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e'" which is less [7. 12. 14]. This mot reflected by at the germinM mone~,) a greater This hypothesis pt and for useful childhood and Gynec., 92. 1965. 4s of 105 cases. cad(el., -56. 1961. na of the ova~'. ancer. 42, 197,% lec. scand-, mlogy. :Philadel- he ova~a.-. anced met ~tatiC • F.. P~-~)~- ~yn@c., 69. 1974, tdy of 22 rico-pathol°gic~d ~ et revue de 1~ o. 175. erminom~ of Ob~et. GY~wc'" NEOPLASMA. 31, 4. 1984 465 The epidemiologieal risk factors of the larynx cancer among the native and migrant male population B. Z]~.~r~_~. Z. Woacn~szv.K Institute of O~cology, Can~er ~pldem@logy Unit, Teleradiotherapy Department, 4~.101 Giiwice, Poland :Received :February 7. 1984 In the present paper relati~ri~k o~ larynx cancer has been evalu- ated in 272 cases in the stationax~- (native Upper Silesians) (65.4%) and migrant (34.6°~o) popttlafio~ of men. Tile corresponding control groups (total 739 men) consisted of 401 (54.3°o) and 338 (45.7qo) men, respectively, who did not suffer from neoplastic diseases. The important relationship between larynx cancer incidence and cigarette (with or without filter), pipe and cigar smoking has been proved. It has also been sho~vn that the evaluation of larynx cancer risk according to the birth place of populations is more useful, because it enables to discover new ~pidemiologieal aspects _of the larynx cancer. The higher larynx cancer Agk has also been disclosed i'n men who are in manual work. and who are immediately exposed to the influence of various dusts and gases in t.hei.r place of work. It has been discovered, that chronic inflammation of the upper respiratory tract, pneumonia, tuberculosis, emphysema or bronchitis also influence higher larynx cancer incidence risk in the natWe and migrant populations analysed. Key words: Lartp,x ca~cer;-~m.tires, migra~,ts, tobacco smoking, occupat io~tal }~azard~. Some world registers have recorded high frequency of the larynx cancer in- cidence, 5Inking comparison with them, the incidence among the Polish population ha~ also been found lfigh [3, 31]. Nevertheless, within the area of Poland (similarly the 9ther world registers) there exist, sometimes very basic, regional differences the frequency of inc{dence (or mortality) caused by the larynx cancer [7, II, ~11---25, 33. 44).'In recen~ years the morbidity and mo~tality increase dsmamicallv, r*)tlt itt Poland [7.10, 12, ~4, 44] and in ether'countries [4, 20, 36]. " Increasing morbidity and mortality (especially in the male population) give rise iatertsive search of etiological factors 5nducing neoplastic diseases of this organ ~eeording ~o Directory of on-going research in cancer epidemiology. IARC Sci. V~bl., 46, 1982). ' Larynx cancer risk is most often connected with the tobacco smoking [6. 15.38]. far. relatively few pavers were devoted to anMvsis of the relationship Of lar~,-ax ~ncer incidenc~ and ris~ factors (e g. dust and ga~ pollution) in t.he work environ- I

466 ' ZEM~A, WOIC~ESZEK meat. Some researchers [5, S, 16. I9, 26] have discussed this phenomenon in details, some treated it only marginally [5, 7, 22, 32, 39]. Very rarely relationships between the lar~-ax cancer and the diseases preceding in the past [7, 32] are referred to. The aim of this paper was to_evaluate larynx cancer risk in two populations sorted according to the place of birth, tobacco smoking, exposure to multifraotioa dusts and vapors of various substances and diseases suffered from in the past. 3Iaterials and methods During the years 1980~1982, based upon a special questionnaire the data con- coming tobacco smoking, places of work and their characteristics, and preqeding diseases have been collected from 272 men suffering from larynx cancer, who wet0 admitted primarily ~o~he ~st.i~ute of 0neology in Gli~ce for ~rea~mon~ and fo~ow. -up. The control group consisted of 739 nonc~roinoma men. From the population of 272 diseased and 739 not diseased men two groups were made according ~o the place of birth: 1. Na~ives~ i. e. native Silesians, who have been exposed from early chi!~mod to systematic and long-last4ng i~uence of dusts and gases from factories in their li~ng place. -=- -- 2. ~igr~nts. the m~jority of which (~bout o/ . 