April: Esophageal, Testicular, Head and Neck Cancers Awareness Month

Esophageal Cancer

Esophageal cancer (EC) consists of two primary pathological types: squamous cell carcinoma (ESCC) and adenocarcinoma, with the worldwide incidence of the first to be higher (1). Several studies have shown that smoking is an important risk factor for the development of EC, especially ESCC (2-3). The incidence of ESCC was 7 times higher than that of non-smokers in the study population (4).


1. Lin Y, Totsuka Y, He Y, et al. Epidemiology of esophageal cancer in Japan and China. J Epidemiol. 2013;23(4):233-242. doi:10.2188/jea.je20120162.

2. Jain S, Dhingra S. Pathology of esophageal cancer and Barrett’s esophagus. Ann Cardiothorac Surg. 2017;6(2):99-109. doi:10.21037/acs.2017.03.06.

3. Okamura A, Watanabe M. [Perioperative Management Team in Esophageal Cancer Surgery]. Kyobu Geka. 2017;70(8):712-715.

4. Liu, Lili, et al. “Smoking behavior and smoking index as prognostic indicators for patients with esophageal squamous cell carcinoma who underwent surgery: a large cohort study in Guangzhou, China.” Tobacco induced diseases 18 (2020).

5. Zambon P, Talamini R, La Vecchia C, et al. Smoking, type of alcoholic beverage and squamous-cell oesophageal cancer in northern Italy. Int J Cancer. 2000;86(1):144-149. doi:10.1002/(sici)1097-0215(20000401)86:1<144::aid-ijc23>3.0.co;2-b.

Testicular Cancer

Testicular cancer is strongly associated with tobacco smoking (1). The relationship of testicular cancer and smoking is plausible: cigarette smoke contains known carcinogens such as arsenic. Furthermore, smoking may modify sex hormones, which are implicated in the onset and/or progression of testicular cancer (2).


1. Song, Ashley, et al. “Incident testicular cancer in relation to using marijuana and smoking tobacco: A systematic review and meta-analysis of epidemiologic studies.” Urologic Oncology: Seminars and Original Investigations. Elsevier, 2020.

2. Smith C. J., Livingston S. D., Doolittle D. J. An international literature survey of “IARC Group I carcinogens” reported in mainstream cigarette smoke. Food Chem. Toxicol., 25: 1107-1130, 1997.

Head and Neck Cancer

Head and neck cancers include cancers of the oral cavity, pharynx, and larynx and are among the most common cancers worldwide (1,2). In the IARC Monograph, the association between cigarette smoking and the incidence and mortality of head and neck cancers is well established. Previous research has suggested that cigar and pipe smoke may contain equivalent, or in some instances higher, doses of carcinogens such as benzo a pyrene compared with cigarette smoke supporting the association of cigar or pipe smoking and the risk of head and neck cancers (3). 

A recent systematic review aiming to assess the association between the cigarettes and head and neck cancers outlined potential dangers associated with the use of the cigarettes and their role in head and neck cancers (4). 


1. Curado MP,  Hashibe M. Recent changes in the epidemiology of head and neck cancer, Curr Opin Oncol, 2009, vol. 21 3(pg. 194-200)

2. Wyss, Annah, et al. “Cigarette, cigar, and pipe smoking and the risk of head and neck cancers: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.” American journal of epidemiology 178.5 (2013): 679-690.

3. International Agency for Research on Cancer, IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Volume 83: Tobacco Smoke and Involuntary Smoking, 2004Lyon, FranceInternational Agency for Research on Cancer

4. Flach, Susanne, Pavithran Maniam, and Jaiganesh Manickavasagam. “E‐cigarettes and head and neck cancers: A systematic review of the current literature.” Clinical Otolaryngology 44.5 (2019): 749-756.

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