Body mass index and risk of head and neck cancer by race: the Carolina Head and Neck Cancer Epidemiology Study

PurposeMost studies, primarily conducted in populations of European ancestry, reported increased risk of head and neck cancer (HNC) associated with leanness (body mass index [BMI] <18.5 kg/m²) and decreased for overweight or obesity (25.0 to <30.0 and >30 kg/m², respectively), compared with normal weight (18.5 to <25.0 kg/m²).MethodsThe Carolina Head and Neck Cancer Epidemiology Study is a population-based, racially diverse case-control study of 1289 incident HNC cases (330 African Americans) and 1361 controls (261 African Americans). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for associations between BMI 1 year prediagnosis and HNC risk stratified by race and adjusted for age, sex, smoking, alcohol, and education.ResultsMultiplicative interaction between BMI and race was evident (P_int = .00007). Compared with normal weight, ORs for leanness were increased for African Americans (OR, 3.91; 95% CI, 0.72–21.17) and whites (OR, 1.48; 95% CI, 0.60–3.65). For overweight and obesity, ORs were decreased in African Americans (OR, 0.51; 95% CI, 0.32–0.83 and OR, 0.47; 95% CI, 0.28–0.79, respectively) but in not whites. The increased risk associated with leanness was greater for smokers than nonsmokers (P_int = .02).ConclusionsThese data, which require replication, suggest that leanness is associated with increased HNC risk among African Americans to a greater extent than whites and overweight and obesity is associated with decreased HNC risk only among African Americans.     

Recreational physical activity and risk of head and neck cancer: a pooled analysis within the international head and neck cancer epidemiology (INHANCE) Consortium

Increasing evidence suggests that physical activity could prevent cancer, but scanty data is available on head and neck cancer (HNC). The aim of our study is to clarify the effect of recreational physical activity (rPA) on HNC. We analyzed data from four case-control studies, including 2,289 HNC cases and 5,580 controls. rPA was classified as: none/low (reference group), moderate and high. We calculated summary Odds Ratios (ORs) by pooling study-specific ORs. Overall, moderate rPA was associated with 22% lower risk of HNC compared to those with none or very low rPA levels [OR?=?0.78, 95% Confidence Interval (95% CI): 0.66, 0.91]. Moderate rPA is associated with reduced risk of oral (OR?=?0.74, 95% CI: 0.56, 0.97) and pharyngeal cancer (OR?=?0.67, 95% CI: 0.53, 0.85), as well as high rPA levels (OR?=?0.53, 95% CI: 0.32, 0.88 for oral cavity, OR?=?0.58, 95% CI: 0.38, 0.89 for pharynx). High rPA levels, however, is associated with higher risk of laryngeal cancer (OR?=?1.73, 95% CI: 1.04, 2.88). Stratified analyses showed that such inverse association between moderate rPA and HNC was more evident among males (OR?=?0.75, 95% CI: 0.62, 0.90), subjects ≥45?years (OR?=?0.78, 95% CI: 0.66, 0.93), and ever smokers and ever drinkers (OR?=?0.72, 95% CI: 0.59, 0.88). High rPA significantly reduces HNC risk among subject ≥45?years (OR?=?0.66, 95% CI: 0.48, 0.91). Promoting rPA might be inversely associated with HNC.     

Higher micronutrient intake is associated with human papillomavirus-positive head and neck cancer: a case-only analysis

No studies have investigated dietary differences between head and neck squamous cell carcinoma (HNSCC) patients with human papillomavirus (HPV)-positive tumors and patients with HPV-negative tumors. This study was designed to investigate the relationship between diet and HPV status in HNSCC patients. Cases of HNSCC were recruited from 2 clinical centers participating in the University of Michigan Head and Neck Specialized Program of Research Excellence (SPORE). HPV tissue genotyping was performed, and epidemiological and dietary data collected. Multivariable logistic regression tested whether pretreatment consumption of 12 selected micronutrients was significantly associated with HPV-positive status in 143 patients newly diagnosed with cancer of the oral cavity or pharynx. After controlling for age, sex, body mass index, tumor site, cancer stage, problem drinking, smoking, and energy intake, significant and positive associations were observed between vitamin A, vitamin E, iron, β-carotene, and folate intake and HPV-positive status (P(trend) < 0.05), suggesting that diet may be a factor in the improved prognosis documented in those with HPV-positive HNSCC. Dietary differences by HPV status should be considered in prognostic studies to better understand the influence of diet on HNSCC survival.     

