Head and neck cancers risk

Preventable cases

Head and neck cancer cases are preventable, UK, 2015

Preventable cases

Larynx cancer cases are preventable, UK, 2015

Preventable cases

Oral cavity cancer cases are preventable, UK, 2015

Preventable cases

Pharynx cancer cases are preventable, UK, 2015

The estimated lifetime risk of being diagnosed with laryngeal cancer is 1 in 188 (less than 1%) for males, and 1 in 834 (less than 1%) for females born after 1960 in the UK.[1] The estimated lifetime risk of being diagnosed with oral cancer is 1 in 55 (2%) for males, and 1 in 108 (less than 1%) for females born after 1960 in the UK.[1]

These figures take account of the possibility that someone can have more than one diagnosis of each of these cancer types in their lifetime (‘Adjusted for Multiple Primaries’ (AMP) method).[2]

References

  1. Lifetime risk estimates calculated by the Statistical Information Team at Cancer Research UK. Based on Office for National Statistics (ONS) 2016-based Life expectancies and population projections. Accessed December 2017, and Smittenaar CR, Petersen KA, Stewart K, Moitt N. Cancer Incidence and Mortality Projections in the UK Until 2035. Brit J Cancer 2016. 
  2. Sasieni PD, Shelton J, Ormiston-Smith N, et al. What is the lifetime risk of developing cancer?: The effect of adjusting for multiple primaries. Br J Cancer, 2011. 105(3): p. 460-5. 

About this data

Data is for UK, past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961, ICD-10 C32.

The calculations used past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961 to project risk over the lifetime of those born in 1961 (cohort method).[1] Projections are based on observed incidence and mortality rates and therefore implicitly include changes in cancer risk factors, diagnosis and treatment.

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46-88% of head and neck cancer cases in the UK are preventable.

Head and neck cancer risk is associated with a number of risk factors.[2,3]

Head and Neck Cancer Risk Factors

  Increases risk Decreases risk
'Sufficient' or 'Convincing' evidence
  • Alcoholic drinks [a,b,g]
  • Betel quid with tobacco [a,b]
  • Betel quid without tobacco [a]
  • Human papillomavirus (HPV) type 16 [a,b,c]
  • Tobacco smoking [a,b,g]
  • Smokeless tobacco [a]
  • X-radiation, gamma-radiation [d]
  • Epstein-Barr virus (EBV) [e]
  • Formaldehyde [e]
  • Strong inorganic acid mists [g]
  • Asbestos [g]
  • Salted fish, Chinese-style [e,i]
  • Wood dust [e]
 
'Limited' or 'probable' evidence
  • HPV type 16 [g]
  • HPV type 18 [a]
  • Hydrochlorothiazide [f]
  • Sulphur mustard (mustard gas) [g]
  • Solar radiation [f]
  • Radioiodines, including Iodine-131 [d]
  • Asbestos (all forms) [b]
  • Printing processes [b]
  • Working in rubber production [g]
  • Environmental tobacco smoke [b, g]
  • Body fatness [h]

 

International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications.
 
a Oral cavity; b Pharynx; c Tonsil; d Salivary gland; e Nasopharynx; f Lip; g Larynx; h WCRF/AICR classification is for mouth, pharynx and larynx.

See also

Want to generate bespoke preventable cancers stats statements? Download our interactive statement generator.

Find out more about the definitions and evidence for this data

Learn how attributable risk is calculated

References

  1. Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018.
  2. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 122*. Accessed October 2018.
  3. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed October 2018.

