Patterns of cancer occurrence in different regions of West Bengal--a hospital based study

The incidence of cancer has been rising steadily in the third world countries including India. The patterns of cancer incidence reflect the racial, cultural and pharmacogenomic diversity within populations and nowhere is this diversity more striking than in the Indian subcontinent. This article shows the diversity in patterns of incidence of major cancers across three medical college hospitals in the state of West Bengal in India. All the data were collected from the period between 2001 and 2005. The results show a striking variation of incidence of major cancers in the urban, semi-urban and rural parts of the same state. Indeed the differences of the patterns are explainable by the cultural and socioeconomic differences within the populations from which the study samples are drawn. This constitutes the largest single hospital based data collected from this part of the world till date and will help in re-evaluation of cancer control programmes promulgated by the health authorities of the region.

[Assurance-associated aspects of head and neck carcinomas: disposition, exposition, prognosis]

After a brief introduction into the basics of head and neck oncology, the current review focusses on potential predictive markers and predisposing factors for these kinds of cancers. Furthermore, prognosis and degree of disability of cancer patients are commented on. With a survival rate of approximately 50%, the prognosis of head and neck carcinomas seems rather good, but it is in fact unsatisfactory. Since the treatment of advanced head and neck cancers is often accompanied by profound functional (articulation, phonation, respiration, and deglutition) and aesthetic impairment, it repeatedly leads to a high degree of disability and occupational invalidity. Furthermore, special limitations of head and neck cancer patients are discussed as well as the consequences they may have on the qualification for certain jobs.

Berufliche Krebserkrankungen im HNO-Fachgebiet

Head and neck cancer can be caused by the occupational contact with cancerogenic substances, which contribute to the formation of cancer. The knowledge about those cancer entities which are frequently found under similar circumstances and working conditions, helps for getting compensation and alternatively for a realistic view when other influences--particularly lifestyle factors like smoking, alcohol and nutrition--have mainly contributed for the origin of the cancer disease. Our knowledge increases and therefore it is helpful from time to time to keep up to the state-of-art of cancer genesis. This article has two parts: part I deals with occupational cancer diseases, which are listed in a decree of the German government and part II deals with the cancer diseases, which could likely be caused by occupational factors according to latest scientific findings and are not yet listed.

Occupational exposure to eight organic dusts and respiratory cancer among Finns

BACKGROUND

There is inconclusive evidence concerning cancer risks of organic dusts.

AIM

The carcinogenic exposures are mainly inhalatory and the authors therefore studied associations between occupational exposure to eight different organic dusts and respiratory cancers in Finland.

METHODS

The authors followed up a cohort of all economically active Finns born between 1906 and 1945 for 30 million person-years during 1971-95. Incident cases of nasal, laryngeal, and lung cancer and mesotheliomas were identified through a record linkage with the Finnish Cancer Registry. Occupations from the population census in 1970 were converted to exposures to eight organic dusts with a job-exposure matrix (FINJEM). Cumulative exposure (CE) was calculated as a product of prevalence, level, and estimated duration of exposure. Standardised incidence ratios (SIR) and 95% confidence intervals (CI) adjusted for age, period, and social class were calculated for each organic dust using the economically active population as the reference.

RESULTS

A total of 20 426 incident cases of respiratory cancer were observed. Slightly increased risk was observed among men exposed to wood dust for nasal cancer (SIR 1.42, 95% CI 0.79 to 2.44). For laryngeal cancer, men exposed to plant dust (mainly grain millers) had a raised SIR in the high exposure class (SIR 3.55, 95% CI 1.30 to 7.72). Men exposed to wood dust had a raised SIR for lung cancer, but only in the low exposure class (SIR 1.11, 95% CI 1.04 to 1.18). Women exposed to wood dust showed an increased SIR for mesotheliomas in the low exposure class (SIR 4.57, 95% CI 1.25 to 11.7) and some excess in the medium exposure category.

CONCLUSIONS

Exposure to organic dusts is unlikely to be a major risk factor of respiratory cancer. Even exposure to wood dust which is a major exposure in Finland seems to have minor effect for nasal cancer. The authors found suggestive evidence that exposure to grain dust may increase the risk of laryngeal cancer, and some support to the hypothesis that exposure to textile dust, and to plant and animal dust (agricultural dusts) may decrease the risk of lung cancer.

[Sonographical differential diagnosis of cervical lumps]

A brief synopsis for a practical approach in the clinical and sonographical evaluation of cervical lumps except for lymph node diseases is presented.

