The rising rate of nonsmokers among laryngeal carcinoma patients: Are we facing a new disease?

Abstract

Objectives/Hypothesis Laryngeal squamous cell carcinoma (SCC) is strongly associated with tobacco smoking. With the rising awareness of tobacco's adverse health effects, we have witnessed a global decrease in tobacco use. Nevertheless, laryngeal SCC remains prevalent and includes a subset of patients lacking the traditional risk factors. Study Design A two‐center retrospective cohort. Methods Medical records of patients diagnosed with laryngeal SCC between 2009 and 2016 were reviewed. Data collected included demographics, smoking status, and tumor site. Patients who have never smoked were designated as nonsmokers. Results The study included 330 patients with laryngeal SCC, of whom 75 (22.7%) were nonsmokers; this rate was relatively similar for each of the two institutions independently (21.9% and 25%). There were 285 patients with glottic SCC and 45 with supraglottic SCC. All nonsmoking patients in this cohort had glottic SCC, representing 26.3% (75/285) of the glottic SCC cases. The rate of female patients was significantly higher among nonsmokers. Of the patients with glottic SCC, females represented 25.3% (19/75) of the nonsmokers compared with 12.4% (26/210) of the smokers (P = .008). Mean age at diagnosis was 60.2 ± 17.5 years for nonsmoking glottic SCC patients and 63.6 ± 12.4 years for smokers (P = .280). However, nonsmokers demonstrated a distinct age distribution pattern. Nonsmoking females with glottic SCC demonstrated a bimodal age distribution pattern; 73.7% (14/19) were age <40 years or >75 years at diagnosis. Conclusions The rate of laryngeal SCC in nonsmokers is higher than what has previously been reported, representing a growing proportion, and may suggest a shift in etiology. Knowing that laryngeal SCC in nonsmokers predominantly affects the glottis, and that females and age extremities are more vulnerable, the traditional screening paradigm should be revised. Level of Evidence 4 Laryngoscope, 130:E108–E115, 2020

Characteristics and outcomes of young patients with laryngeal cancer: National hospital‐based retrospective cohort analysis

“…A recent study of young patients with laryngeal cancer (<40 years old) has similarly shown that young patients are more likely to be female compared to older patients (33.6% vs. 19.6%) 9 . In addition, young patients were noted to have decreased supraglottic tumors and increased glottic tumors compared to older patients 9,17 . Prior laryngeal cancer studies have noted an association between nonsmokers and glottic tumors 17,18 and another study noted differences in the anatomic distribution of premalignant and malignant glottic lesions according to smoking status 19 .…”

“…A handful of other investigators have also highlighted the unique patient-and tumor-level characteristics of younger patients with laryngeal cancer and wondered if these findings pointed to a nontraditional disease etiology. 9,14,17,18 A recent study of young patients with laryngeal cancer (<40 years old) has similarly shown that young patients are more likely to be female compared to older patients (33.6% vs. 19.6%). 9 In addition, young patients were noted to have decreased supraglottic tumors and increased glottic tumors compared to older patients.…”

“…9 In addition, young patients were noted to have decreased supraglottic tumors and increased glottic tumors compared to older patients. 9,17 Prior laryngeal cancer studies have noted an association between nonsmokers and glottic tumors 17,18 and another study noted differences in the anatomic distribution of premalignant and malignant glottic lesions according to smoking status. 19 Since our study is constrained by the absence of tobacco and alcohol data, further exploration of these findings is warranted.…”

Analysis of the pathological characteristics of locally advanced laryngeal carcinoma in Egyptian females: 7-year review

“…On the contrary, androgen receptors showed significantly lower expression in poorly differentiated tumors and cancers with lymphatic invasion. Estrogen receptors B and progesterone receptors were thus considered as markers of aggressive tumor biology [14].…”

Epidemiological, Clinical, and Oncological Outcomes of non-Alcohol Drinking and non-Smoking Laryngeal Squamous Cell Carcinoma Patients: A Distinct Entity

“… 3 , 4 The reported smoking rate among adults decreased by 25.8% from 20.9% in 2005 to 15.5% in 2016. 5 Moreover, the age-standardized mortality rate of alcohol-related LSCC decreased by 1.78% per year, whereas the death number has increased by 29.2% during the study period. 4 Overall, the 5-year relative survival rate improved from 52.7% to 65.9% for patients with head and neck cancers in recent years.…”