[Risk factors for cancers of the oral cavity, pharynx (cavity excluded) and larynx].
OBJECTIVE
To review the risk factors for squamous cell carcinoma of the oral cavity, pharynx, and larynx.


METHODS
Review of the literature using the Medline digital database (1980-2007). Previously published studies or studies not found in the database were included if relevant. Four types of studies were selected: (1) epidemiological, (2) toxicologic, (3) clinical, and (4) fundamental research. Publications concerning cancer of the nasopharynx were excluded. This work is based upon the ANAES guide for analysis of the literature and rating of guidelines, published in January 2000.


RESULTS
The principal risk factors are tobacco and alcohol. Other risk factors, particularly infectious (viral) or environmental (nutritional and occupational), are also involved. From this analysis we conclude that: (1) most clinical and fundamental publications concern smoking and alcohol use; (2) studies of other risk factors are relatively old, especially those concerning nutritional and occupational factors; (3) most publications have a low level of scientific proof (grade C, levels 3 and 4). These 3 points explain the delay in the analysis of risk factors for upper aerodigestive tract (UADT) cancers.


CONCLUSIONS
We must make up for this delay by prospective studies that include very large samples and use thorough and multivariate statistical analyses to estimate the impact of various toxic substances on the incidence of UADT cancer. This demands: (1) awareness on the part of all physicians who manage this type of cancer of the need to ask questions about exposure to risk factors besides than tobacco and alcohol; (2) collaboration between these physicians as well as with general practitioners, epidemiologists, nutritionists, and occupational physicians.
Clinique ORL, Pôle tête et cou et chirurgie réparatrice, CHU de Grenoble, F-38043 Grenoble, France. CRighini@chu-grenoble.fr
Christian Adrien
CA
Righini
Alexandre
A
Karkas
Nils
N
Morel
Edouard
E
Soriano
Emile
E
Reyt
D000437:Alcoholism / Q000150:complications; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D009062:Mouth Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D010610:Pharyngeal Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000235:genetics