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| From OncoLog,
October 2004, Vol. 49, No. 10 |
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The Role of Alcohol and Tobacco in Head and Neck Cancer
 By now, everyone knows that smoking increases a person’s risk of cancer, in particular lung cancer and head and neck cancer. The connection between head and neck cancers and tobacco use has been well documented (85% of head and neck cancers, which 45,000 Americans are diagnosed with each year, are related to tobacco use). Most people are also aware that excessive consumption of alcohol is harmful—the risk of cancers in the mouth, throat, esophagus, liver, and breast increases in those who have an average of more than two drinks per day. What is not so well known is that alcohol consumption combined with tobacco use is especially dangerous. People who smoke and drink are many times more likely to have cancers of the head and neck than those who do not.
How alcohol and tobacco use can lead to cancer
Researchers know that the lining of mucus that protects head and neck structures such as the mouth and throat can be damaged by exposure to tobacco and alcohol. Furthermore, they have found that to repair this damage, the cells in the lining must grow faster than normal. Chemicals in tobacco damage DNA and thus impede its ability to send instructions for cell repair and growth. Alcohol has not been proven to damage DNA, but it has been shown to aid and increase the penetration of DNA-damaging chemicals into cells. Therefore, it is easy to see that the combination of drinking and tobacco use can be a very harmful one.
Squamous cell carcinoma
The negative impact of using alcohol and tobacco is most vivid when one looks at studies of squamous cell carcinoma. In the head and neck, the development of this type of cancer is most often associated with alcohol and tobacco use. In fact, the risk of this cancer is 15 times greater in those who use alcohol and tobacco than in those who do not.
 Cancer of the esophagus
Using any tobacco product—cigarettes, cigars, pipes, chewing tobacco, or snuff—increases one’s risk of cancer of the esophagus. Specifically, the risk of esophageal adenocarcinoma is doubled in those who smoke at least one pack of cigarettes a day when compared with nonsmokers, and smoking is linked with more than half of all cases of squamous cell carcinomas of the esophagus. Although alcohol use is not as much of a risk factor for these cancers as tobacco use is, the combination of the two carries a greater risk than does either factor alone.
Cancers of the larynx and hypopharynx
Use of tobacco is the primary risk factor for cancers of the larynx (also known as the voice box) and the hypopharynx, or lower throat. Also, heavy drinkers have a much greater risk of laryngeal cancer than nondrinkers do. Again, use of both alcohol and tobacco multiplies the risk of these cancers. In fact, some studies have shown that individuals who smoke and drink have a risk of laryngeal and hypopharyngeal cancers that is 100 times greater than that in individuals who do not smoke or drink.
Oral cavity and oropharyngeal cancer
As many as 90% of patients with oral cavity (mouth) or oropharyngeal (upper throat) cancer are smokers or smokeless tobacco users, and 75% to 80% of these patients are heavy drinkers. The combination of tobacco and alcohol use is the deadliest risk factor for these cancers.
Recommendations
Researchers and physicians recommend the avoidance of tobacco in all forms, as it accounts for at least 30% of all cancer deaths and is the number one avoidable cause of illness and death in the United States. Men who drink alcohol should limit their intake to two drinks per day on average, whereas women should average no more than one. A drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.
People who smoke and drink heavily should get regular medical checkups and watch for the warning signs of head and neck cancer, which include swollen lymph nodes in the neck, persistent sores and swelling in the mouth, voice changes, blood in the phlegm or saliva, trouble swallowing, constant throat pain or earaches, and any skin changes on the face, scalp, or neck. If caught in time, many cancers of the head and neck are curable.
For
more information on this topic or for questions about M. D. Anderson’s treatments,
programs, or services, call askMDAnderson at (877) MDA-6789.
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OncoLog, October 2004 issue:
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