60 ,'o) hare settled do~ in Upper Silesia during the most active immigration movemen~ in the years I9~8~1992. This group has been exposed to the indnstrial pollution for a shorter period of time in their living place. These men came in most eases from the villages in various parts of the co,try. - ~ " Evaluation of the relative risk of lar3~ cancer ineidence (~) according g~the piece of birgh, the way of smoNng (cigaretges, pipe, eig~r), the character of the work environment and the concomitant or preceding diseases, was made according to the Mantet~Haenszel p~oeedure [2] and the Pearson Ohi-square test. Results and discussion Out of 272 larx-ax cases analyzed 178 (65.4%) were natives, whereas 94 (34.600) were migrants. Ali cases were confirmed by histopathological diagnosis. In both groups squamous :cell carcinoma predominated (93--95%), similarly as i~ other reports [22, 24, 29, 30, 38]. The cancer group of Upper Sileslans corresponded to the control group of 401 men (54.3% of total). The control group of migrants consisted of 338 (45.7% of total number) men. Larynx cancer incidence risk among the population of native Upper Silesians is higher and statistically differs Considerably from the risk factor in the migrantS' group (Table ] ). Long-term ecological factors, generally worse due to industrializatio~ of the region influenced to a tort.sin extent the higher risk factor among the native population. Although higher morbidity (or mortality), or l~gher incidence ri~k ha.re been observed earlier ~ithin the area of towns of industrialized regions in general. no conclusive casual links have been detected yet. This resulted from inhomogeneiLv of the whole popularion as regard the place of birth and various duration of livi~g in the ~iven area [3, 7, 13, 25. 34, 36, 38]. Even if the necessity of investiga~io~s aimed ~t these factoys has bee£ stressed before [44], analysis of such a kind has not, The e of pc] Discs Tabl Mark (s) disp~ beer of t] "wet( (;otlt (ver corn tim~ grol

aenon in details, onships between eferred %o. two populations to mu]tifraction the past. tre the data con- S. and preceding • ancor, who were mont. and follow- two groups were early ohildhood actories in their dow~ in Upper ars 1948--1952- period of in various according to the ,cter of the work according to the THE EPIDEMIOLOGICAL RISK FACTORS OF THE LARYNX CANCER 467 Table 1. The relative risk of lar}~r~x cancer among the m~tive (~) ~nd migrant (m) mule populatior~ (n) tin) The character of population ~umber of 1Relative .Number of :Relative cases risk (~R) cases risk Diseased 178 94 1.00 Xon-diseased 401 338 !control group) 0.63~) 10.15 Source: own caleula~tion~.__~_)_p (Z~ > 10.$2) = 0.001 -- statistically relevant difference relatiotx to (t/R) = 1.00 for native popu--~ation. Table 2. The average age (5) of men with larynx cancer and control groups, in relation to their place of birth ~nadves, migrants) with s~atistieal evMuation Natives Migrants ]Iark~) "~ - -- Diseased Comrol group Diseased Conu'ol group Source: own calculations, ~) (~.) average number of ~vorking years to the diagnosis of lan.uax cancer. ¢8) -- standard deviation, (;;.~) -- 95-00 confidence intervals, (v) -- coefficient of dispersion. been published vet. In the present p~per certain additional epidemiologieM aspects of the laryr~ c~ncer have been obtained. Out. of the total number of 94 larsmx cancer migrant patients, 74, i.e. 78.7% Were born in villages of various regions in Poland (out of the total of 338 men of the }'~at~ol group, 215, i.e. 63.6% came from the country). The vast. majority of them ~migrated to U~er Silesia after having lived for 17--26 years in the country ~ er,v rarely more than 26 years). From this it appears: that migrant pvpulation, in ~'°taparisor~ with native o~e was exposed to pollution for much shorter period of ti~e, which may also influence lowqr la)ynx cancer incidence ri~k ..... ' -*~an age oi the nauve group with cancer was 56.5 years, and of the migrant ~oup 53.5 years and did not differ statistieMly from the "mean age of the control ~rOUps (Talkie 2). These values do not differ ossentiMlv from those in 104 world registe~rs, wlfieh ~t~ 56.4 years [3] and in the range from~52 to 58 years in other reports [~ 10, 2"), -o, 30, 33].