[Alcohol related diseases of the head and neck]

Chronic consumption of alcohol is an accepted social custom worldwide. In the upper aerodigestive tract, local morphologic, metabolic and functional alterations can be present due such consumption. Gastroesophageal reflux or alterations in sleep structure are typical examples of functional disorders. While alcohol was initially described as a risk enhancer only in smokers, a number of epidemiological studies have now shown that chronic alcohol consumption increases the risk of head and neck cancer independently of exposure to tobacco smoke. In addition, alcohol leads to an accumulation of pathologic microbes within the mucosa, leading to chronic infection. Susceptibility to carcinogens and cell proliferation in the mucosa are increased, resulting in genetic changes with the development of dysplasia, leucoplakia and carcinoma. Chronic alcohol consumption is correlated with an increased risk of cancer and increased mortality in a dose-dependent relationship. A number of biologically plausible mechanisms exist by which alcohol may cause cancer.

Dietary antioxidant intake in patients at risk for second primary cancer

OBJECTIVES

To analyze dietary antioxidant intake for head and neck cancer patients at risk for development of second primary cancers.

STUDY DESIGN

Prospective observational study.

METHODS

Twenty-four patients underwent three random, unscheduled, 24-hour dietary recalls over a 15-day period within 6 to 60 months after successful treatment for stage I or II oral cavity squamous cell carcinoma.

RESULTS

The study sample had a lower mean daily dietary intake of fruits and vegetables and antioxidant nutrients, including vitamins A, C, E, and total carotenes than age- and sex-matched historic control subjects (all P <.05 except vitamin A). A positive linear correlation was noted between daily servings of F&V and dietary intake of vitamins A, C, E, and total carotenoids (all P <.05 except vitamin A). Compared to current recommendations, the study sample had lower mean daily dietary intake of vitamins A, C, and E (P =.81,.06, and <.01) and servings of fruits and vegetables (P <.01). When vitamin supplements were included in the analysis, mean daily intake exceeded recommended dietary allowance (RDA) for vitamins A, C, and E (all P <.05).

CONCLUSION

This study suggests that patients treated for early-stage oral cavity carcinoma, at risk for second primary cancers, have a statistically significant deficiency in dietary (food) sources of antioxidant nutrients when compared with both historic control subjects and current recommendations. Vitamin supplementation significantly exceeded current RDAs. Because increased fruit and vegetable intake, but not vitamin supplementation exceeding RDA, is associated with reduced cancer risk, physicians may consider recommending at least five daily servings of fruits and vegetables as an alternative to vitamin supplementation.

The prevalence of occult carotid artery stenosis in patients with head and neck squamous cell carcinoma

OBJECTIVES/HYPOTHESIS

Risk factors for atherosclerotic carotid artery disease (ASCAD) and squamous cell carcinoma of the head and neck region (HNSCCA) are similar. This study was conducted to determine whether patients with HNSCCA have an increased rate of occult ASCAD compared with the general population.

STUDY DESIGN

A cross-sectional study was performed to identify the prevalence of clinically significant ASCAD in the specific population of patients with a diagnosis of HNSCCA using noninvasive color flow duplex imaging. In addition, the demographic variables and risk factors for head and neck cancer and for carotid disease, as identified in the literature, were recorded with the use of a questionnaire.

METHODS

Forty-nine patients with a diagnosis of HNSCCA completed the questionnaire and then had a duplex screening examination.

RESULTS

The most common risk factor identified was tobacco smoking in 41 of 49 patients (84%). ASCAD was identified in one patient (2%). The stenosis in that patient was less than 60%.

CONCLUSIONS

We conclude from this study that even though patients with HNSCCA usually have risk factor(s) associated with ASCAD, the rate of occult ASCAD was not different from that found in the general population. Thus, routine screening of patients with HNSCCA with color flow duplex imaging to detect occult ASCAD is not warranted.

Employment as butcher and cancer risk in a record-linkage study from Sweden

OBJECTIVE

To investigate the risk of cancer among butchers and other meat workers in a large record-linkage study from Sweden.

METHODS

The Swedish Cancer Environment Register III contains nationwide data on cancer incidence during 1971-1989 for all residents, by occupation and industry of employment as reported at the 1960 and 1970 censuses. We identified 25,049 men classified as butchers or meat workers at either census. We used as a comparison group the remaining part of the active male population, after exclusion of workers with direct contact with animals.