International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] 64% of laryngeal cancer cases, 37% of pharyngeal cancer cases, 25% of nasopharyngeal cancer cases, and 17% of oral cavity cancer cases are caused by smoking.[2]

Larynx cancer risk

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.[3] Tobacco-associated laryngeal cancer risk may vary with specific site of cancer within the larynx, with a stronger association for supraglottis than glottis cancers.[4]

Pharynx cancer risk

Pharyngeal cancer risk is 3 times higher in current smokers compared with never-smokers, a meta-analysis showed.[5] Oropharynx cancer risk in men is almost twice as high in the heaviest- and longest-smokers versus the lightest- and shortest-smokers.[6] Oropharynx cancer risk in women is more than 3 times higher in the heaviest- and longest-smokers versus the lightest- and shortest-smokers.[7]

Nasopharynx cancer risk 

Nasopharyngeal cancer risk is 47-95% higher in current smokers compared with never-smokers, meta-analyses have shown.[5,7

Oral cavity cancer risk 

Oral cavity cancer risk is 91% higher in current smokers compared with never-smokers, a cohort study showed.[8] Oral cavity cancer risk in men is almost 3 times higher in those who have smoked the most cigarettes for the most years, compared with those who have smoked the least for the fewest years, a pooled analysis showed.[6] Oral cavity cancer risk in women is more than 4 times higher in the heaviest- and longest-smokers versus the lightest- and shortest-smokers.[6]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 122*. Accessed October 2018.
  2. Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018. 
  3. Muscat JE, Liu HP, Livelsberger C, et al. The nicotine dependence phenotype, time to first cigarette, and larynx cancer risk. Cancer Causes Control 2012; 23(3):497-503.
  4. Gandini S, Botteri E, Iodice S, et al. Tobacco smoking and cancer: a meta-analysis. Int J Cancer 2008; 122(1):155-64.
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Head and neck cancer risk

Head and neck cancer (comprising oral cavity, pharynx and larynx) risk is 3.5 times higher in cigar-only smokers compared with never-smokers, a pooled analysis showed.[1] Head and neck cancer risk is nearly 4 times higher in pipe-only smokers compared with never-smokers. Risk increases with heavier or longer-term cigar or pipe use.[1]

Larynx cancer risk

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.[1]

Oral cavity cancer risk

Oral cancer risk is around 3 times higher in bidi smokers compared with bidi never-smokers, a meta-analysis of south Asian studies showed.[2]

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Larynx cancer risk

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.[1] Laryngeal cancer risk is higher in ex-smokers than never-smokers for up to 20 years after smoking cessation.[1]

Oral cavity cancer risk

Oral cavity cancer risk is 35% lower in ex-smokers who quit 1-4 years previously, compared with current smokers, a pooled analysis showed.[2] Oral cavity cancer risk is no higher in ex-smokers who quit 20+ years previously, compared with never-smokers.[2]

Pharynx cancer risk

Oropharynx/hypopharynx cancer risk is 49% lower in ex-smokers who quit 5-9 years previously, compared with current smokers. Oropharynx/Hypopharynx cancer risk is no higher in ex-smokers who quit 20+ years previously, compared with never-smokers.[2]

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1]

Larynx cancer risk

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.[2-4]

Oral and oropharynx cancer risk

Oral and oropharyngeal cancer risk is 87% higher in never-smokers who have ever been exposed to ETS at home or work, compared with unexposed never-smokers, a case-control study showed.[2] Oral and oropharyngeal cancer risk is more than twice higher in never-smokers exposed to ETS at home or work for 15+ years, compared with unexposed never-smokers.[2]

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1]

Oral cancer risk

Oral cancer risk among South Asians (who comprise the majority of smokeless tobacco users globally) is 5-7 times higher in smokeless tobacco users versus non-users, meta-analyses have shown.[2,3] Gum and oral cavity cancer risk may be higher in never smokers who have ever used nasal snuff or chewing tobacco, compared with non-users, a meta-analysis showed.[4]

The association between smokeless tobacco use and oral cancer risk varies by country probably due to differences in smokeless tobacco composition and format (e.g. chewing or inhaling nasally).[5]

Oral cancer risk in non-smokers is 3.5 times higher in betel quid without tobacco users compared with non-users, meta-analyses have shown.[6-8] Oral cancer risk in non-smokers and non-drinkers is around 15 times higher in betel quid without tobacco users compared with non-users.[6-8]

