title: Emerging and established global life-style risk factors for cancer of the upper aero-digestive tract.
abstract: BACKGROUND
  Upper aero-digestive tract cancer is a multidimensional problem, international trends showing complex rises and falls in incidence and mortality across the globe, with variation across different cultural and socio-economic groups. This paper seeks some explanations and identifies some research and policy needs.
  
  
  METHODS
  The literature illustrates the multifactorial nature of carcinogenesis. At the cellular level, it is viewed as a multistep process involving multiple mutations and selection for cells with progressively increasing capacity for proliferation, survival, invasion, and metastasis. Established and emerging risk factors, in addition to changes in incidence and prevalence of cancers of the upper aero-digestive tract, were identified.
  
  
  METHODS
  Exposure to tobacco and alcohol, as well as diets inadequate in fresh fruits and vegetables, remain the major risk factors, with persistent infection by particular so-called "high risk" genotypes of human papillomavirus increasingly recognised as also playing an important role in a subset of cases, particularly for the oropharynx. Chronic trauma to oral mucosa from poor restorations and prostheses, in addition to poor oral hygiene with a consequent heavy microbial load in the mouth, are also emerging as significant risk factors.
  
  
  CONCLUSIONS
  Understanding and quantifying the impact of individual risk factors for these cancers is vital for health decision-making, planning and prevention. National policies and programmes should be designed and implemented to control exposure to environmental risks, by legislation if necessary, and to raise awareness so that people are provided with the information and support they need to adopt healthy lifestyles.
authors.affiliation: School of Dentistry and Population and Social Health Research Programme, 2Griffith Health Institute, Griffith University, Queensland, Australia E-mail : bhawna.gupta@griffithuni.edu.au.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Gupta
authors.forename: Newell W
authors.initials: NW
authors.lastname: Johnson
mesh_terms: D004032:Diet / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000209:etiology*; D014943:Global Health; D006801:Humans; D007822:Laryngeal Neoplasms / Q000209:etiology*; D008019:Life Style; D009062:Mouth Neoplasms / Q000209:etiology*; D010610:Pharyngeal Neoplasms / Q000209:etiology*; D012307:Risk Factors