Tobacco Documents Online

,vosal'COll~ 983, 70. qr~,vosarco - 'th. Amer., ~ed clinical ancer, 35, ,ma of the 2810. "coma and years ex- ..e survival • 49, 1982, h systemic ,~ patients ncer Inst. NEOPLASMA. 34. 2, t987 Larynx cancer risk factors* B. ZE3iL.~, N. DAY,z J. ~AVL4eT_N'ICK.4.,2 1~. B,kh-_~SIK Cadaver Epiderniology ['~it. I~stitute of Ontology, dJ-lO1 Gliwice, Poland; ~Internationa~ Age~cy for Research o,, Ca~cer, Lye,, 2~rance; "-Teleradiotherapy Department, I~stitute of Oncology, 44.101 Gl_iwice, Poland Received 3-anuary 2, 1986 The larynx cancer r.elative risk has been evaluated (328 cases) in the stationary-native Upper Silesians (63.7%) and migrating (36.3°0) male po~ttlation. The' particular control groups (656men) included 418 and 238 men respectively not s~fffering from malignant neoplasrns: - The essentially highe~ ~arynx cancer incidence risk has been shown for men manual labor and exposed ~o the influence of various dusts, gases and vapors and o~:her pollutants in their place of work. The increased substantial iucidence risk is also true for men who smoke tobacco and are professionally exposed to the pollution. The results in regard to ~he consm-nptio~ of raw and boiled veget- ables suggest that these may be inhibitors of the neoplasmatic process in the area of larynx (although not only). The frequenSy of the consttmp~ion of alcohol -- vodka or beer -- increases the la~'nx cancer incideuce risk bo~h among autochthons and ira.migrants..%-evertheless, the d~ta concerning the amount of alcohol consumed are less valuable here; zhey do not allow to establish fully reliable quantitative levels of the beer or vodka consumed. In comparison with the literature of ~he subject, divergen~ data have been obtained as far as the joint, influence of drinking alcohol with simultaneous smoking of tobacco and professional exposure are con- cerned. Key words: Larynx c~ncer~ risk .relative, autochtlmns, ~'mmfgra~ts, tobacco smelting, occ~pational ha=ards, diet, The trends in larynx cancer incidence observed in ~he available literature are characterized by d3mamie progression. This eoncenrs both registers for the whole countries, and particular registers within their area [11, 17. 18]..N'evertheless, it is possible to observe stagnation in the incidence [20]. Trends in the lary,~x cancer mortality are also increasing [1, 18, 24]. * The project was supported by funds partly provided by the International Cancer Research Data Bank Programme ~of the ~National Cancer Iustitute, R'~itional Institutes of Health {US), under Contract ~'o. ~NO 1-CO -- 65341 (Inter~tational Cancer Research Tectmology Transfer-ICRETT) and partly by the Inter,rational Union Against. Cancer.

224 ZEMSA, DAY, SWIATNICKA, BANASIK The present analysis is an attempt at more complex evaluation of the larwnx cancer incidence risk, in two separate men's populations selected according to'the place of birth and other factors (i.e. migrations, the character of the place of living, diet, exposure to air pollution in the place ofavork, tobacco smoking and consumption of alcohol). Haterials and methods Ill the )'ears 1980--198-1 the questionnaire data relating to tobacco smoking and alcohol consumption, the history of professional hazards, the place of living and diet before the larynx cancer was diagnosed have been obtained for the group of 328 men suffering from this type of cancer, who called ~he Institute of Oneology in Glixdce (southern Poland, Kato~dce province), for the ~st time for treatmen~ purposes. Out of fl~em 97 ~ could be evaluated 3~ were left out due to ~dem~onghtly data. ~ze contrastive control group .was made of 656 men not suffering from neoplastic diseases. Out of ~he 328 patients ~nd 656 controls, two subgroups were made depending on the place of birth: autochthons, i.e. native Upper Silesians, who in the majority of cases (93~ of patients and 90.5% of controls) have not changed their place of liv- ing and have been exposed to permanent influence of the air-pollution of industrial and municipal character (in relatively large amount), ~nd the remaining men (7~ and 9.5~, respectively) although ~grated, but only ~thin the area of the highly industrialized [29] Upper Silesi~ (Fig. 1), in whom no improvement in ~ir pollution conditions in their new place of living has occurred; i~grants,the majority of whom / / ":~ ',',,'~" "/,"}~ ~ voivodship / '.v.:" .':.">~,:'"z'~::".M.