December 21, 2017
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Reflux linked to head and neck cancers in elderly

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Edward D. McCoul, MD, MPH
Edward D. McCoul

Elderly patients with gastroesophageal reflux disease showed a higher risk for malignancies of the upper aerodigestive tract in a recent case-control study.

Perspective from Miriam N. Lango, MD, FACS

“Population-level data suggests a link between gastroesophageal reflux disease and cancer of the throat and sinuses in adults over 65 years of age,” Edward D. McCoul, MD, MPH, of the department of otolaryngology, head and neck surgery, at Tulane University School of Medicine, and the Ochsner Clinic Foundation in New Orleans, told Healio Gastroenterology and Liver Disease. “The strength of association between reflux and cancer is strongest for anatomic sites closest to the esophagus, where acid and other stomach contents may have the greatest exposure.”

Prior studies on the link between GERD and malignancies of the upper aerodigestive tract (UADT) have produced conflicting results, and studies in older patients are lacking, McCoul and colleagues wrote.

Therefore, they reviewed SEER data from 2003 through 2011 on 27,610 Medicare recipients (median age, 74 years; 75.24% men), 13,805 of whom had a malignancy of the larynx (60.5%), hypopharynx (5.4%), oropharynx (5.2%), tonsil (14.4%), nasopharynx (5.5), or paranasal sinuses (9%). Researchers compared GERD rates between these cancer patients and a random sample of Medicare recipients without cancer matched by age, sex and year of diagnosis.

They found that patients with GERD showed a greater risk for developing malignancies of the larynx (adjusted odds ratio [aOR] = 2.86; 95% CI, 2.65-3.09), hypopharynx (aOR = 2.54; 95% CI, 1.97-3.29), oropharynx (aOR = 2.47; 95% CI, 1.90-3.23), tonsil (aOR = 2.14; 95% CI, 1.82-2.53), nasopharynx (aOR = 2.04; 95% CI, 1.56-2.66), and paranasal sinuses (aOR = 1.4; 95% CI, 1.15-1.70). The risk was lowest for cancers of the paranasal sinuses and highest for cancers of the larynx.

McCoul and colleagues also noted the associations remained significant even when they accounted for GERD exposure time.

They concluded that the data suggest elderly patients with GERD are 3.47 times more likely to receive a diagnosis of laryngeal cancer, 3.23 times more likely to receive a diagnosis of hypopharyngeal cancer, 2.88 times more likely to receive a diagnosis of oropharyngeal cancer and 2.37 times more likely to receive a diagnosis of tonsillar cancers in the U.S.

While these results indicate an opportunity for earlier detection and intervention, future research should evaluate these associations in younger patients and evaluate their underlying causes, they noted.

“It is important to point out that a causative link cannot be established from this type of data,” McCoul said. “It is unclear what effect acid exposure may have on tumor development, although chronic inflammation is a possibility. Further research should focus on assessing these associations in a younger population and investigating mechanisms of causation.” – by Adam Leitenberger

Disclosures: The authors report no relevant financial disclosures.