Z~M~,A, WOJCIESZE~ Table 3. The relative risk (RR) of larynx cancer axaong the native (n) and migrant population in relation t.o cigarette smoking Analyzed mark and its level - (RR) (n) (m) Z~ (RR) Z~- Not smoking ~t, all 1.00 Smoking cigarettes WithoUt filter (total) 19.90 a) Smoking < It c~garettes.day 21.44 b) '" 10~14 '" 17.42 c) "" 15~20 '" 19.78 d) '" 21~30 "" 18.79 e) '" o1~4 ~ I0.32 Smoking cigarettes xvit~lte, (total) 98.69 a) Smoking 15~20 6ig~et tesMay 13.27 108.43 9.63~) 20.14 49.26 13.50~> 16.55 48.27 14.54~) 14.95 93.27 8.25~) 15,41 69.29 10.57~) 17.99 11.76 6.00a) 3,90 108.81 13"50~) 9.71 14.75 Source: own calculations. > 3.84) = 0.05 -- statisticalh" x'Mid differences in incidence risk in relation to IRR) -- 1.~('* to not dm o-king Out of 178 Upper Silesians with cancer 94.9% were smokers and out of 94 migrants 96.8% with a history of a few to several years of smoking. In comparison wR.h nofismokers, ~hose who smoke filterless cigarettes, are statisticMly more prone t.o larynx cancer incidence. This concerns bo~h stationary and nonstat.ionary po~ulatloff independently on the number of cigarettes smoked per day. Higher risk can be observed also in the group of natives, who smoke cigaret- tes with fil~er (among immigrants this category was not recorded) (Table 3). Taking into consideration both populations and the number of cigarettes without filter smoked per day (from less than I0 to 30--40 cigarettes), relative risk of larynx cancer among natives in higher but neither in the first nor in the other population exp(~ctcd increase of risk proportional to the number of cigarettes smoked per day is observed (Table 3). Some authors [17.27.29.4i---43] have sho~ such a proportional prog~dssiot~. but the others, simil£rlv ~s We have not confirmed it [9]. Fundamental relation of larynx cancer and ~ob~cco smoking~ but without distinguishing the category of smokers according .t~o the cigarettes number smoked per day has been cohfirmed [5, 6, 18.21]. - Thelargest group of men smoking filterless cigarettes ~i'ere both natives and migrants, smoking 15--20 cigarettes per day. :For ghis category of smokers• the mean duration of smoking has been additonally analyzed (Table 4). On the average, about 36 years, natives, and 33 years, migrants, passed from the moment thev had star[ed smoking until the diaguosis of larynx cancer. The duration of smog"rig 15--20 cigarettes without filter per day in the control group~ {not suffering from larynx cancer or anv other neoplasm) do~s not differ stati;tically from the cancer group (Table 4). It appears that neither long time nor intensity of smoking are the most important risk factors of the larsa~x cancer incidence, bnt th0 more fact of cigarette smoking, even lasting for a short time. According to soma Table native. Mark~ Table 5 Analy 1 2 fiht a) : 3 (to~ • tL auth [9] o thes~ eX-S~ Pala- Year~ Cane ipipe

d migralxt (m) male (m) 7.2 0 -- 3~ o_0.14 Ox) 16.55 4~) 14.95 ~;~ 17.99 ~0~) 3.90 ",0~) 9.71 =O.O1. Z) p(z~ 's and out of 94 /arettes, are ~ix stationary igarettes smoked ~o smoke cigarct- Table 3). Taking es ,~-ithout filter of lar~mx cancer ,ulatio~n expected ~ day is observed )nal progression" ental relation of the catego~" of been confirmed ,elk natives ~nd ,lokers. the mesa uts. passed from vnx cancer. Tt~e e control groups iffer statistically nor intensity of teidence, but the cording to sor~e THE EPIDEMIOLOGICAL RISK FACTORS OF THE LARYNX CANCER 469 Table 4. Average period of time (in years) of cigarette smoking for patients and control groups, natives (n} and migrants (m} together with statistical evaluation (for the category of smokers : - of 15--20 cigarettes without filter a day) (n) (m) Mark~) Diseased Diseased Control group Control group 12~ 36.1 .... 