~ "" l" .,. --~ -- / ~~~.;:;>, ..,,. ..... atow ce v -~ ~~~.4~ .... ...... -- ..,.v..~~',~-.. ..... ~...'-~ / ~,.";t", '~"::Y, :~v':ZX I Balik Sea / . ~..: z~..-.'.. ,+ xc.. Czechoslovakia "~ / / Bielsko-Biata v. ,/~/7/, Poland Upper-Silesia k ~ > :(shoded urea) Fig. 1. L'pper Silesia ind~txisi-~b&n ~rea. the eonCempoeaw boundaries of Polish voivodship. -- ..... -- the et~c and historical bondages of ~ppe? Silesia, /~///inSust.ri~l-urban ~glomet~ign ~ea of gppe~ Silesia, : : : : : : d~s ~n8 g~es e~s- mon in tons pe~ square ~/y (4t ~nd ove~). ~ has been worked o~g ~eeording to 8o~fl Afl~s ~olski (~olish National Atl~s). ~, 197a--19~8, gd. St. Leszezyeki. (ab pol pla pol for star ~> and ~ II' pO sn of ris di~ ch in co In %-( n] o o~

the larsmx ling to the • e of living, ,nsumption ~oking and tg and diet of 328 men 'in G1Ldce purposes. ~htly data. neoplastic depending e majority lace of liv- industrial men (7o/0 ~he highly • pollution oundaries er Silesia, ~ses emis- to Naro- czycki. LARYNX CANCER RI~K FACTORS : ~.5 (about - o, 60/o) settled in the area of Upper Silesia (Fig.)) in the period after the World War II. is a result this population was exposed to the influence of the industrial pollution for ~ shorter period of time. It has to be Stressed that these migrants origi- nated in majori~,V {80°.,o) from villages in various parts of Poland. The analysis of the relative larynx cancer incidence risk (RE) depending on the place of birth, kind of tobacco ~moked (cigarette, pipe, cigar), the character of the pollution exposure in the microenviro~maent of the place of work and di~t has been made according to ~IANTEL-~-[.a, ENSZEL [2], applying the Pearson Chi-square test for statistics. The average work time in arduous conditions has been evaluated statistically, taking into consider..ation standard deviation,. 95% confidence intervals and coefficients of dispersion. Results Out of 3281a.nalvzed larynx cancer cases, 209 (63.7%) were au~ochthons, and 119 (36.3%) immigrants. The corresponding control group to autochthons were 418 men and tgimmigrants 238. men. All suffering from larynx cancer cases were confirmed by histopatology. :For both populations epidermoid carcinom) w_as decidedly dominant, as compared to relatively small number of other types of cancer. The population of immigranfs born and living until the migration in the villages of various parts of Poland is characterized by the highest larynx cancer incidence risk. Nevertheless, no statistical difference was found in relation to the incidence risk (1~1% --= 1.00) of the native Upper Silesians population. The lower larsnax cancer incidence risk characterizes the immigrants from various to~as in Poland (statistical difference in relation to the autochthons), who lived in tm~-ns from their birth before they migrated to Upper Silesia. and immigrants from the tm~-ns and villages who changed their p_lace of living once or many times before they settled in Upper Silesia (Table 1). Out. of the 119 immigrants Suffering from larynx cancer, 84 (70.6%) were born in villages in various regions of Poland, including also inhabitants of former eastern territory of Poland before World War II. Out of the :238 men from the control group I33 (55.9%) comg from the villages too. A great majority of the patients and for the controls migrated to Upper Silesia after living (from 16 to 30 years) in the country. In turn 26 patients migTants [21~8%) were born in small and big towns of Poland and so were 73 controls (30.7}/0). Before the migration to Upper Silesia these popula- tions lived in their place for 14 to 26 ~-ears., Out of the total number 7.6°~,,o of patients and 13.4% of controls were multiple migrants (Table 1). The average age of the autochthons was 61.0 years, and of the migrants 54.2 years (statisticMly significant difference). Out of the 209 l~rxnax cancer l)ationt~ ant~ehthon.~. 187 (g.q.5°~ migrants 115 /96.~5°,,o) were Smokers and the time of smoking tobdcco varied fl.om a few to several years. In the control group of the autochthons, the tobacco was smoked by ~9.~ ~o men out the total number of 418, and among 238 immigrants was 89.20,.0. For both populations 92.1% of the patients and 83.1. °o of the controls were smokers. Both autochthons and migrants smoking cigarettes (with or without filter), being analyzed separately or as one population show higher, most often statistically si~fifieant larynx cancer risk factor in comparison with nonsmokers (Table 2).

