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Laryngeal cancer risk factors overview

93% of laryngeal cancer cases each year in the UK are linked to major lifestyle and other risk factors.1

Laryngeal cancer risk is associated with a number of risk factors (Table 4.1).2,3

Table 4.1: Laryngeala Cancer Risk Factors

Increase risk ('sufficient' or 'convincing' evidence) May increase risk ('limited' or 'probable' evidence) Decreases risk ('sufficient' or 'convincing' evidence) May decrease risk ('limited' or 'probable' evidence)
  • Strong inorganic acid mists
  • Alcoholic drinks
  • Asbestos
  • Tobacco smoking
  • Human papillomavirus (HPV) type 16
  • Maté drinking (hot)b
  • Working in rubber production
  • Sulphur mustard (mustard gas)
  • Environmental tobacco smoke
-
  • Non-starchy vegetablesa,c
  • Fruitsa,c
  • Foods containing carotenoidsa

International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications. Find out more about IARC and WCRF/AICR classifications.
a WCRF/AICR classification is for mouth, pharynx and larynx; b WCRF/AICR classify this evidence as ‘limited-suggestive’; c Not salted or pickled

Use our interactive tool to explore risk factors for laryngeal cancer.

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Age and sex

Laryngeal cancer risk is strongly related to age and sex.

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Tobacco

Smoking

Tobacco smoking is classified by IARC as a cause of laryngeal cancer (Table 4.1).2 An estimated 79% of laryngeal cancers in the UK are linked to tobacco smoking.1

Laryngeal cancer risk is 8.3 times higher in people who have ever smoked cigarettes compared with those who have never done so, a pooled analysis of case-control studies showed.4 Head and neck (including oral cavity, pharynx, hypopharynx, oropharynx, and larynx) cancer risk increases with amount and duration of cigarette smoking.4

Laryngeal cancer risk is substantially higher in people who both smoke tobacco and drink alcohol, meta- and pooled analyses show; the effect of these two behaviours together is greater than the sum of their individual effects.5,6

Tobacco-associated laryngeal cancer risk may vary with specific site of cancer within the larynx, with a stronger association for supraglottis than glottis cancers.7

Laryngeal cancer risk in ex-smokers compared with continuing smokers is 30% lower after 1-4 years of non-smoking, and 64% lower after 10-19 years, a pooled analysis of case-control studies showed.8 Laryngeal cancer risk is higher in ex-smokers than never-smokers for up to 20 years after smoking cessation.8

Laryngeal cancer risk among people who have never smoked cigarettes is higher in those who have ever smoked cigars or a pipe, compared with never-users of these products.4

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Environmental tobacco smoke

Environmental tobacco smoke is classified by IARC as a probable cause of laryngeal cancer, based on limited evidence (Table 4.1).2

Laryngeal cancer risk may only be higher in people exposed to environmental tobacco smoke for many years, case-control studies have shown; evidence is limited by small numbers of laryngeal cancer cases in never-smokers.9-11

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Smokeless tobacco

Laryngeal cancer risk is not associated with smokeless tobacco use in the US or Scandinavia, a meta-analysis showed;12 nor is it associated with smokeless tobacco use in India.13

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Alcohol

Alcoholic drinks are classified by IARC and WCRF/AICR as a cause of laryngeal cancer (Table 4.1).2 An estimated 25% (27% in males, 12% in females) of laryngeal cancers in the UK are linked to alcohol.1

Laryngeal cancer risk is 2.5 times higher in people who drink around 6 units or more of alcohol per day, compared with non-drinkers/occasional drinkers, a meta-analysis showed.14 Laryngeal cancer risk is 50% higher in people who drink around 1.5-6 units of alcohol per day, compared with non-drinkers/occasional drinkers.14 Laryngeal cancer risk is not associated with drinking less than around 1.5 units of alcohol per day,15 but beyond this level, risk increases with higher alcohol intake.14

Alcohol-associated laryngeal cancer risk may vary with specific site of cancer within the larynx, with a stronger association for supraglottis than glottis cancers.16

Laryngeal cancer risk in ex-drinkers compared with continuing drinkers decreases by 2% per year of non-drinking, a meta-analysis showed.17 Laryngeal cancer risk is higher in ex-drinkers than never-drinkers for around 35 years after drinking cessation.17

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Diet

Hot maté

Drinking hot maté is classified by IARC as a probable cause of laryngeal cancer, based on limited evidence; it is classified by WCRF/AICR as a possible cause of laryngeal cancer, based on limited-suggestive evidence (Table 4.1).2,3

Laryngeal cancer risk may only be associated with drinking maté in large amounts,18,19 and/or at high temperatures,19 case-control studies have shown.

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Meat

Laryngeal cancer risk is 36% higher among people with the highest processed meat intake versus those with the lowest, a pooled analysis of case-control studies showed.20 Laryngeal cancer risk is not associated with red or white meat intake.20 Laryngeal cancer risk may vary with type of processed meat, a case-control study indicates.21 Laryngeal cancer risk is higher in people with the highest fat intake versus those with the lowest, a pooled analysis of case-control studies showed.22

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Medical conditions and treatments

Gastro-oesophageal reflux disease

Laryngeal cancer risk is 2.2 times higher in people with gastro-oesophageal reflux disease (GORD/GERD), versus people without GORD, a meta-analysis showed.23

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Laryngeal dysplasia

Laryngeal cancer develops in 14% of people with laryngeal dysplasia, on average around 6 years after dysplasia diagnosis, a meta-analysis showed.24 Laryngeal cancer risk among people with laryngeal dysplasia is higher in those with more severe dysplasia.24