31.9 33.1 31.5 18t 6.2 _ 12.2 7.9 11.7 Izra) 34.5--37.6 29.2--34.6 30.4----35.8 29.3--33.7 (c) 17.2% 38.2°0 23.9% 37.1:% . Source: (nvn calculations. ~) See Table 2. Table 5. The relative risk (RR) of lar.~mx.cancer in the native (n) and migrant (m) male population in relation to cigarette smoking (for ex-smokers) Analyzed mark and its level (n) (m) (RR) X~ (RR) Z" 1 Not smoking at all 1.90 -- 1.00 2 F--x-smokers of cigarettes without filter (total) 5.81 z) 10.28 6.75"-) a) Sine,king 10--14 cigarettes/day 11.68 1.04 18.00~) b) : 15--20 " o 73 0.49 3.38 c) '" 2t~30 : " 9.95~) 8.17 -- d) " 31--40 '" ~ -- ~ 108.00~) 3 Ex-smokers of cigarettes with filter (total) 7.74 0.61 7.35 5.94 1.04 28.22 Source: own calculations: ~) p (Z~ > 10.8"2) = 0:001. a) p (Z~ > 6.68) = 0.01. a) p (7.z _> ~ 5.02) = 0.025 -- statistically valid differences in incidence risk in relation to (Nit) = 1.~ for those not smoking at all. authors it is sufficient to activate most probably certain virus of carcinogenic effect [9] or the precursor influence of cigarette smoke containing carcinogenic nitrosamines t!4, 18]. The data on the larynx cancer risk in ex-smokers may partially confirm ae~e su¢ m arisen ~ath natives or ml rants nonsmokers g~estions (Table 5). In co p " " ." "g , ". , ~X-smokers of those populations have higher incidence risk (Table 5). In both po- Pulations, there are Categories of smokers who had smoked for one year or Several Years in the past. and stopped smoking a few or several years before ~he larynx cancer was diagnosed. These observations need to be furthe~ analyzed. 1 The native and migrant Upper S1lesianssmo-king pipe or cigars, have higher a.ryax cancer incidence risk than nonsmokers. Among the native population smoking P~pe. the incidence risk was 11.7 and in those who smoked cigars 255.4 (Ze >_ 10.82, ~. ~ 0.001). On tile other hand. among migrants, the pipe smokers, the risk ,,'as 27.1 ]." ~ 6.63, p = 0.01), and cigar smokers 27.0.

470 ZEM~,A, WO~CIESZEK Table 6. The relative risk (RR) qf lar)m._x cazmer in male populatiorm (natives and migrants) in re]at.ion to the character of their work and exposure to dust and gas pollution in mioro- environ.men~s of work Natives Migrants The character of work and hazards - Dis- _Con. Dis- Con- ea~ed trol (I~R) Z2 trol eased group group (RR) Z" ManuM workers, not. exposed to dus~ and gases iu their environment of work -- %Vhite-eoll~r workers (nor exposed 17 to any air pollutants) 3Ianual workers, inhaling dusts and gases intheir microenviron- 147 meats of work 49 1.00 -- 6 40 51 1.17 0.14 i3: 97 301 1.71~) 2.87 75 1.00 -- ~ 0.89 0.05 201 2.49n 4.18 ± Total 178 401 Source: own calculations. ~) p (Z-~ > 3.S4) = 0.05. ~) p (Z~ ~ 2.70) = 0.1 -- statistically valid differences in relation to (RR) = 1.00, = The pipe and cigar smoking was often connected xdth the lip or other mout.h organs cancer incidence [40, 41]. The data obtained from the present study show that the pipe or cigar smoking has also importan~ influence on the larynx cancer risk. Irrespective the place of birth (both natives and migrants), the men who do manual work and i~hale in Qxoir cantonment various industriai dusts and gases. ~re characterized b~ higher lar.