2.°6 ZEM5 ~., DAY~ SWIATNICKA, B"N.~SIK Table 1. Larynx cancer incidence risk in immigrants (single migration) born in the country and in ~owns in differon~ parts of Poland and in men migrating repe,~teclly (i.e. mo~o than once) from various villages and towns in Poland, before settling down ia the area of Upper Silesia in comparison with%ubochShon~ Autochthons l_mmigran~s ravel or urban rural population urban popttla~ion po.pulation migrat- migrating to L'pper migrating to mg repeatedly Silesia Upper Silesia before settling (single migration) (single migrationt ~lo~-n in Upper Silesia num- num- am- num- ber (RI~) her (RR) Z~ tmr (RR) ~ bet of of of of cases cases C,~se~ , ~ses Patients suffering 209 84 26 9 from larynx cancer 1.00 1.26 2.06 0.71a 1.95 .0.56a 2.27 Control groups 418 133 73 32 Explanation: a- p(Z~ >_ 3.82) _< 0.05- statistically essentiM 4.ifferenees in relation to (RR.) = 1.0o. The prevailing number of tobacco smokers wore cigarettes smokers both in the autochthons and the immigrants. The average periods of smoking cigarettes till the larynx cancer diagnosis was 35.1 years in autochthons and ~3.6 years in immigrants, with the age ranging from I5 to 6i years for autochthons and from 7 to 60 for immigrants. Both autochthons and inunigrants working as manual workers and [abating in t heir place of work various dusts and gases of indus%vial origin can be characterized by a higher incidence risk of the larynx cancer in comparison with people who have never been exposed in their profession to this type of industrial pollution. The pa- tients -- both autochthons and immigrants -- have been working in unwholesome conditions for a few or many years (in average 28.4 for immigrants and 29.6 for au- tochthons) before the larynx cancer diag~nosis (Table 3). In the pgpulation of autochthons the highest incidence risk concerns workers who have been constantly exposed to inhalation of multifractional dusts (Table 4) from various materials used for installation and isolation, trinitrotoluene, asbestos, plaster, cement, lime, brick, leather, fertilizers, silicon, iron ore, quartz, coke, sulphur, _ aluminium sulfate, abrasives, various powdered chemical compounds: wood, stone dusts of various mineral composition, but most often coal dust and dusts of various those people who ~re expos~ to the composit~ influence of gases ~ad dusts in ~hdr place of work (Table 4) mostly coal miners, who have b~en simultaneously exposed to the multifractional dusts of coal and stone as wall ~s afterdamp gases. ~igher incidence risk has also been observed in autochtho~ who ha~e been exposed to the inhalation of dusts and vapors, bu{ most often of pawder~ pMnts and glues together with diluents.