Oral cancer risk in non-smokers and non-drinkers is around 7 times higher in betel quid with tobacco users compared with non-users, a meta-analysis of studies from India (where tobacco is usually added to betel quid[9]) showed.[8] Oral cancer risk in smokers and drinkers is over 30 times higher in betel quid with tobacco users compared with non-users.[8]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 122*. Accessed October 2018.
  2. Khan Z, Khan Z, Tönnies J, Müller S. Smokeless tobacco and oral cancer in South Asia: a systematic review with meta-analysis. J Cancer Epidemiol 2014;2014:394696.
  3. Gupta B, Johnson NW. Systematic review and meta-analysis of association of smokeless tobacco and of betel quid without tobacco with incidence of oral cancer in South Asia and the Pacific. PLoS One 2014;9(11):e113385.
  4. Wyss AB, Hashibe M, Lee YA, et al. Smokeless Tobacco Use and the Risk of Head and Neck Cancer: Pooled Analysis of US Studies in the INHANCE Consortium. Am J Epidemiol. 2016 Oct 15.
  5. Boffetta P, Hecht S, Gray N , et al. Smokeless tobacco and cancer. Lancet Oncol 2008; 9(7):667-75.
  6. Thomas SJ, Bain CJ, Battistutta D, et al. Betel quid not containing tobacco and oral cancer: A report on a case-control study in Papua New Guinea and a meta-analysis of current evidence. Int J Cancer 2007; 120(6):1318-23.
  7. Song H, Wan Y, Xu YY. Betel Quid Chewing Without Tobacco: A Meta-analysis of Carcinogenic and Precarcinogenic Effects. Asia Pac J Public Health 2013. doi: 10.1177/1010539513486921.
  8. Petti S, Masood M, Scully C. The magnitude of tobacco smoking-betel quid chewing-alcohol drinking interaction effect on oral cancer in South-East Asia. A meta-analysis of observational studies. PLoS One 2013;8(11):e78999.
  9. Jacob BJ, Straif K, Thomas G, et al. Betel quid without tobacco as a risk factor for oral precancers. Oral Oncol 2004;40(7):697-704.
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International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classify the role of this risk factor in cancer development.[1,2] 38% of pharyngeal cancer cases, 34% of oral cavity cancer cases, and 22% of laryngeal cancer cases are caused by alcohol drinking.[3]

Larynx cancer risk

Laryngeal cancer risk is 49% higher in people who consume around 12.5-50g (1.5-6 units) of alcohol per day, and 2.4 times higher in those who consume 50g+ (6+ units) of alcohol per day, compared with non- or occasional drinkers, a meta-analysis showed.[4] Laryngeal cancer risk is not associated with drinking less than around 1.5 units of alcohol per day,[4,5] but beyond this level, risk increases with higher alcohol intake.[4,5]

Alcohol-associated laryngeal cancer risk may vary with specific site of cancer within the larynx, with a stronger association for supraglottis than glottis cancers.[6]

Laryngeal cancer risk in ex-drinkers compared with continuing drinkers decreases by 2% per year of non-drinking, a meta-analysis showed.[7] Laryngeal cancer risk is higher in ex-drinkers than never-drinkers for around 35 years after drinking cessation.[7]

Laryngeal cancer risk is substantially higher in people who both smoke tobacco and drink alcohol, meta- and pooled analyses have shown.[8,9] The effect of these two behaviours together is greater than the sum of their individual effects.[8,9]

Oral and pharynx cancer risk

Oral and pharyngeal cancer risk is 81% higher in people who consume around 12.5-50g (1.5-6 units) of alcohol per day, and 5 times higher in those who consume 50g+ (6+ units) of alcohol per day, compared with non- or occasional drinkers, a meta-analysis showed.[4] Oral and pharyngeal cancer risk is 2.5 times higher in regular drinkers compared with non- and occasional drinkers, a meta-analysis showed.[10]

Oral and pharyngeal cancer risk is almost tripled in alcohol drinkers who currently smoke tobacco, while it is 32% higher in alcohol drinkers who do not currently smoke, both compared with never-drinkers, a meta-analysis showed.[11]

