Tobacco and Public Health - TCSC Indonesia

Effect on survival
In two studies from Europe, mortality of laryngeal cancer cases was greater among
heavy smokers than among non-smokers and light smokers (Crosignani et al. 1996;
Boffetta et al. 1997). This result reflects the increased risk of other tobacco-related
causes of death; however, similar results were obtained when only deaths from laryngeal
cancer were considered, possibly reflecting an effect of smoking on the natural history
of the neoplasm and on response to therapy.
Public health impact
PAOLO BOFFETTA 377
Tobacco smoking greatly increases the risk of laryngeal cancer. The proportion of male
cases of laryngeal cancer attributable to tobacco smoking in Europe and North
America is around 80%. This proportion might be lower in men from other regions
of the world where other causes of laryngeal cancer might play an important role,
and in women. A study of the burden of tobacco-related cancer worldwide provided
conservative estimates of 67% of cases in men and 28% in women, corresponding
to 100 600 new cases each year and, assuming no effect of smoking on laryngeal
cancer-specific mortality, 55 600 deaths (Parkin et al. 1994).
Tobacco control is the main avenue for prevention of laryngeal cancer; the evidence
of an interaction between tobacco smoking and other risk factors should not be used
as an argument to reduce the emphasis on avoiding and quitting smoking. As it is
shown in Fig. 21.5, tobacco smoking plays by far the largest aetiological role in laryngeal
carcinogenesis, either alone or in combination with other factors. The decline during
the recent decades in the incidence of laryngeal cancer among men in some regions in
which tobacco control has been implemented more effectively (e.g. the USA and
Finland vs. Denmark, Fig. 21.6) suggests that prevention of this disease through the
avoidance of its major cause is possible. As for other tobacco-related diseases, the main
priorities are today among women and in the developing countries.
Smoking alone
Alcohol alone
Smoking and alcohol
Other factors
Fig. 21.5 Risk of laryngeal cancer
attributable to tobacco smoking and
alcohol drinking—Northern Italy
(Tavani et al. 1994).