Tablo 2. Auf, oeht, hons (a) I mn~igrant, a (i) Togot.her (a) + (i) "smokers of cigarof~fsos wit.h flit, or -6 f~imes a day -3 cigars a day ; • obt.osi and. ,piil/~ "i i , ; 1.0'0 2.55a 2.41o' 2.92i~ 2,55 2.90 0.till ;I.54 IJ 9.66i; o.o~ ] 1 ii,73 5,00 13.03 5,;13~ 9.1t4 ;I.08d l 1.~8 11.47 ,.i: " k06 7.4~ ~: 0.81 6.8(ff. " 10.4l ll,10t ~.~. 2.95 !0.28. 7.8( 11.95 .0.15. 1.00 3,01ti 3.2011 2.82 3.07 3.24 2.59° 2.56o 17.08b 24,14 24.55 '- 12.63 ; 12.(16 21.95 18.82 7.33 5.11 16.24-~" , . 0.81 '%:, 0.72~"" '~'" o~oni, ial 4i ffol~ Table 3. ~tia: a~p(2:l >__ 10.82) < 0.(i01, i,_ p(x~ >_ 6.63) .< 0.01, <*--p(X~ _ 5.~12) _< 0.025, d---T)(g:~ > 2.70) < (I,!- sl>at.ist, ically cos in rolafioil t~o (RR) = 1.00; Y -- Yate's coi.i'ocf, icln if t, ho OXl)OC/,ed valties are loss f~haix 5. ,x cancer incidence risk ia ~ubochfllolls ~nd immigrant,s in rokf, ion t~0 file :~ypo of work and exposure 6o dlmb and ~aso~ in bho plaeo of work Those xvho wor~ ~ovor oxpossd ~o any pollution in tho plae(~ Aul~ochthona (a) Immigrant~ (i) Together (a) + (i) ill conh'o| ill con~ol ill conlrol 209 418 (R~) Z~ ]19 238 (RI-¢) Xt328 656 (~R) Z~ 31~ J381 1.1)0 ~ 25° 81l) 1.00 -- 56 219 1.00 ,)fw,irk (concer, i both manual workers and whlt.o collars) Maiuitd w~irh~l';, ~Xl)~sed. Lo throb and gas~ ill pl~ i*f wi*i'k 177 I. v Nllliinitiiual Wli :e~ ll'hll worked in the con(Ill,ions ~)f 1 274II 2.88'~ 2,l.I 93°° 1431t) 2.11l~ 8.1 270 417 2.53a31.4 6 0.74 0.115 %" I 14 0.23 1.I~ t" 2 20 0.39 1.01 ~-" correction to ~( Aufl~eht, hons Immigrant~ ¢ + the spali of workiilg fimf~ (ill y;ars) 16---50; ~." W 34.7 + ~" 6~fi4; ~ :.= 28.4 ~ i 1--59; 5 = 32.0 ii 6~(i(i; • ~ 28.6 oo 9~57 ; • 29.6 2~50; 5 ~ 33.8 2~56; • ~ 29.5 : 10.82) ~ 0.001, b ~ p(Z~ ~ 6.63) ~ 0.01 -- ~t, lst, ie~lly relo~n~ difforene~ h rd~fion ~o (~ = 1.00; Y--~'~ r~o~'~ ~e~ ~i~h ~ber from ~10. , I

'rabl c 4. Larynx cancer incidence risk in auh,cht,hons and immigr~nl,s in relation to t,ho t,ypo of exposure (only fer mmtual wm'kors) ~ Mark Augoohthons (~) Immigrant~ (i) Togct.her (a) -F (i) ill control (1~) gs ill con$rol ill control (I~) 209 418 119 238 (~I~) g~ 328 656 ~ g~ Never oxp, med 1~o any kind of pollul.iort in the place of work O~nu~l and nonlnanual workers ~ogot,hor) htan,,M w,,rkors eonsl~anbly expend t,o tim influence of dus~ ~[~nual workers eonsSanOy oxpo~4 t,o l,ho influence of gases Manual worke~ const, antly exposed to tim influence ef vapors Mtmual workor~ constantly exposed 1,o tim influence of dus~ and gmses toget,tmr Manual workn~ constantly exposed t.o ldm influence of dus~ and vapers togot,hor 31 138 1.00 -- 25 81 1.00 -- 56 219 1.00 -- 6{i 84 3.50a 24.72 40 44 2.95a 12.03 106 128 3.25a 36.23 8 23 1.55 6.93 13 15 2.81c 5.65 21 38 2.16¢ 6.35 2 7 1.27 0.02Y 9 4 7.27b 9.69Y 11 11 4.27a 12.19 86 131 2.92a 20.38 26 62 1.36 0.88 112 193 2.27a 18.8[ 15 29 2.30° 5.1 l 5 18 0.90 0.04 20 47 1.66 2.81 EXlfl,mafions: a __ p(g~ ~ 10.82) _< 0.601, b __ p(Z~ _>. 6.63) :_~ 0.01, o ~ p(ga ~ 5.02) ~ 0.025 ~ statistically rclovanb difference in relation t,o (RI~) .