RESULTS

Butchers in the meat industry had a slight increase in the risk of cancer (relative risk [RR] 1.1, 95% confidence interval [CI] 1.0-1.3), which was due to an increased risk of cancers of the oral cavity and pharynx (RR 1.6, 95% CI 1.0-2.7), stomach (RR 1.6, 95% CI 1.1-2.7), larynx (RR 1.4, 95% CI 0.6-3.4), and lung (RR 1.4, 95% CI 1.1-1.9). The risk of stomach cancer was highest during the first 5 years of the study, and among butchers from urban areas. No temporal or geographic variations were seen for lung cancer risk, with elevations restricted to squamous cell carcinoma. An increased risk of stomach, laryngeal and lung cancers was present in butchers and meat workers outside the meat industry. There was no clear indication of an increased risk of other neoplasms.

CONCLUSIONS

The increased risk of oral, laryngeal, lung and stomach cancers among Swedish butchers may be at least partly due to confounding by tobacco smoking, alcohol drinking, and other lifestyle factors. However, exposures in the meat industry (e.g., viruses, nitrosamines, polycyclic aromatic hydrocarbons) may contribute the elevated cancer risks.

[Environmental health in ENT medicine]

BACKGROUND

Genetic and environmental factors contribute to the development of human diseases. This review article deals with the impact of physical and chemical environmental pollutants on the development of various diseases in otorhinolaryngology.

METHODS

Data were obtained from textbooks, review articles, original publications, medical databases, internet searches, and publications of various German and international agencies and organizations concerned with environmental health.

RESULTS

Environmental pollutants are important contributing factors in the etiology of head and neck diseases. Health effects include hearing loss due to noisy leisure time activities and cardiovascular diseases due to traffic noise, impairment of hearing and equilibrium induced by various compounds, odor annoyance and olfactory disturbances, irritation and alterations of respiratory mucosa, acute and chronic inflammatory and allergic diseases of the upper airways and the middle ear, disorders of the voice and larynx, and head and neck tumors.

CONCLUSION

Environmental medicine may play an increasingly important role in the prevention of head and neck diseases. It requires a considerable toxicological and epidemiological qualification. However, the contribution of specialists well familiar with the complex anatomy, physiology and functional diagnosis of organ systems located in the head and neck are essential for the reliable assessment of environmental diseases in otorhinolaryngology.

[Occupation and cancer of the head-neck area]

Head- and neck-cancer is a multifactorial disease. Besides major risk factors like alcohol and tobacco consumption, occupational factors play a significant role. At present it is estimated that in western industrial nations about 4 to 10% of all head- and neck-cancer cases are caused by occupational exposures. Combined exposures to occupational and non-occupational risk factors as well as the interaction of different occupational agents may have a synergistic effect on the cancer risk. It is very likely that the cancer risk due to occupational factors is modulated by host factors like DNA repair capacity and enzymatically controlled activation and inactivation of carcinogens.

[Construction workers as an extreme risk group for head and neck cancer?]

BACKGROUND

Workers in the construction industry carry an increased risk for head and neck cancer due to the high consumption of alcohol and tobacco plus exposure to occupational carcinogenic or co-carcinogenic agents. These latter substances include asbestos, tar products, metal dust, wood dust, cement dust and paints.

RESULTS

The Heidelberg case-control studies showed a statistically increased risk of pharyngeal cancer (RR=2.5 adjusted for tobacco and alcohol) and laryngeal cancer (RR=2.3 adjusted for tobacco and alcohol) in the construction workers (23.3%) when compared to controls (8.2%). A random sample analysis of patients with head and neck cancer referred by the largest health assurance company in Heidelberg (AOK), revealed that 21.2% were employed in the construction industry. Similar results have been obtained in a number of international epidemiological studies.

CONCLUSIONS

Our findings show that male construction workers who regularly consume alcohol and tobacco represent an extreme risk group for head and neck cancer. Measures for early detection are important and must be implemented carefully.