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Immune system

Organ transplant

Laryngeal cancer risk is 1.6-2 times higher in organ transplant recipients compared with the general population, a meta-analysis and cohort study have shown.30,25

This may reflect higher rates of HPV infection in organ transplant recipients.30

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Infections

Human papillomavirus

Human papillomavirus (HPV) type 16 is classified by IARC as a probable cause of laryngeal cancer, based on limited evidence (Table 4.1).2 An estimated 11% of laryngeal cancers in the UK are linked to HPV infection.1,26

Laryngeal squamous cell carcinoma (SCC) risk is 5.4 times higher in people with HPV infection, a meta-analysis showed.27 Laryngeal cancer risk is higher for HPV type 16 than HPV type 18.27

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Helicobacter pylori

Laryngeal cancer risk is twice as high in people with helicobacter pylori (H pylori) infection versus those without, a meta-analysis showed.28

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Human immunodeficiency virus

Laryngeal cancer risk is 50-172% higher in people with human immunodeficiency virus (HIV) versus those without, meta-analyses have shown.29,30

This may reflect higher rates of smoking and HPV infection in people with HIV.29,30

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Previous cancer

Laryngeal cancer risk is 6.1 times higher in head and neck cancer (non-larynx) survivors, a pooled analysis of cancer registry data showed.31 Laryngeal cancer risk is higher in survivors of several other cancer types including lung, oesophageal, bladder, and cervical squamous cell carcinoma.32-35

This may reflect shared risk factors, e.g. tobacco, alcohol and HPV. Oral cavity, pharynx and larynx cancer risk among survivors of upper aerodigestive tract cancer is 2.2 times higher in those with the highest alcohol intake versus those with the lowest, a meta-analysis showed.36

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Family history and genetic conditions

Family history

Laryngeal cancer risk is 2.1 times higher in people with a first-degree relative (parent, sibling, child) who has/had head and neck cancer, a pooled analysis of case-control studies showed.37 Laryngeal cancer risk is 27% higher in people with a first-degree relative who has/had a non-head and neck smoking-related cancer.37

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Occupational exposures

Strong inorganic acid mists and asbestos are classified by IARC as causes of laryngeal cancer; working in rubber production and sulphur mustard (mustard gas) are classified by IARC as probable causes of laryngeal cancer, based on limited evidence (Table 4.1).2 An estimated 3% of laryngeal cancers in the UK are linked to occupational exposures.1

An estimated 2% of laryngeal cancers in Great Britain are linked to occupational exposure to strong inorganic acid mists.38

An estimated 0.4% of laryngeal cancers in Great Britain are linked to occupational asbestos exposure.38 Laryngeal cancer risk is 38% higher in people with high levels of occupational asbestos exposure, compared with unexposed people, a meta-analysis of case-control studies showed.38

An estimated 0.1% of laryngeal cancers in Great Britain are linked to working in the rubber production industry.38 Laryngeal cancer risk may be 39% higher in rubber industry workers compared with the general population, a meta-analysis showed.39

Laryngeal cancer risk may be higher in people occupationally exposed to polycyclic aromatic hydrocarbons, engine exhaust, textile dust, or silica dust, and hairdressers, meta-analyses have shown.39-41

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Factors shown to decrease or have no effect on laryngeal cancer risk

Decrease

Consumption of non-starchy vegetables, fruits, and foods containing carotenoids is classified by WCRF/AICR as probably protective against mouth, pharynx and larynx cancer, based on limited evidence (Table 4.1).3 An estimated 45% of laryngeal cancers in the UK are linked to people eating fewer than 5 portions of fruit and vegetables per day.1

Laryngeal cancer risk is 45% lower among people with the highest vegetable intake versus those with the lowest, a pooled analysis of case-control studies showed.20 Laryngeal cancer risk is not associated with vegetable intake in cohort studies.42,43

Laryngeal cancer risk is 41% lower among people with the highest fruit intake versus those with the lowest, a pooled analysis of case-control studies showed.20 Laryngeal cancer risk is not associated with total fruit intake in cohort studies,42,43 though risk may be lower in those with the highest citrus fruit intake.42

Laryngeal cancer risk is lower in people who are overweight or obese (body mass index [BMI] 25+) compared with those who are a healthy weight (BMI 18.5-25), a pooled analysis of case-control studies showed; however this may be limited to tobacco or alcohol users, and reverse causality (weight loss caused by early symptoms of cancer) is possible.44 Laryngeal cancer risk is lower in people with lower levels of recreational physical activity, a pooled analysis of case-control studies showed.45

Laryngeal cancer risk among males is 21% lower in those with Parkinson’s disease versus those without the condition, a cohort study showed.46 Laryngeal cancer risk among women is not associated with Parkinson’s disease, a cohort study showed.46

This may reflect lower smoking rates in people with Parkinson’s disease.46

No effect

WCRF/AICR make no judgment on the association between laryngeal cancer risk and cereals (grains) and their products; starchy roots, tubers, and plantains; dietary fibre; pulses (legumes); meat; poultry; fish; eggs; milk and dairy products; total fat; animal fats; plant oils; coffee; tea; frying; grilling (broiling) and barbecuing (charbroiling); protein; vitamin A; retinol; thiamin; riboflavin; niacin; folate; vitamin C; vitamin E; calcium; iron; selenium; body fatness; energy intake, due to limited evidence.3

Laryngeal cancer risk is not associated with the following factors, meta- and pooled analyses or systematic reviews have shown:

  • Marijuana smoking.47
  • Vitamin or mineral supplement use.48
  • Diabetes (though some evidence of higher risk in never-smokers).49
  • Tea or coffee.50,51
  • Sweetened carbonated drinks.51

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Updated: 19 December 2014