- 1.00; Y - - Yat,o's correction I,o Pore'son's l,esb wit,h nundmr fl*onl 5~10. Taldo 5. Larynx cant,or incidence rink in tudoehl,hons mad immi~ant,s in rohd.ion t.o combined influence of cigarot,l,o smoking and pollul.it*n ctut~d I)y dusb and gases in tim phmo of work ~ Autocht,hons (a) Immigrants (i) Toget,hor (a) q- (i) 2~[ark ill con- (1%I'4) Z~ ill con~ (~1~) Z~ ill con- %rol ~rol ~rol Nonsmokers and bhoso who wore nob cxp,mod in tim pla~o of work 6 24 1.60 -- 2 15 1.00 -- 8 39 1.00 ~ Sm,,k~rs of eigarol,~es (wi~h or without fill,at)~ and immedia[oly o~osod in t,ho pl~o of work l !0 196 2.24e 3.07 80 125 4.80b 5.01 190 321 2.89a 7.64 l'ip, or cigar mnoko~m (or so called mixed mnokors) ~md immcdi~ly exposed in bho phmo of w~,rk 12 29 1.66 0.79 5 7 5.36Y ~.0 17 3~ ~.36~ 3.01 ]~xphuwAiion.~:!' ~wiLhoul~ox.smokers; a .... p(x~ > .... 6.63) < 0.01, l*---p(:Z~ _~_ "~ 3'.84) _< 0.05, c~(g~ _> 2.7) ~ 0.1--s~a~isi.ically. ro- levan~ diftbroneo in foist,ion to (1~]~) = 1.00; Y -- y~to's eorri'.clfimt ~o "Pearson's l.ost, with ntlnlber h'om 5---10. l...,'ynx ,',u.'or incid,,,ne,~ risk in aul.,,chl,h, ms and imnfi,~,'an,l.s in "oh~.t,i,m I,o join/, infhmnc,~ of t.wo Ik~.l,o,.s: smokiing and drinking Atfl,,mhtho,,s (a) ill |,,',,1 (1~1{,), J.nnnigranl~s (i) T,,gct~h¢(r (~) -F (i)~ ill con- trol ( I?~ I~) ..... '

I mmigra~nt, s (i) e,,,~- (1~1~) ;t~ ill (I.~1~) ,~ -ill (l~I~) ill t r,~l Lrol 14 1.0o , - 3 1o l.OO --- Io 24 1.00 -- 20 0.8(| (). 1 .'] ,q 16 1.67Y: 0.08 16 36 0.56l) 3.10 9 1.5Ii t).42 2 5 1.33k" 0.07 9 1~ 0.81 0.21 5 0.~t0(" :0.02 I 2 1.67Y 0.14 2 7 0.36k" 0.92 39, l.TIV~O.186 i64 ~ 116 0.70b 3.05 45 1.85Y 0.32 64 , 122 0.66• 4.01 I",Xl)10,mzi,it)tas: t~ ~ I)(Z,a ~ :1.84) "~ l~.l)5, l) . . I~(Z'Z ::. 2.'~) • " 0.1 - sl,~l,ist.i(.t~ll.v" relovattl; difforotteo in xa~lt~.tion ~o (1%]-¢) = 1.00; V • - 'l't~h Io 7. L~,r3r~lx etrtt(,er it~t;idt~tee risk in e.tl|,ot~ht~h¢)lls al'~d immigr~t~tbs itt ral~),l;ion I;~ .i,,i~t, i~flttoneo of Lwo £aet.ors: exposed, t,o cItmt, ~,nd, ga,cv'.s itt ph~,¢i~: ~f work ~,tid alt!ohol drinking Mark Aul;oeht, h,~ns (a) Immigrantz~ (i) Togel~hor (a) + (i) ~ ~ ill co,t- (RR,) X~ ill con- (~T'4) Zz ill con- t, rol trol trol" 'l'h~s~ wh~ ~tovo.r dri~k t¢le~hol (absf, t~inet's) a, nd who ~t'~ n,~t, ~Xltosed t¢~ (hls,~ =end gases in place of wnrk 10 14 1.00 -- 11 7 1.00 ~ 2l 21 l.O0 -- "l'h¢~ao wh~ (trink v¢~tik~ oee~ion~lly a~d xvh[) ¢,Xl~s~'d t,o dttsl, at~d gases itt place of w~rk 47 91 0.93 0.03 25 48 0.33 4.36 72 119 0.66 1.45 "l'h~m~ who d~'i~)k more oft, o~t and who t~rt) ~'xl~sod I,(, [.htsb and g~e8 in place of work 9 27 0.47 1.85 7 20 0,22 5.57 16 47 0.34a 6.68 ".1"1~" wh~ dri~k vo~lk~ and beer fl.om oee=~sionnlly wh~ =~ro (~xp[)sed ~o (lu~ a~=¢l gas(~8 i=t pla(~n of w~rk 40 79 0.71 (I.57 19 31 0.39 2.87 59 110 0.54e 3.25 'l'h¢~st~ xxrh<) drink vnclka anti b=~,er mora oxi>~s~,~t to dtts+ a~ad gases in pltreo of w<~rk 34 79 0.60 1.22 24 45 0+34 4.12 58 124 0.47b 4.91 Explav~al~iot~s: r,_ p(z~ > 6.63) < 0.01, b_ p(zz ~ 3.84) _< 0.05, e __p(z= > 2.7) _< 0.1- sl~at, ist, ieally relevant; differences in relation t.o (i¢R) ~ 1.00.

