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Occupational asbestos exposure is associated with pharyngeal squamous cell carcinoma in men from the greater Boston area
  1. Scott M Langevin1,2,
  2. Mattie H O'Sullivan3,
  3. Jennifer L Valerio4,
  4. Michael Pawlita5,
  5. Katie M Applebaum4,6,
  6. Melissa Eliot1,
  7. Michael D McClean7,
  8. Karl T Kelsey2,8
  1. 1Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  2. 2Department of Epidemiology, Brown University, Providence, Rhode Island, USA
  3. 3Department of Biological and Chemical Sciences, University College Cork, Cork, Ireland
  4. 4Department of Environmental and Occupational Health, School of Public Health and Health Services, The George Washington University, Washington, DC, USA
  5. 5Research Program Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
  6. 6Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
  7. 7Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
  8. 8Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Professor Karl T Kelsey, Department of Pathology and Laboratory Medicine, Brown University, 70 Ship Street, Box G-E5, Providence, RI 02912, USA; karl_kelsey{at}


Objectives Asbestos is the name given to a group of naturally occurring silicate mineral fibres that were widely used in industry during the 20th century due to their desirable physical properties. Although use in the USA has fallen over the last three decades, significant exposure in the developing world continues and the burden of disease is considerable. Asbestos is a known risk factor for several malignant diseases, including lung cancer and mesothelioma, and has more recently been implicated in pharyngeal and laryngeal cancer. However, studies of asbestos and cancers of the larynx or pharynx with adequate sample size that control for major head and neck squamous cell carcinoma (HNSCC) risk factors remain relatively sparse.

Methods We report findings from a case–control study of 674 incident male HNSCC cases from the greater Boston region and 857 population-based male controls, matched on age (±3 years), sex, and town or neighbourhood of residence. Multivariable logistic regression was used to assess the association between occupational asbestos exposure and HNSCC by primary tumour site.

Results 190 cases (28.2%) and 203 controls (23.7%) reported occupational exposure to asbestos. Occupational asbestos exposure was associated with elevated risk of pharyngeal carcinoma in men (OR 1.41, 95% CI 1.01 to 1.97), adjusted for age, race, smoking, alcohol consumption, education, income and HPV16 serology, with borderline increasing risk for each decade in the exposed occupation (OR 1.10, 95% CI 0.99 to 1.23).

Conclusions These observations are consistent with mounting evidence that asbestos is a risk factor for pharyngeal cancer.

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