Cross-country comparisons suggest shared risk factors for carcinomas, including male lung adenocarcinoma and colon cancer development

Smoking is clearly the major risk factor for both squamous cell carcinomas (SCCs) and adenocarcinomas (ACs) of the lung, although less so for the latter, where other influences appear to be important. In order to determine whether cross-country comparisons might provide evidence of shared risk factors with cancers in other organs of males, an examination of IARC/WHO data for cancer incidence was made for countries/registries in Europe, North America, Australia and Asia. Significant simple correlations, which persisted on partial analysis, were observed between lung SCCs and tumors of the larynx (P < 0.001), but not the buccal cavity or oesophagus, along with a link to rectal ACs (P < 0.001). Incidences of lung ACs also correlated with those for colon ACs (P < 0.001) but not lung SCCs. Oesophageal ACs were only related to colon cancers at the simple correlation level, this not persisting on partial analysis or separation into Asian and Western groups. The results suggest that blood borne factors, like hormones, may be important as determinants for the increasingly prevalent lung AC.

[Immunohistologic and molecular genetic studies of the effect of glutathione-S-transferases on the development of squamous epithelial carcinomas in the area of the head-neck]

BACKGROUND

While cigarette smoking and alcohol consumption are the major risk factors for the development of head and neck carcinomas, it is assumed that genetic factors contribute to risk. The aim of this study was to characterize the influence of the carcinogen metabolizing glutathione-S-transferases on susceptibility to head and neck carcinomas.

PATIENTS AND METHODS

Polymorphisms at GSTM1, M3, T1 and P1 gene loci were determined in 398 head and neck cancer patients and 216 controls using polymerase chain reaction and restriction enzyme digestion. The epithelial distribution of the GSTs was determined by immunohistochemical methods.

RESULTS

The GSTM1 A/B genotype was less frequent in all tumor groups compared with controls. The GSTM3 B/B genotype was reduced only in the laryngeal cancer group whereas GSTP1 A/A showed significant differences between pharyngeal cancer patients and controls. Accordingly, GSTM3 was expressed only in the cilia of the laryngeal respiratory epithelium. In contrast, GSTP1 was distributed throughout all outer layers of the squamous cell epithelium.

CONCLUSIONS

While GSTM1 seems to influence susceptibility to all head and neck cancers, GSTM3 and P1 reflected site-specific differences. Thus GSTM3 appears to be associated with altered risk only to laryngeal cancer whereas GSTP1 is likely to influence pharyngeal cancer risk.

[Possibilities and limits of Doppler ultrasound in the area of the head-neck]

Sonography has provided an important addition to the tools available for the diagnosis of the soft tissues in the head and neck region. The ENT surgeon himself is able to examine pathological formations by this quick, non-invasive and, last but not least, less expensive method. Due to the high resolution of the procedure the chance of detecting even small changes is increased and the exactness of diagnosis of pathological lymph nodes of the neck has been significantly improved compared to palpation alone. Ultrasound has replaced the sialographic procedures in the field of diagnostic evaluation of salivary gland disease in the daily practice except for special indications. After inauguration of color Doppler sonography non-invasive evaluation of vascular stenosis of the large cervical vessels concerning their hemodynamic effects has become possible. This issue is important for the differential diagnosis of otoneurological diseases such as sudden hearing loss, vertigo and tinnitus. Additionally, the extent of perfusion of space-occupying lesions can be easily examined, and therefore the risk of mass bleeding can be preoperatively assessed by this method without harm to the patient. Especially carotid body tumors may be diagnosed with high accuracy by the evidence of significant diffuse perfusion of the lesion. In several studies the specificity of the assessment of cervical lymph node disease could be increased by examination of resistance indices. However, other authors have shown inconsistent results in differentiation of benign and malignant lumps; therefore, final judgment does not seem to be possible yet. Use of echo-contrast agents to enhance the ultrasound signal seems to be a promising approach for future developments in color Doppler imaging.

[In search of new treatment methods for head-neck carcinoma]

During the past decades the clinical prognosis of head and neck squamous cell cancer has remained unchanged. This indicates that new therapeutic strategies are needed. Cancer prevention strategies focusing on the elimination of carcinogenic substances could help to lower the incidence of this disease. Documentation of the clinical outcome in tumor registers could help to establish a better understanding of tumor biology and adequate treatment of different tumor types. Nevertheless the most promising approach at the current time seems to be the development of new immunotherapeutic treatment regiments. One possible way of future cancer treatment could be the application of bispecific antibodies that redirect immune effector cells to the tumor. A second approach could be in vivo gene therapy with direct intratumoral injections of a gene coding for interleukin-2. This should help to reactivate tumor-suppressed immune effector cells.

Use of wood stoves and risk of cancers of the upper aero-digestive tract: a case-control study

BACKGROUND

Incidence rates for cancers of the upper aero-digestive tract in Southern Brazil are among the highest in the world. A case-control study was designed to identify the main risk factors for carcinomas of mouth, pharynx, and larynx in the region. We tested the hypothesis of whether use of wood stoves is associated with these cancers.

