysis. Am J Ind Med 2012; 55:669-76. [PMID: 22457229 DOI: 10.1002/ajim.22037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND Individual epidemiological studies generally lack the power to examine the association between silica exposure or silicosis and laryngeal cancer. We summarized pertinent evidence from published literature by using meta-analysis. METHODS A systematic literature search was performed to identify cohort and case-control studies, and the method of meta-analysis was used to combine standardized mortality ratios (SMRs) or standardized incidence ratios (SIRs) from cohort studies and odds ratios (ORs) from case-control studies. RESULTS A significantly increased risk of laryngeal cancer (pooled OR = 1.39, 95% confidence interval (95% CI): 1.17-1.67) among workers exposed to silica dust was observed by combining six case-control studies with adjustment for smoking and alcohol consumption. A similarly increased but statistically non-significant risk estimate was observed from cohort studies, with a pooled SMR of 1.38 (95% CI: 0.79-1.96) for silicosis cases; and a pooled SMR of 1.13 (95% CI: 0.82-1.45) and a pooled SIR of 1.50 (95% CI: 0.59-2.42) for workers with silica dust exposure. CONCLUSION This systematic review demonstrated a weak association between silica or silicosis and laryngeal cancer. Owing to the inherent limitations of the original studies, interpretation of the results of this meta-analysis should be cautious.
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Affiliation(s)
- Minghui Chen
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
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Brown T, Darnton A, Fortunato L, Rushton L. Occupational cancer in Britain. Respiratory cancer sites: larynx, lung and mesothelioma. Br J Cancer 2012; 107 Suppl 1:S56-70. [PMID: 22710680 PMCID: PMC3384016 DOI: 10.1038/bjc.2012.119] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Terry Brown
- Institute of Environment and Health, Cranfield Health, Cranfield University, Cranfield MK43 0AL, UK
| | - Andy Darnton
- Health and Safety Executive, Epidemiology Unit, Redgrave Court, Merton Road Bootle L20 7HS
| | - Lea Fortunato
- Department of Epidemiology and Biostatistics, School of Public Health and MRC-HPA Centre for Environment and Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 3PG, UK
| | - Lesley Rushton
- Department of Epidemiology and Biostatistics, School of Public Health and MRC-HPA Centre for Environment and Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 3PG, UK
| | - with the British Occupational Cancer Burden Study Group
- Institute of Environment and Health, Cranfield Health, Cranfield University, Cranfield MK43 0AL, UK
- Health and Safety Executive, Epidemiology Unit, Redgrave Court, Merton Road Bootle L20 7HS
- Department of Epidemiology and Biostatistics, School of Public Health and MRC-HPA Centre for Environment and Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 3PG, UK
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Wang XR, Yu ITS, Qiu H, Wang MZ, Lan YJ, Tse LY, Yano E, Christiani DC. Cancer mortality among Chinese chrysotile asbestos textile workers. Lung Cancer 2011; 75:151-5. [PMID: 21798615 DOI: 10.1016/j.lungcan.2011.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 06/25/2011] [Accepted: 06/29/2011] [Indexed: 10/17/2022]
Abstract
To determine mortality associated with exposure to chrysotile asbestos, a cohort of asbestos workers from an asbestos textile factory in China was followed prospectively from 1972 to 2008. A total 577 workers were successfully followed, achieving a follow-up rate of 98.5% over 37 years. Employment data and smoking information were obtained from factory and individual workers. Vital status was ascertained from factory personnel records and the municipal death registry. Workers were categorized into high, medium and low exposure groups in terms of their job titles and workshops. Follow-up generated 17,508 person-years, with 259 deaths from all causes, 96 all cancers and 53 lung cancers and 2 mesotheliomas. The highest cancer mortality was observed in the high exposure group, with 1.5-fold age-adjusted mortality from all cancers and 2-fold from lung cancer compared to the low exposure group. Age and smoking adjusted hazard ratio in the high exposure group was 2.99 (95%CI, 1.30, 6.91) for lung cancer and 2.04 (1.12, 3.71) for all cancers. Both smokers and nonsmokers at the high exposure level had a high death risk of lung cancer, with a clearer exposure-response trend seen in smokers. This study confirmed increased mortality from lung cancer and all cancers in asbestos workers, and the cancer mortality was associated with exposure level.
