HEAD AND NECK Laryngeal cancer and passive smoking: the neglected factor? Antonios Mallis • Eleni Jelastopulu • Nicholas S. Mastronikolis • Stefanos S. Naxakis • Christos Kourousis • Theodoros A. Papadas Received: 15 June 2010 / Accepted: 6 October 2010 / Published online: 21 October 2010 Ó Springer-Verlag 2010 Abstract In the present paper we investigate the rela- tionship of environmental tobacco smoke (ETS) exposure to laryngeal cancer. 209 patients who were diagnosed with laryngeal cancer from 2000 to 2009 at the University Hospital of Patras, Western Greece, were reviewed with regard to patient age, disease stage at presentation, tumor differentiation, tobacco product use, alcohol consumption, occupation, and ETS exposure in the working environment. Pearson Chi-square method was used to determine the effect of ETS exposure on cancer stage, TNM classification and tumor differentiation in the dichotomized population (exposed vs. not exposed) and in groups of low, medium and high ETS exposure. ETS exposure in the working environment was found to significantly affect overall dis- ease stage and T stage (p \ 0.01) both in the dichotomic analysis and the group analysis. Minor significance was also noted for N stage (p = 0.047) in the exposure group analysis. Our data suggest that occupational ETS exposure presents a contributing risk factor for laryngeal cancer that requires further research to determine its significance. Keywords Laryngeal cancer Á Risk factors Á Passive smoking Introduction Laryngeal cancer represents a disease with high incidence accounting for 2.4% of new malignancies worldwide every year [1]. Estimates of 139,230 new cases of laryngeal cancer worldwide are indicative of its importance [2] with a reported incidence of 45,900 cases in 2006 in Europe further illustrating this case [3]. Typically considered a disease of middle aged males [4], laryngeal cancer shares a well-documented causal associ- ation with cigarette smoking [5, 6] instating it as one of the most lifestyle-related cancers, as indicated by reports in World Cancer Report 2008 projecting a decrease of 90% in incidence rates by smoking cessation [7]. In spite of the thoroughly documented association of laryngeal cancer to tobacco product usage, the correlation of environmental tobacco smoke (ETS) exposure to lar- yngeal cancer has been the topic of only a limited number of papers [8], although it has been associated with diseases of the respiratory tract including lung cancer and chronic obstructive pulmonary disease [9]. In the present paper we analyze the effect of ETS exposure in the occupational environment in a group of 209 laryngeal cancer patients. Patients and methods Study population The records of 209 patients who were diagnosed with laryngeal cancer over the course of 8 years (2000–2009) at the University Hospital of Patras, Western Greece were reviewed. Data on patient age, disease stage at presenta- tion, tumor differentiation, tobacco product use, alcohol A. Mallis (&) Á N. S. Mastronikolis Á S. S. Naxakis Á T. A. Papadas ENT Department, University Hospital of Patras, Patras, Greece e-mail: 6976154469@mycosmos.gr E. Jelastopulu Department of Public Health Medical School, University of Patras, Patras, Greece C. Kourousis Sismanoglion General Hospital, Athens, Greece 123 Eur Arch Otorhinolaryngol (2011) 268:727–731 DOI 10.1007/s00405-010-1403-z