~mx cancer risk (Table 6). The white.collar and mammal workers working in better conditions have low larynx cancer incidence risk in com- parison w~th the group presented above. This phenomenon has been confirmed by literary d£ta. Before the brynx cancer was diagnosed, the majority of the investi- gated population has been exposed to various factors irritating upper respirator)" ways [1.5, 8, 15, I6.26.28, 37]. Among immediately, exposed native and migrant populations, some professions dominate (Table 7). Lar)mx cancer was mostly diagnosed in coal-miners (inhalation of various fractions of c0£1 dust, stone dust from waste rocks, and the mixture of af~rshot gases), then in :other professions, exposed to inhalation of me~al dusts (of iron. steel, cast iron, ~ine, copper and lead) and to inhalation of metal oxids. free silicon dioxide and irritating gases during the process of welding. Iron and stvel metallurgists and coke makers were immediately exposed to various pollutants like: dusts, vapors, blast furnace gases and coke-oven gases. There was also a aurae; 2 ::.7 ~2:'~',_~• ,~F ,qr~x-or.~ xvhC~ inhaled combustion gases of oil-pe~rol engines, and ofte~ were in touch with greases and minera~ o~[~. - " ~_ In the group of other professions (most often 2--3 cases and even less) different pollutants were identified in their places of work such as dust and vapors of synthe" ~ic plastics, dusts of flour and mould, cement, lime, asbestos, plaster, glass wool. Table 7. Su Occupation Coal mine "Workhng ( Stdei me~ Car drive~ Others TotM ~ouree: O r,,ofers. ~) Tog. aluminium tic glues, It ha, migrants t several 15 to 2(~ The mentioned the coal-m apart dioNde (2 vanadium Paeumoeo oNde and fl~wnee pa aeeted a lot of co The to the and gases For t of Work p Popul~tio~ dis~rsion Values. 0 ~ nOSed, eh~ %0th nati men in w ~anv tim

and migrants} ition in micro- igrants ~p , 1.00 -- 0.89 0.05 THE EPIDEMIOLOGICAL RISK FACTORS OF THE LARYNX CANCER 471 Table 7. Structure of occupation of natives and rnigraa~ts men with larynx cancer immediately exposed to industrial dusts and. gases in their microenvironments of work Occupation Migrants Number Number % of eases of cases Coal miners 45 30.6 15 20.0 ~Vorklng on metals treatment1) 39 23.1 12 16.0 Steel metalurgists and coke makers 23 15.6 5 6.7 Car drivers and mechanicsz) 3 5.4 11 14.7 Others 37 25.3 32 42.6 Total 147 I00.0 75 I00.0 2.491) 4.18 ~ -- statistically mouth ~t study show la~nax cancer men who do sts and gaseS. ar and mannal .e risk in eom- coaf~'med by of the investi- er respirator" me professions ers (i~halatio~ he minute of ,f metal dusts f megM oxids. Iron ~nd st~l )us pollutants s ~lso a nes, and le~) differe~t )ors of sx~th~" ~r. glas£ Source: own calculations. ~) Welders, fitters, turners, machine millers, grinders, blacksmith~, reefers. ~) Together with drivers and mechanics of other machines. aluminium sulfate, color pigment, artificial fertilizers, wood asphalt, and also s3n~the- tic glues, organic solvents and various acids. It has to be mentioned, that out of 222 larbmx cancer diseased (natives and migrants together), working in dangerous conditions (Table 7), 98.6°/0 smoked tobacco several years (tmtil cancer was diagnosed) and the number of cigarettes varied from 15 to 20 per day. The existing literary data on the subject [6, 26] concern mostly professions mentioned above (Table 7). The fact of ~equent occ~rence of lars~ cancer among the coal-miners must specially be emphasized. The coal dusts of Upper Silesia mines, apart ~om the basic constituents of coal, co~ist of certain quanti~ies of free silicon dioNde (2~15%), anffmiaute quantities of su~, selenium, beryllium, zinc, Nckel, Vanadium, manganese and chromium._The miners of these mines often suffer ~om Paeumoconiosis and emphysema [35]. But coo~ragion of coal dust, free silicon di- 0Nde and aftershot gas~s (maiMy ~xt.ure of Ntric oxides) is also supposed ~ a lot of comprehensive; extensive anMv~s should be conducted. The value of the increased l~rx~ cancer risk can ~lso be calcNated accor~ng to the