Swallowing Problems in Patients With Head and Neck Cancer:

The restoration of swallowing skills in head and neck cancer surgery patients demands a two-pronged approach: thorough and systematic evaluation and simple, fundamental treatments. Therapists should begin with an assessment of their own biases and their knowledge of head and neck cancer and its surgeries. The patients themselves should be evaluated presurgically-to determine food preferences, other medical conditions, nutritional status, and current swallowing abilities, and postsurgically-to assess facial symmetry, oral mobility and strength, saliva management, aspiration risk, and altered swallowing skills. Treatment approaches should generally be basic, stressing oral exercises, positioning techniques, the use of feeding aids, and teaching the supraglottic swallow. Attention to special considerations, like problems with cuffed tracheostomies and the controversies over using variable food consistencies, will refine the treatment.     

Disinfection byproducts and bladder cancer: a pooled analysis

BACKGROUND: Exposure to disinfection byproducts in drinking water has been associated with an increased risk of bladder cancer. We pooled the primary data from 6 case-control studies of bladder cancer that used trihalomethanes as a marker of disinfection byproducts. METHODS: Two studies were included from the United States and one each from Canada, France, Italy, and Finland. Inclusion criteria were availability of detailed data on trihalomethane exposure and individual water consumption. The analysis included 2806 cases and 5254 controls, all of whom had measures of known exposure for at least 70% of the exposure window of 40 years before the interview. Cumulative exposure to trihalomethanes was estimated by combining individual year-by-year average trihalomethane level and daily tap water consumption. RESULTS: There was an adjusted odds ratio (OR) of 1.24 in men exposed to an average of more than 1 microg/L (ppb) trihalomethanes compared with those who had lower or no exposure (95% confidence interval [CI] = 1.09-1.41). Estimated relative risks increased with increasing exposure, with an OR of 1.44 (1.20-1.73) for exposure higher than 50 microg/L (ppb). Similar results were found with other indices of trihalomethane exposure. Among women, trihalomethane exposure was not associated with bladder cancer risk (0.95; 0.76-1.20). CONCLUSIONS: These findings strengthen the hypothesis that the risk of bladder cancer is increased with long-term exposure to disinfection byproducts at levels currently observed in many industrialized countries.     

Weight Loss in Post-Chemoradiotherapy Head and Neck Cancer Patients

Background: Weight loss is well-known among head and neck (HNC) patients during radiotherapy and could continue after the treatment is completed. Weight monitoring is essential for treatment outcomes and cancer surveillance. The purpose of the study is to evaluate the weight loss during and post-treatment among HNC patients. Methods: A total of 45 out of 50 patients post-treatment were included in this secondary treatment. Data were collected at baseline, at the completion of radiotherapy and one month after completion of radiotherapy. Results: The mean weight loss was 4.53 ± 2.87 kg (7.4%) during treatment and 1.38 ± 2.65 kg (2.1%) post-treatment. There were significant improvements one month after completion of radiotherapy in Patient-Generated Subjective Global Assessment (PGSGA), muscle mass, nutrition impact symptoms (NIS) score, energy and protein from oral intake (p < 0.0001). Energy and protein from oral nutritional supplements (ONS) decreased significantly (p < 0.0001). Conclusions: The results of this study underline the importance of early identification and monitoring post-treatment in HNC patients. The post-treatment recovery stage is very important for HNC patients to ensure a healing process.     