METHODS

Information on known and potential risk factors was obtained from interviews with 784 cases and 1568 non-cancer controls. We estimated the effect of use of wood stove by conditional logistic regression, with adjustment for smoking, alcohol consumption and for other sociodemographic and dietary variables chosen as empirical confounders based on a change-in-estimate criterion.

RESULTS

After extensive adjustment for all the empirical confounders the odds ratio (OR) for all upper aero-digestive tract cancers was 2.68 (95% confidence interval [CI] : 2.2-3.3). Increased risks were also seen in site-specific analyses for mouth (OR = 2.73; 95% CI: 1.8-4.2), pharyngeal (OR = 3.82; 95% CI: 2.0-7.4), and laryngeal carcinomas (OR = 2.34; 95% CI: 1.2-4.7). Significant risk elevations remained for each of the three anatomic sites and for all sites combined even after we purposefully biased the analyses towards the null hypothesis by adjusting the effect of wood stove use only for positive empirical confounders.

CONCLUSIONS

The association of use of wood stoves with cancers of the upper aero-digestive tract is genuine and unlikely to result from insufficient control of confounding. Due to its high prevalence, use of wood stoves may be linked to as many as 30% of all cancers occurring in the region.

[Indications and risks of manual lymph drainage in head-neck tumors]

BACKGROUND

Secondary lymphedema of the head and neck can develop as a result of obstruction of lymphatic channels following the surgical removal of lymph nodes and fibrosis due to irradiation. This can be treated with manual lymphatic drainage. An increase of tumor recurrence due to this therapy is at controversial discussion.

PATIENTS

In a retrospective study 191 patients treated for head and neck cancer were questioned on occurrence of lymphedema and therapy with manual lymphatic drainage.

RESULTS

100 patients had received lymphatic drainage, whereas 91 patients belonged to the group without lymphatic drainage therapy. In 37 cases a tumor recurrence or local metastases were reported, 18 of whom had received lymphatic drainage and 19 belonged to the control group. Among these 37 patients neither the group with lymphatic drainage nor the control group differed significantly concerning stage of cancer, histopathological grading, the in sano/non in sano resection of the primary tumor and a lymphangiosis carcinomatosa. An increased recurrence rate among patients who underwent a lymphatic drainage therapy could not be found.

CONCLUSION

A lymphatic drainage therapy for patients presenting with lymphedema after the oncological therapy does not increase the rate of local recurrencies. Moreover it improves the quality of life after the cancer therapy. As only few data are available for cases with non in sano surgery and tumors with lymphangiosis carcinomatosa these cases should be excluded from a lymphatic drainage therapy. A spreading of occult tumor cells in these patients might be possible.

Incidence of tobacco and alcohol-related cancers in western Europe

The relative importance of the tobacco and alcohol-related cancer burden varies across countries. Within western Europe, the incidence of lung cancer has a clearly different geographical pattern to the incidence of alcohol-related cancer. Each country's public health policies should take into account its own tobacco and alcohol-related morbidities.

[Epidemiology of cancers of the upper respiratory and digestive tracts]

Tumours of the upper aerodigestive tract affect mainly industrial countries. Squamous cell carcinomas of the pharynx and larynx are linked to alcohol and tobacco abuse. Other factors (such as poor dental or nutritional status, viral or genetic or occupational factors) are, by far, of less importance. Glandular tumours of the ethmoid are, undoubtedly, due to wood dust exposure. Undifferentiated carcinoma of nasopharynx are associated with Epstein-Barr virus exposure, genetic profiles and diet behaviour.

Diet, alcohol, smoking and cancer of the upper aerodigestive tract: a prospective study among Hawaii Japanese men

A cohort study of upper aerodigestive tract cancer was conducted among 7,995 Japanese-American men who were interviewed and examined from 1965 to 1968. Information was collected about smoking history and alcohol and dietary intake. After 24 years, 92 incident cases with histological confirmation of diagnosis were identified. Current cigarette smokers at time of examination had a 3-fold risk for upper aerodigestive tract cancer compared with never-smokers. A dose-response relationship was present with increasing amount and duration of cigarette use. Consumption of beer, wine, spirits and total alcohol was strongly associated with increased risk. Of 23 food and beverage categories, only candy/jelly/soda pop consumption had a statistically significant inverse trend. Frequent consumption of fruit was also inversely associated with this cancer. In contrast, the risk tended to be positively associated with consumption of rice, seaweed, tofu or tsukudani (a mixed dish of fish, sugar, soy sauce and seaweed), but the dose-response relationship was not statistically significant. For nutrient intake, increased calcium and fat intake decreased the risk for this cancer.