duration of work ~thin th~ ~re~ of immediate ex~sure to ~dustrial dusts and ga~s. For the group of natives working i~ ardous condition, on the average 33 years of Work ~assed, before ~he lar~ eance~was dia~osed. On the other hand, in ~Pulation of ~graats, this l~sted for 2~ years on the average. The coefficients of aNrsion: 34.4 and 34i% (Table 8) attest relatively low deviation of the mean values. Out of the diseases recorded in patients before "the larsmx cancer was diag- Onal, c~onic~ammation of uuuer resuiratorv tract may be of importance among • a natives and ~grants. The high lar3mx cancer incidence risk also concerns ~en in whom to~ilectomv had been ~fformed and in men who suffered (once or ~any times) from bronchitis, pneumonia, tuberculosis and emphysema (Tabl~ 9). 0

472 ZEMLA, WOJCIESZEK Table s. Average value (in years) of the length of work for natives, migrants and control groups inri~k conditions (dusts and gases) ,Nat ires Migrants Mark ~ ~ Diseased Control group Diseased Control group (:~) 33.1 30.7 27.3 28.2 (S) 11.4 i0.2 9.3 9.6 (= m) 31.1--34.9 29.5--31.9 25.2--29.4 26.9--29.5 (c) 34.4°,0 33,2% 3~.1% 34,0% Source: own calculations. ~) See Table 2. T~ble 9. The relative risk (RR) of larynx cancer in male populations (natives and migrants) in rein.rich to past, diseases ~atives 5Iigran~s ..... Mark .... ; (RR) y.Z (RR) Z* ~N~t suffering fl'om any of the 1.00 -- 1.00 -- following diseases 1 Chronic inflammation of tl~e :~pper 35.19~) 131.66 6.99n 35.52 respiratory tract 2 Pneumonia (of nonspecified 6.91~) 38.79 2.12~) 4.21 etiology) 3 Emphysema 3.75s) 2.97 (Y) 2.65 4.2 × IO-~(Y~ 4 Tuberculosis 10.24~) 17,13 (Y) ].18 0,05 (Y) 5 Bronchitis -- acute or chronic 13.65~) 19.49 (Y) 6.61a) 6,53 (Y) 6 Bronchial asthma 1.02 0.1 (¥) 1.18 1.4 × 10-a (Y) 7 :Hypertension 2.42*) 5.01 2.02 2.28 8 Diabetes 5 0.62 1.2 × 10-a {¥) 0.76 0.06 (Y) 9 Stomach Ulcer 2.66*) 8.23 2.04~) 2.76 10 Duodenum ulcer 2,66*) 4.88 2.i2 1.27 {Y) 11 Tonsilectomy 7,44*) 4.48 15.88a) 5.8 (Y) 7 Source: o~ calculations. ~) p (Z'* 2 10.82) = 0.001. ~) p (Z~ => 6.63) = 0.01. ~) p (Z" ~ 5.02) = 0.025. ~ 12 ~Z2 ~ 3,84i = 0.05. ~) p (Z~ ~ 2.70) = 0.i -- statistically valid differences ~-relafi0n to~RR) = 1.00. (Y) -- Yates correction to PearsOn's test with number from 5--10. Out of very few reports on this subject [7, 32] it may be assuaned that especiallS chronic inflammation of the upper respiratory tract may have important influence on the frequency of larynx cancer incidence, wha¢ has also been confirmed by the present analysis. On the basis of our analysis the following conclusions can be 1. The ~.valuation of the larynx ca'ncer incidence risk in a population sorted according to the place of birth is useful since new epidemiological factors concerning cancer incidence of this organ (and most probably not only of this organ) can be revealed. 2. The higher larynx cancer incidence risk is connected with smoking cigarett:: (with or without filter), pipe and cigars, but correlation of the obtained data (o flwther ana dus~s and g 3. Pro} of work in~ crease is an, migra~nts w, 4. Int may be con diseases lik, [1] BLot, ~V. New [2] BRESLOW. Of Ca~ [3] Cancer [4] Cancer of [5] CEODV: chs [6] faro [7] nee 197 J.t . [9] me] 196. scri [12] GADO~f~ On [13] and 205 [14J [15] [16] Bis. epic up. [18J ff~F(' [19] Jaz~Eas