230 Z~MLA, DAY, SWIATNICKA, BANASIK ~ the population of immigrants the highest larbmx cancer incidence risk has been observed for the men _w_ho.__have been exposed in their place of work to the influence of the vapors of sulfuric acid..- hydrochloric acid and nitric aSid. The essentially higher incidence risk concerns also those patients who have been exposed to ~he immediate influence of dusts, the most common of which were the coal dusts, stones used for the house building or road building purposes Of various mineralogical composition and also the dusts of various metals (especially so called nonferrous met.Ms) (Table 4). Comparing such factors like tobacco smoking and simultaneous immediate exposure to the air-pollution (dusts, gases, vapors) in the place of work, essentially higher lar.~mx cancer incidence risk has been observed than in people who have never smoked tobacco, or have never had any contact with poisonous or acrid substances. The incidence risk is higher for population exposed in the place of work to the in- fluence of the above mentioned factors and it is not important whether the per.son in question smokes cigarettes_,, pipe or cigars. What is important is the fact of smoking tobacco itself (Table 5). Relation between the larbmx cancer incidence and the diet has not been investi- gated thoroughly yet. In the present, paper an attempt has been made to evaluate the influence of certain basic elements of diet {i.e. meat, lard, smoked bacon, fish) upon the lar~uax cancer incidence risk both in stationary and migratory population. These factors seem to be controversi~l. Only larynx cancer incidence is significantly lower when the consumption of dried vegetables increases. This regularity has been observed both in autoehthons and immigrants.* Larynx cancer incidence risk has been analyzed in the light of the joint influence of tobacco smoking and alcohol consumption (Table 6). The obtained data ~'ere va,riable and it is not clear whether ~ especially in autoehthons and men population in general -- the joint influence of tobacco smoking and alcohol consumption restfite4_ in :[.he increased lar~mx cancer incidence risk. The same concerns ~he joint influence of alcohol consumption and exposure ~o the dust and gases pollutior~ in the environ- ment of work. In men exposed to air polluiants in the place of work and drinking alcohol "frequently", lar~vnx cancer incidence risk is lower in comparison to the non- ext~sed abstainers (Table 7). Discussion The data obtained on lar)mx cancer incidence or risk in stat.ionary or migratory populations of men in the area of Upper Silesia, do not allow to determine objectively to what extent the conditions of the place of living influence the larynx cancer fre- quency [31] and data of other authors may also cause doubts [1, 18]. Moreover, there are regions in which the larynx cancer incidence, especially in men, is greater ~ Ch~ rural ~,rea~ than in the industrial ones [3]. There are. however, reports [23, 24] which clearly document connection between larb~x cancer me~ctence anct ~l~e penny,on- of industrial and communicationM dus~ and fumes especially in the place of living. The larynx cancer risk is essentially connected with tobacco smoking, both in Upper Silesians and immigrants, h~eve~theless, it has to be stressed that in these populations nonproportional incredse in the relative risk coefficients conditioned * Exae$ and extensive statistical data concerning this problem at the auihors. L