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Affiliation(s)
- X R Wang
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
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Ramroth H, Ahrens W, Dietz A, Becher H. Occupational asbestos exposure as a risk factor for laryngeal carcinoma in a population-based case-control study from Germany. Am J Ind Med 2011; 54:510-4. [PMID: 21538446 DOI: 10.1002/ajim.20963] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND As several studies have identified asbestos exposure as an independent occupational risk factor for laryngeal cancer, the aim of our study was to confirm this association. METHODS In a population-based case-control study on laryngeal cancer in South-West Germany occupational exposures and other risk factors were obtained by face-to-face interviews using a detailed standardized questionnaire covering the complete individual working history, supplemented by job-specific questionnaires (JSQ) especially for selected jobs known to entail exposure to asbestos. Detailed exposure information was collected over a wide range of asbestos related jobs and branches and analyzed using different modeling strategies. RESULTS Seventy-three (28.4%) cases and 158 (20.5%) controls reported any exposure to asbestos. Elevated risk estimates for asbestos exposure were found. However, those became substantially reduced after adjustment for smoking and alcohol. CONCLUSION Moderately elevated risks for laryngeal cancer after exposure to asbestos were confirmed. Difficulties in the collection of adequate exposure data were demonstrated.
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Ahmad SM, Sataloff RT. Asbestos Exposure and Laryngeal Cancer: Is there an Association? EAR, NOSE & THROAT JOURNAL 2009. [DOI: 10.1177/014556130908801001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Robert T. Sataloff
- Chairman Department of Otolaryngology-Head and Neck Surgery Drexel University College of Medicine Philadelphia
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Shangina O, Brennan P, Szeszenia-Dabrowska N, Mates D, Fabiánová E, Fletcher T, t'Mannetje A, Boffetta P, Zaridze D. Occupational exposure and laryngeal and hypopharyngeal cancer risk in central and eastern Europe. Am J Epidemiol 2006; 164:367-75. [PMID: 16801374 DOI: 10.1093/aje/kwj208] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A multicenter case-control study was conducted during 1999-2002 in four European countries (Poland, Romania, Russia, and Slovakia) to evaluate the role of occupational exposures in risk of laryngeal/hypopharyngeal cancer. Male cancer cases (34 hypopharyngeal, 316 laryngeal) with full data on occupational history and nonoccupational factors were compared with 728 hospital controls for occupational exposure to 73 suspected carcinogens. Occupational history was evaluated by industrial hygienists blinded to case/control status. Elevated risks for ever exposure to coal dust were found for both hypopharyngeal (odds ratio (OR) = 4.19, 95% confidence interval (CI): 1.18, 14.89) and laryngeal (OR = 1.81, 95% CI: 0.94, 3.47) cancer, with clear dose-response patterns. Inclusion of a 20-year lag in the analysis strengthened these associations. Hypopharyngeal cancer risk was also significantly associated with exposure to mild steel dust (OR = 3.04, 95% CI: 1.39, 6.64) and iron compounds and fumes (OR = 2.74, 95% CI: 1.29, 5.84), without clear dose-response relations. Laryngeal cancer was significantly associated with exposure to hard-alloys dust (OR = 2.23, 95% CI: 1.08, 4.57) and chlorinated solvents (OR = 2.18, 95% CI: 1.03, 4.61), without dose-response relations. A possible link between high formaldehyde exposure and laryngeal cancer was suggested. No association was found for exposure to asbestos or inorganic acid mists. These data indicate that occupational exposure to coal dust may play a role in laryngeal and hypopharyngeal cancer. Other possible relations need further evaluation.
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Licitra L, Rossini C, Bossi P, Locati LD. Advances in the changing patterns of aetiology of head and neck cancers. Curr Opin Otolaryngol Head Neck Surg 2006; 14:95-9. [PMID: 16552266 DOI: 10.1097/01.moo.0000193170.23956.5f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Recent cumulated evidence suggests that factors other than those conventionally known may contribute to the development of head and neck cancer. In fact, a review of the most recent literature shows interesting advances in molecular epidemiology. RECENT FINDINGS Recent studies have pointed out the role both of exposure to carcinogens and of an inherited or acquired genetic susceptibility. A very broad mechanism by which gene families can be responsible for the disease has been depicted. This mechanism ranges from behaviour genes, which can regulate lifestyle habits, to metabolizing genes, DNA repair genes and cell cycle control genes. SUMMARY This review tries to summarize the most recent advances in the field of cancerogenesis in head and neck cancer.
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Affiliation(s)
- Lisa Licitra
- Head and Neck Cancer Medical Oncology Unit, Cancer Medicine Department, Istituto Nazionale Tumori, Milan, Italy.