Phase Angle,a Cornerstone of Outcome in Head and Neck Cancer

In patients with head and neck cancer, malnutrition is common. Most cases are treated by chemo-radiotherapy and surgery, with adverse effects on the aerodigestive area. Clinical and biochemical characteristics, health-related quality of life, survival, and risk of death were studied. The selected subjects were divided into normal- and low-phase-angle (PA) groups and followed up for at least two years. Mean ages were 67.2 and 59.3 years for low and normal PA, respectively. Patients with PA < 4.42° had significant differences in age, anthropometric and biochemical indicators of malnutrition, and inflammatory status compared to patients with PA > 4.42°. Statistical differences were found in the functional and symptom scales, with lower functional scores and higher symptom scores in patients with low PA. Median survival was 19.8 months for those with PA < 4.42° versus 34.4 months for those with PA > 4.42° (p < 0.001).The relative risk of death was related to low PA (2.6; p < 0.001). The percentage of living patients (41.7%) is almost the same as the percentage of deceased subjects (43.1%; p = 0.002), with high death rates in patients with PA < 4.42°. Phase angle was the most crucial predictor of survival and a risk factor for death in the studied cases.     

Associations between dietary patterns and head and neck cancer: the Carolina head and neck cancer epidemiology study

Few studies have examined the associations between dietary patterns and head and neck squamous cell carcinoma (SCC) or whether they differ by race. This was evaluated using data from a population-based case-control study (2002-2006) including 1,176 cases of head and neck SCC and 1,317 age-, race-, and gender-matched controls from central and eastern North Carolina whose diets had been assessed by food frequency questionnaire. Factor analysis identified 2 patterns of intake: 1) high consumption of fruits, vegetables, and lean protein and 2) high consumption of fried foods, high-fat and processed meats, and sweets. Associations were estimated using logistic regression, adjusting for matching factors and confounders. Heterogeneity by tumor site (oral/pharyngeal vs. laryngeal) and effect-measure modification were also evaluated. Reduced odds of head and neck SCC were found for the fruit, vegetable, and lean protein pattern (for highest quartile vs. lowest, odds ratio = 0.53, 95% confidence interval: 0.39, 0.71). The fried foods, high-fat and processed meats, and sweets pattern was positively associated only with laryngeal cancer (odds ratio = 2.12, 95% confidence interval: 1.21, 3.72). These findings underline the importance of a dietary pattern rich in fruits and vegetables and low in high-fat and processed meats and sweets for prevention of head and neck cancer.     

螺旋断层放射治疗技术在头颈部肿瘤中的应用

螺旋断层放射治疗技术是近年来逐渐发展起来的一种调强适形放疗技术,目前已经初步应用于口咽癌、鼻咽癌等多种头颈部肿瘤治疗中。与传统的调强放疗比,螺旋断层放射治疗技术具有剂量更准确、分布更均匀、更好保护重要器官以及降低放疗后不良反应发生率等优点。该文就国内外螺旋断层放射治疗技术在头颈部肿瘤中的应用予以综述。     

STAT3与头颈肿瘤的研究进展

STAT3是近年来国内外头颈肿瘤的研究热点,前期研究显示一些重要成果,表明有较好的前景.本文综述了STAT3在头颈肿瘤中研究进展,介绍了STAT3的结构、STAT3信号转导通路、STAT3生物学功能及STAT3与头颈肿瘤的关系.最后指出STAT3在头颈肿瘤的临床意义.     

Pooled analysis of alcohol dehydrogenase genotypes and head and neck cancer: a HuGE review