and control groups Control group 28.2 9.6 26.9--29.5 34.0% "es and migrants} 35.52 4.21 4.2 × 10-'( 0.05 (¥) 6.53 1.4 X i0-= (~') 2.28 0.06 (¥) 2.76 1.27 (Y) 5.8 (¥) ).01. ~) p valid differer~ceS from 5--10- hat especially ant influence irmed by the an be lotion sorted rs concerning rgan) can be ng cigarettes ~ed da.ta (o~. THE EPIDEMIOLOGICAL RisI< FACTORS OF THE LARYNX CANCER 473 further analysis) with other risk factors (e.g. diseases suffered, exposure to industrial dusts and gases in microenvironments of work) is necessary. 3. :Prolonged inhaling if various gases and industrial dusts in microenvironments of work influences the increase of relative risk of larynx cancer (~Ithough this in- cre~se is most probably caused by tobacco smoki~'g, because almost all natives and migrants working in such conditions smoked tobacco). 4. In the analyzed populations the increase in the larynx cancer incidence risk may be contributed to chronic inflammation of the upper respiratory tract or other diseases like pneumonia, tuberculosis; emphysema or bronchitis. References .~[Ex~, J. :F.: Lung cancer after employment in shipyards during World War II. New Engt. J. Meal., 299, 1978. 620. [2] BaEs~.ow, .N., D.~-, N. : Statistical Methods in Cancer Research. ¥ol. 1. The Analysis of Case-Control Studies. Lyon, IARC 1982. [3] Cancer Incidence in :Five Continent~. Lyon, IAI~C 1982. [4] Ca~acer of the larynx. In: The Health Consequences of Smoking. Cancer. A Report. of the Surgeon General. Rockville, US Dept. Hlth I-]:uman Serv. 1982. [5] CaoDx'..-~c~, S., GL~gZXE~S~-<, E., Tw2Az, sx.~, M., H~SS.'~N.~', E. : Epidemiological characteristics of pa~.ients with l~ryngeal ca.ncer and precancerous conditions. Otola~mg. pol., .3=1, 1980, 377. (In Polish.) [6] C,~oDy_x~cl~[, S., Tb-~ALs:~, M. : Effects of tobacco smoking and other irritating factors on the larvngotracheal mucasa. %Viad. lek., 32, 1979, 299. (In Polish.) [7] F~z.~)~, S.: T~o.~-cz-~sm~, ~., Dyz~, S.: Epidemiology of malignant laryngeal neoplasms in the L6di region in the years 1967--1974. Otolaryng. pol., 31, 1977, 499. (In Polish.) [8] F~h'DE~S, ~V. D., RoTa.~z-~-~r, K. J. : Oecupdtionat risk for laryngeal cancer. Amer. J. publ. Hlth. 72, 1982, 369. .[9] FLm~cm~, C.: Carcinom~ ~f bronchus. Lancet, ~g18, 1965. 900. [10] O~oo.~s~:.~, H.. W~o=~xo~s~. Z.: Epidemiological assessment of incidence and mortality due to laryngeal malignant neoplasms in Poland in the years 1963-- 1969. O~olaryng. pol., 27. 1973. 593. (In Polish.) [11] G~oo.~s~<, H.: Cancer incidence i:n Poland, 1975--1979. Warsaw 1982. (Manu- script.) [12] G.<~)o.~s~_~, H.. Vf~0~]~ows~, Z., TA~KOWSKL W.: The incidence and mortality on the malignant neoplasms in Poland in the years 197(>--1980. Warsaw 1982. G {Manuscript.) [13] OLDS~[~, J.: The "urban factor" in the cancer: Smoking. industrial exposures. and air pollution as possible explanations. J. Environ. Path. Toxicol., 3, 1980, 205. - [14] H~:OHT. S.. CHE-~: C.. ORN_4.F.R., ~r'~OFF~.N-N'.. D. : Chemical studies on tobacco smoke. LVI. Tobacco specific nitrosamiffes: Origins. carcinogenicity and metabolism. Lyon, IARC Sci. Publ. 19, 1978. ' [15] H~I,~.~ROAL, G., L~h'DHO~.~. C. E.: Larsmgeal cancer and asbestos. Oto-rhino-!aryng., 42. 1980. 233. [16] H.m~{~.~, G., ~o~', E. : Occupational and bronchial carcinoma. Scand. ~. resp. Bis., 60. 1979, 76. [17] H~.<~A.~[A, T.: Smoking and cancerfin Japan..-k prospective study on cancer epidemiology based on census population in 5apart. :Result of 13 years follow , up. In: Th~ UICC Smoking Control Workshop. The Univ. ~Nagoya Press 1982. [18] ~lor~.~L~.-,-_~-. D., H~C~% S., On~'z'z, :R., YV~xz)~, :E., Tso, T. : Chemical studies on tobacco smoke. LX:[I. Nitrososarnicotine: Presence in tobacco, formation and carcinogenicitv. LV0n. IARC Sci. Publ. 14. 1976. [19] g~z~sx~. R. J.:~ La~,yngeal carcinoma in miners. Zdrov. publ., 87, 1976, 907. [20] ~ (In Polish.) ~OI~(;E.~SEN, K. : LaD'ngeal carcinoma. Acta Radio]. Onco]., 18, ]979, 281.

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