Gastroesophageal reflux disease is a risk factor for laryngeal and pharyngeal cancer

OBJECTIVE: Gastroesophageal reflux disease (GERD) is a proposed risk factor for developing laryngeal and pharyngeal cancers. No controlled study has e xamined this association. METHODS: A case-control study was performed using the computerized hospital ization and outpatient databases of the US Department of Veterans Affairs. All patients, who were veterans, had been identified as being hospitalized with laryngeal or pharyngeal during 1991 to 1997. In addition, all persons diagnosed with laryngeal or pharyngeal cancer in 1999 in the outpatient fil es were identified. From the same patient populations, four nonmatched cont rol subjects were randomly assigned for each case. The medical history for cases and controls was retrospectively searched for GERD diagnoses, tobacco use, and alcohol dependence. Multivariable logistic regression analyses we re performed to assess the risk factors for laryngeal and pharyngeal cancer s. RESULTS: A total of 8,228 hospitalized patients with laryngeal cancers and 1,912 with pharyngeal cancers were compared to 32,912 and 7,648 hospitalize d controls, while 9,292 outpatients with laryngeal cancer and 2,769 outpati ents with pharyngeal cancer were compared with 37,168 and 11,076 outpatient controls without cancer. Among hospitalized persons, the prevalence of GER D was higher among patients with laryngeal cancer (8.9 vs 4.0%, p < 0.0001) and pharyngeal cancer (6.2 vs 3.8%, p < 0.0001). In a multivariable logist ic regression analysis that was controlled for age, gender, ethnicity, smok ing, and alcohol, GERD was associated with an adjusted odds ratio (OR) of 2 .40 for laryngeal cancer among hospitalized patients (95% CI 2.15-2.69, p < 0.0001) and an adjusted OR of 2.38 (95% CI 1.87-3.02, p < 0.0001) for phar yngeal cancer. For outpatients, GERD was associated with an adjusted OR = 2 .31 (95% CI 2.10-2.53) for laryngeal cancer and adjusted OR = 1.92 (95% CI 1.72-2.15). CONCLUSIONS: Among US veterans, the risk for laryngeal or pharyngeal cancer s is modestly increased in the presence of GERD. This effect seems to be in dependent of age, gender, smoking, and alcohol intake.