Possession of the fast metabolizing alleles for alcohol dehydrogenase (ADH), ADH1B*2 and ADH1C*1, and the null allele for aldehyde dehydrogenase (ALDH), ALDH2*2, results in increased acetylaldehyde levels and is hypothesized to increase the risk of head and neck cancer. To examine this association, the authors undertook a Human Genome Epidemiology review on these three genes and a pooled analysis of published studies on ADH1C. The majority of Asians had the fast ADH1B*2 and ADH1C*1 alleles, while the majority of Caucasians had the slow ADH1B*1/1 and ADH1C*1/2 genotypes. The ALDH2*2 null allele was frequently observed among Asians, though it was rarely observed in other populations. In a pooled analysis of data from seven case-control studies with a total of 1,325 cases and 1,760 controls, an increased risk of head and neck cancer was not observed for the ADH1C*1/2 genotype (odds ratio = 1.00, 95% confidence interval: 0.81, 1.23) or the ADH1C*1/1 genotype (odds ratio = 1.14, 95% confidence interval: 0.92, 1.41). Increased relative risks of head and neck cancer were reported for the ADH1B*1/1 and ALDH2*1/2 genotypes in several studies. Recommendations for future studies include larger sample sizes and incorporation of relevant ADH and ALDH genes simultaneously, as well as other genes. These considerations suggest the potential for the organization of a consortium of investigators conducting studies in this field.     

Chemopreventive Potential of Natural Compounds in Head and Neck Cancer

Head and neck squamous cell carcinoma (HNSCC) is one of the most fatal cancers worldwide. Despite advances in the management of HNSCC, the overall survival for patients has not improved significantly due to advanced stages at diagnosis, high recurrence rate after surgical removal, and second primary tumor development, which underscore the importance of novel strategies for cancer prevention. Cancer chemoprevention, the use of natural or synthetic compounds to prevent, arrest, or reverse the process of carcinogenesis at its earliest stages, aims to reverse premalignancies and prevent second primary tumors. Genomics and proteomics information including initial mutation, cancer promotion, progression, and susceptibility has brought molecularly targeted therapies for drug development. The development of preventive approaches using specific natural or synthetic compounds, or both, requires a depth of understanding of the cross-talk between cancer signaling pathways and networks to retain or enhance chemopreventive activity while reducing known toxic effects. Many natural dietary compounds have been identified with multiple molecular targets, effective in the prevention and treatment of cancer. This review describes recent advances in the understanding of the complex signaling networks driving cancer progression and of molecularly targeted natural compounds under preclinical and clinical investigation.     

STAT3与头颈肿瘤的研究进展

STAT3是近年来国内外头颈肿瘤的研究热点,前期研究显示一些重要成果,表明有较好的前景。本文综述了STAT3在头颈肿瘤中研究进展,介绍了STAT3的结构、STAT3信号转导通路、STAT3生物学功能及STAT3与头颈肿瘤的关系。最后指出STAT3在头颈肿瘤的临床意义。     

Nonsteroidal antiinflammatory drugs and bladder cancer: a pooled analysis

Case-control studies have shown that regular use of nonsteroidal antiinflammatory drugs (NSAIDs) decreases bladder cancer risk, but few cohort studies have evaluated this association. The authors investigated NSAID use and bladder cancer in 3 large prospective studies (NIH-AARP Diet and Health Study; Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial; and U.S. Radiologic Technologists Study). Frequency of aspirin and nonaspirin NSAID use 1 year prior to baseline was ascertained using self-administered questionnaires. Study-specific hazard ratios and 95% confidence intervals were estimated using Cox regression models and were combined using a fixed-effects meta-analytic model. Data from all studies were aggregated, and aggregated hazard ratios were estimated. The analysis included 508,842 individuals, with 2,489 incident cases of bladder cancer. A reduction in risk was observed for individuals who reported regular use (>2 times/week) of nonaspirin NSAIDs compared with those who reported no use (hazard ratio (HR) = 0.92, 95% confidence interval (CI): 0.81, 1.04). The risk reduction was limited to nonsmokers (HR = 0.58, 95% CI: 0.41, 0.83) (P(trend) = 0.008) (P(interaction) = 0.02). No association was observed between regular aspirin use and bladder cancer risk (HR = 1.04, 95% CI: 0.94, 1.15). Results suggest that nonaspirin NSAIDs, but not aspirin, are associated with a reduction in risk of bladder cancer, particularly for nonsmokers.     

Head and neck cancer: a threat to life and social functioning

This paper deals with the crisis of cancer and the communication loss faced by the laryngectomized patient. It considers the particular issues for the patient and his family and how the use of crisis intervention can reinforce the coping patterns of the patient and his family.