Oral cavity, oropharyngeal and hypopharyngeal cancer risk increases with amount of alcohol consumed among ever-smokers,[12] but among never-smokers the effect may be limited to oropharyngeal/hypopharyngeal cancer, pooled analyses have shown.[11]

Oral cancer risk is higher in alcohol drinkers who use smokeless tobacco, compared with alcohol drinkers who do not use smokeless tobacco.[13,14]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 122*. Accessed October 2018.
  2. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed October 2018.
  3. Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018. 
  4. Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015 Feb 3;112(3):580-93.
  5. La Vecchia C, Zhang ZF, Altieri A. Alcohol and laryngeal cancer: an update. Eur J Cancer Prev 2008;17(2):116-24.
  6. Ahmad Kiadaliri A, Jarl J, Gavriilidis G, et al. Alcohol drinking cessation and the risk of laryngeal and pharyngeal cancers: a systematic review and meta-analysis. PLoS One 2013;8(3):e58158.
  7. Zeka A, Gore R, Kriebel D. Effects of alcohol and tobacco on aerodigestive cancer risks: a meta-regression analysis. Cancer Causes Control 2003;14(9):897-906.
  8. Turati F, Garavello W, Tramacere I, et al. A meta-analysis of alcohol drinking and oral and pharyngeal cancers: results from subgroup analyses. Alcohol Alcohol 2013;48(1):107-18.
  9. Lin WJ, Jiang RS, Wu SH, et al. Smoking, alcohol, and betel quid and oral cancer: a prospective cohort study. J Oncol 2011;2011:525976
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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] 70% of pharyngeal cancer cases and 1% of oral cavity cases are caused by HPV infection.[2]

Human papillomavirus (HPV) prevalence by cancer site

73% of oropharyngeal cancer cases in Europe are HPV-positive Open a glossary item, a meta-analysis showed; this proportion has increased over time.[3] 12% of oral cavity, hypopharynx and larynx cancer cases in Europe are HPV-positive, with no change over time.[3]

Larynx cancer risk

Laryngeal squamous cell carcinoma (SCC) risk is 5.4 times higher in people with HPV infection, a meta-analysis showed.[4] Laryngeal cancer risk is higher for HPV type 16 than HPV type 18.[4]

Oral and oropharynx cancer risk

Oropharyngeal, tonsil, and base of tongue cancer risk is higher in people with more past sexual partners (particularly oral sex partners), people who started having sex at a younger age, and men who have ever had sexual contact with men (base of the tongue only), a pooled analysis showed; this reflects the sexual route of HPV transmission.[5]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] 80% of nasopharyngeal cancer cases are caused by Epstein-Barr virus (EBV)  infection.[2]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

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Exposure to asbestos is classified by IARC as a probable cause of pharyngeal cancer, based on limited evidence.[1]

Asbestos

An estimated 0.4% of laryngeal cancers in Great Britain are linked to occupational asbestos exposure.[2] 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.[2]

Strong inorganic acid mists

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

Formaldehyde

Less than 1% of nasopharyngeal cancers in Great Britain are linked to occupational exposure to formaldehyde.[3]

Wood dust

An estimated 10% of nasopharyngeal cancers in men in Great Britain, and around 2% in women, are linked to occupational exposure to wood dust.[3]

Rubber production

An estimated 0.1% of laryngeal cancers in Great Britain are linked to working in the rubber production industry.[2] Laryngeal cancer risk may be 39% higher in rubber industry workers compared with the general population, a meta-analysis showed.[4]

Polycyclic aromatic hydrocarbons

Oral and pharyngeal cancer risk is 14% higher in people exposed to polycyclic aromatic hydrocarbons.[5]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1]

Less than 1% of oral cavity cancer cases are caused by ionising radiation.[2]

Salivary gland cancer risk is higher in survivors of childhood cancer, Hodgkin lymphoma, and thyroid cancer, compared with the general population, cohort studies have shown; this is due to radiation treatment (radiotherapy or radioiodines) for the primary tumour.[3-6]

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Acknowledgements

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See information and explanations on terminology used for statistics and reporting of cancer, and the methods used to calculate some of our statistics.

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