[Indoor air pollution by emissions from individual fossil fuel stoves. Possibly a so-far underestimated risk factor in development of cancers of the head and neck area]

We have carried out three case-control studies on the relative risk of head and neck cancer in association with indoor air pollution. The studies performed at the Department of Otorhinolaryngology of the University of Heidelberg comprised 369 male patients with squamous cell carcinomas of the oral cavity, pharynx and larynx; one thousand, four hundred and seventy-six healthy subjects were used as controls and were matched for sex, age and residential area. The relative risk (RR) of laryngeal cancer related to daily exposure to fossil fuels due to stove heating with oil, coal, gas and wood in a period longer than 40 years was 2.5 [confidence interval (CI): 1.51-4.05]. After adjustment for tobacco and alcohol the RR declined slightly to 2.0 [CI: 1.10-3.46] but was still significant. Increased risks were also found for daily exposure in a kitchen containing air oil, coal or wood oven for a period longer than 40 years (RR = 1.7; CI: 1.01-2.71). In this latter group the RR because 1.4 after adjustments for use of tobacco and alcohol [CI: 0.76-2.41]). The RR of pharyngeal cancer related to daily exposure to fossil fuels due to stove heating with oil, coal, gas and wood in a period longer than 40 years was 3.6 [CI: 2.04-6.41]. After adjustments were made for tobacco and alcohol, the RR declined slightly to 3.3 [CI: 1.43-7.55] but was still significant. Elevated risks were also found for daily presence in a kitchen with oil, coal or wood ovens for a period longer than 40 years (RR = 1.6 [CI: 0.89-2.77].(ABSTRACT TRUNCATED AT 250 WORDS)

[Cancers related to tobacco smoking]

Tobacco smoking is the major cause of lung cancer. Cigarette smokers have a risk of lung cancer 10 to 15 times greater than nonsmokers. Tobacco and alcohol are the main risk factors for cancers of oral cavity, larynx, pharynx and oesophagus (cancers of the upper respiratory and upper digestive tract) and the effects of tobacco and alcohol are multiplicative. For these cancers, the risk associated with tobacco was about 2 to 4 among people who drink little or no alcohol. Risks of lung cancer and of cancers of the upper respiratory and upper digestive tract increase with an increasing number of cigarettes smoked per day and duration of smoking. Tobacco is also a risk factor for bladder cancer. Cigarette smoking is a possible contributory factor in the development of kidney, pancreatic and cervical cancers. Among males, lung cancer mortality increased regularly over time and today, lung cancer is the leading cause of death and illness from cancer. Substantial reductions in the number of deaths from tobacco-related cancers could be achieved if a large proportion of smokers stopped smoking.

Alcohol-nutrient interactions in cancer etiology

The cancers for which there is the most compelling epidemiologic evidence of associations with both diet and alcohol are oral, pharyngeal, laryngeal, esophageal, and liver cancer. For lung, breast, stomach, and colorectal cancer, there is reasonably strong epidemiologic evidence of associations with diet, but only moderate or equivocal evidence of associations with alcohol. For pancreatic cancer there is suggestive evidence of associations with both exposures. It is probable that the quantitative relationship and the underlying biological mechanisms of the diet-alcohol interaction will not be the same for all cancers. Heavy alcohol consumption and generally poor nutrition, possibly a deficiency of several micronutrients and food groups, were the major risk factors for esophageal cancer in a case-control study of the unusually high rates for this cancer among Washington, DC black men. It is proposed that alcohol might increase risk of esophageal cancer, in part, by reducing nutrient intake. Two descriptive studies are presented that suggest that as the percent of caloric intake from alcohol increases, the daily consumption of protein, carbohydrate, fiber, and many micronutrients steadily and significantly decreases. Alcohol consumption and low fruit and vegetable intake, as well as snuff dipping and cigarette smoking, were shown to be risk factors for oral-pharyngeal cancer in a case-control study of the high rates of these cancers among North Carolina women. Since these women were not heavy drinkers, it is not likely that alcohol functioned by altering nutritional status. A number of mechanisms for the action of alcohol in cancer etiology are presented.