~.~R~NX (lANCER RISK FACTORS by the amount of tobacco smoked (especially cigarettes) during a day has been noted (Table 2). Proportional progression was proved by several authors [6, 8, 16, 18, 27, 30]. Pipe smoking or cigar smoking was mainly associated with m~lignant neoplasms situated in the area of oral cavity and lips and not with larynx cancer [18, 30]. In some ~-orks [22, 27, 31] high larynx cancer incidence risk both in the cigarette and pipe or cigar smokers was demonstrated. The very important f~otor in the etiology of the larynx can0er is the exposure to the dust and gases pollution in the places of work, as found by us in the station~ry and migrating populations (Table 3, 4). 1Relatively numerous data of other papers also confirm this phenomenon. The majority of patients suffering from larynx cancer worked in the conditions of exposure to the agents irritating upper respiratory tracts (dusts, fumes, exhaust g~ses etC.) [4--6, 9, 12--15, 17, 18, 26, 28, 31]. The studies maple on the Upper Silesian male population, point to the fact tha~ the larynx cancer incidence is most often ~agnosed ~ coat miners, tt is assumed that the coal dusts together with postshoot gases influence essentially the pathological changes in the larynx region. Of partieul~.r ir~ter~t is the fact that s~gnifieantly higher values of relative risk of larynx c~.ncer even obtained for men exposed to the dust, g~ses and vapors pollution in the pla~e of ~'ork "~'ho s~multaneously smoke tobacco (Table 5). This to support the thesis that simultaneous influence of those two negativ$ factors is mos~ probably the real re~son of the lary'nx cancex etiology [9, 17, 18]. As far ~s the relation bet~roen larynx c~ncer and the character of diet is con- cerned, not mt~ch h~s been di~overed, and the results that have been obtained do not explain those rel~tion~ ele~rly [?, 21]. In the populations of autochthons and immigrants that have been investigated in Upper Silesia, the calculated larymr c~ncer incidence risk in relation to various elements of diet gives very unclear, picture difficult ~o be analysed, especially when no comparative m~.~rials are available in the literature. Consumption ~>f alcohol also influences the larTnx c&nce~ incidence risk. Frequent consumption of vodka, in large araounts increases the relative risk, both in ~uto- ehthons a~nd immigrants. The same situation is with the beer consumption. This phenomenon has been confirmed also by the existing literary dat~ [1, 7, 8, 10, 18, 19, 25, 27]. l~evertheless, the joint influence of alcohol and tobacco consumption on the larynx cancer incidence risk has not been clear by demonstrated (Table 6). Very low values of relative risk have also been obtained for men drinking alcohol who have been simultaneously exposed to the inhalation of industrial fumes and dusts in their places of work (or in other conditions, like for example drivers and car mechanics) {T~.ble ~). ]~[~ny e~uthors confirm the increase of the larynx c~ncer risk among persons exposed to the joint influence of the above mentioned faetor~ [8, 17--19, 22, 25, 27, 30]. Convlus.ion.~. The increased larynx cancer incidence risk is essentially connected with tobacco smoking (cigarette~ x~tl~ ~ ~"!~h~u'. ~]'~;, _~J~. ~td ~g~r~, amt ~lso ;; :'~1~ ~ exposure to v~.rious pollutants like dusts, gases and vapors in the places of wc.rk. The risk is e~entiMly higher with the joint occurrence of these factors, which must be regarded as real one~ in the etiology of the larynx cancer. As far ~s t,he influenco of the cho.';~ n ¢l~.ments of diet is concerned, it is difficult ~o draw univoc~.l conclusion (alert from the consumption of raw and boiled vegetab- les) because of different v~.lues of the r~.le, tive risk: and of the lack of comparative literary d~.ta.

232 ZEMLA, DAY. SWIATNICKA. BANASIK The consumption of alcohol (vodka, beer) also substantially influences the in- creased lar)-nx cancer incidence risk, although it is difficult to evaluate from which level of the amount of the alcohol consumed, the larynx cancer incidence risk in- creases. The attempts, to evaluate the joint influence of alcohol consumption and tobacco smoking with professional exposure did not provide, in the populations of autochthons and immi~ants studied here, the results that would be similar to the data in literature of the subject.. This lack of agreement makes further thorough studies on the subject necessary. Re~erenees [21] [2.~] [23] ~ [24] " [27] 1V] [2s] " [29] " [30] [31].