Risk factors for the development of second primary tumors among men after laryngeal and hypopharyngeal carcinoma

A multicentric European study

Authors

  • Rajesh P. Dikshit Ph.D.,

    1. Gene-Environment Epidemiology Group, International Agency for Research on Cancer, Lyon, France
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    • Dr. Rajesh P. Dikshit worked on the current study under the tenure of an American Cancer Society Beginning Investigators Award from the International Union Against Cancer.

  • Paolo Boffetta M.D., M.P.H.,

    1. Gene-Environment Epidemiology Group, International Agency for Research on Cancer, Lyon, France
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  • Christine Bouchardy M.D.,

    1. Geneva Cancer Registry, Geneva, Switzerland
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  • Franco Merletti M.D., M.Sc.,

    1. Cancer Epidemiology Unit, Center for Experimental Medical Research (CERMS) and Centre for Oncology Prevention, University of Turin, Turin, Italy
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  • Paolo Crosignani M.D.,

    1. Division of Epidemiology, National Cancer Institute, Milan, Italy
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  • Teresa Cuchi M.D., M.P.H.,

    1. Department of Statistics and Epidemiology, Spanish Association against Cancer, Zaragoza, Spain
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  • Eva Ardanaz Ph.D.,

    1. Navarra Cancer Registry, Institute of Public Health of Navarra, Pamplona, Spain
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  • Paul Brennan Ph.D.

    Corresponding author
    1. Gene-Environment Epidemiology Group, International Agency for Research on Cancer, Lyon, France
    • Gene Environment Epidemiology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, 69008, France
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    • Fax: (011) 33–4-72738320


Abstract

BACKGROUND

Second primary tumors (SPT) constitute a major threat to the survival of patients with laryngeal carcinoma. However, to the authors' knowledge little is known regarding the risk factors for developing SPTs or about the strategy to be followed to avoid them.

METHODS

Eight hundred seventy-six male patients with laryngeal/hypopharyngeal carcinoma enrolled in a population-based, case–control study in 5 centers from South Europe during 1979–1982 were followed up to ascertain the occurrence of SPTs. Standardized incidence ratios were calculated to estimate the risk of SPT occurring in the cohort. Cox proportional hazard models were fitted to estimate the hazard ratio for development of SPTs in relation to use of tobacco smoking, alcohol consumption, and dietary habits before the first primary tumor.

RESULTS

One hundred forty-five patients developed an SPT with an annual average rate of 2.1%. An excess risk of developing an SPT of the tongue, mouth, esophagus, and lung was observed. No elevated risks of SPTs were observed in other organs. Alcohol consumption strongly increased the risk of developing an SPT of the upper aerodigestive tract (UADT). Heavy cumulative cigarette smoking increased the risk of developing a lung SPT. A protective effect of high intake of citrus fruit was noticed for SPT in the lung, whereas high butter intake was associated with an increased risk for SPT of the UADT.

CONCLUSIONS

Continuous medical surveillance was essential in the UADT and lung to reduce the risk from an SPT after initial laryngeal/hypopahryngeal carcinoma. Alcohol consumption before the first primary tumor was a risk factor for SPT of the UADT. The study suggested a protective role of citrus fruits in the development of a lung SPT. Cancer 2005. © 2005 American Cancer Society.

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