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Weed DL. Weight of evidence: a review of concept and methods. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2005; 25:1545-57. [PMID: 16506981 DOI: 10.1111/j.1539-6924.2005.00699.x] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
"Weight of evidence" (WOE) is a common term in the published scientific and policy-making literature, most often seen in the context of risk assessment (RA). Its definition, however, is unclear. A systematic review of the scientific literature was undertaken to characterize the concept. For the years 1994 through 2004, PubMed was searched for publications in which "weight of evidence" appeared in the abstract and/or title. Of the 276 papers that met these criteria, 92 were selected for review: 71 papers published in 2003 and 2004 (WOE appeared in abstract/title) and 21 from 1994 through 2002 (WOE appeared in title). WOE has three characteristic uses in this literature: (1) metaphorical, where WOE refers to a collection of studies or to an unspecified methodological approach; (2) methodological, where WOE points to established interpretative methodologies (e.g., systematic narrative review, meta-analysis, causal criteria, and/or quality criteria for toxicological studies) or where WOE means that "all" rather than some subset of the evidence is examined, or rarely, where WOE points to methods using quantitative weights for evidence; and (3) theoretical, where WOE serves as a label for a conceptual framework. Several problems are identified: the frequent lack of definition of the term "weight of evidence," multiple uses of the term and a lack of consensus about its meaning, and the many different kinds of weights, both qualitative and quantitative, which can be used in RA. A practical recommendation emerges: the WOE concept and its associated methods should be fully described when used. A research agenda should examine the advantages of quantitative versus qualitative weighting schemes, how best to improve existing methods, and how best to combine those methods (e.g., epidemiology's causal criteria with toxicology's quality criteria).
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Pira E, Pelucchi C, Buffoni L, Palmas A, Turbiglio M, Negri E, Piolatto PG, La Vecchia C. Cancer mortality in a cohort of asbestos textile workers. Br J Cancer 2005; 92:580-6. [PMID: 15702125 PMCID: PMC2362078 DOI: 10.1038/sj.bjc.6602240] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A cohort of 889 men and 1077 women employed for at least 1 month between 1946 and 1984 by a former Italian leading asbestos (mainly textile) company, characterised by extremely heavy exposures often for short durations, was followed up to 1996, for a total of 53 024 person-years of observation. Employment data were obtained from factory personnel records, while vital status and causes of death were ascertained through municipality registers and local health units. We observed 222 cancer deaths compared with 116.4 expected (standardized mortality ratio, SMR=191). The highest ratios were found for pleural (SMR=4105), peritoneal (SMR=1817) and lung (SMR=282) cancers. We observed direct relationships with duration of employment for lung and peritoneal cancer, and with time since first employment for lung cancer and mesothelioma. Pleural cancer risk was independent from duration (SMR=3428 for employment <1 year, 7659 for 1–4 years, 2979 for 5–9 years and 2130 for ⩾10 years). Corresponding SMRs for lung cancer were 139, 251, 233 and 531. Nonsignificantly increased ratios were found for ovarian (SMR=261), laryngeal (SMR=238) and oro-pharyngeal (SMR=226) cancers. This study confirms and further quantifies the central role of latency in pleural mesothelioma and of cumulative exposure in lung cancer.
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Affiliation(s)
- E Pira
- Dipartimento di Traumatologia, Ortopedia e Medicina del Lavoro, Università degli Studi di Torino, via Zuretti 29, 10126 Torino, Italy
| | - C Pelucchi
- Istituto di Ricerche Farmacologiche ‘Mario Negri’, via Eritrea 62, 20157 Milano, Italy
- Istituto di Ricerche Farmacologiche ‘Mario Negri’, Via Eritrea, 62-20157 Milano, Italy. E-mail:
| | - L Buffoni
- Dipartimento di Traumatologia, Ortopedia e Medicina del Lavoro, Università degli Studi di Torino, via Zuretti 29, 10126 Torino, Italy
| | - A Palmas
- Dipartimento di Traumatologia, Ortopedia e Medicina del Lavoro, Università degli Studi di Torino, via Zuretti 29, 10126 Torino, Italy
| | - M Turbiglio
- Dipartimento di Traumatologia, Ortopedia e Medicina del Lavoro, Università degli Studi di Torino, via Zuretti 29, 10126 Torino, Italy
| | - E Negri
- Istituto di Ricerche Farmacologiche ‘Mario Negri’, via Eritrea 62, 20157 Milano, Italy
| | - P G Piolatto
- Dipartimento di Traumatologia, Ortopedia e Medicina del Lavoro, Università degli Studi di Torino, via Zuretti 29, 10126 Torino, Italy
| | - C La Vecchia
- Istituto di Ricerche Farmacologiche ‘Mario Negri’, via Eritrea 62, 20157 Milano, Italy
- Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, via Venezian 1, 20133 Milano, Italy
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