Review Article

Laryngeal Cancer: Epidemiology, Etiology, and Prevention: A Narrative Review


Laryngeal cancer comprises 30%-40% of head and neck malignancies, and it is the most common malignancy in otolaryngology. The main risk factors for laryngeal cancer are tobacco use, excessive alcohol consumption, gastroesophageal reflex, Plummer-Vinson syndrome, exposure to heat, chemicals, and some viral infections. This literature review summarizes all known data over the past decade with an assessment of the main etiological factors related to cancer incidence, general measurement issues in the cancer epidemiology and the current state of science in relation to laryngeal cancer. The geographical distribution of laryngeal cancer also reveals some important aspects. Europe remains the most prevalent continent for this type of malignancy, whilst the epidemiologic burden in Africa remains low. Overall, there are clear differences in morbidity and mortality from laryngeal cancer between urban and rural areas, with gender inequalities. In some countries, the incidence rates are high in rural areas, and in some, such as in China, the urban population is more affected. High rates of laryngeal cancer are closely associated with both low average income and a high percentage of the population with lower-than-average education countries with higher Socio-demographic Index (SDI) have made greater improvements in the treatment of LC than countries with lower SDI. Epidemiological data on risk factors can provide valuable information for developing cancer prevention strategies.

1. Mody MD, Rocco JW, Yom SS, Haddad RI, Saba NF (2021). Head and neck cancer. Lancet, 398(10318):2289-2299.
2. Son E, Panwar A, Mosher CH, Lydiatt D (2018). Cancers of the Major Salivary Gland. J Oncol Pract, 14(2):99-108.
3. National Cancer Institute (2023). Head and Neck Cancers. Available from:
4. Ferlay J, Ervik M, Lam F, et al (2022). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer [cited 2022 Aug 25].
5. Wang JY, Zhang QW, Wen K, et al (2021). Temporal trends in incidence and mortality rates of laryngeal cancer at the global, regional and national levels, 1990-2017. BMJ Open, 11(10):e050387.
6. Tang JA, Lango MN (2019). Diverging incidence trends for larynx and tonsil cancer in low socioeconomic regions of the US. Oral Oncol, 91:65-68.
7. Zhang QW, Wang JY, Qiao XF, et al (2021). Variations in disease burden of laryngeal cancer attributable to alcohol use and smoking in 204 countries or territories, 1990-2019. BMC Cancer, 21(1):1082.
8. Deng Y, Wang M, Zhou L, et al (2020). Global burden of larynx cancer, 1990-2017: estimates from the global burden of disease 2017 study. Aging (Albany NY), 12(3):2545-2583.
9. Balogun O, Rodin D, Ngwa W, et al (2017). Challenges and Prospects for Providing Radiation Oncology Services in Africa. Semin Radiat Oncol, 27(2):184–88.
10. GBD 2019 Viewpoint Collaborators (2020). Five insights from the Global Burden of Disease Study 2019. Lancet, 396(10258):1135–59.
11. Steuer CE, El-Deiry M, Parks JR, et al (2017). An update on larynx cancer. CA Cancer J Clin, 67(1):31–50.
12. Ciolofan MS, Vlăescu AN, Mogoantă CA, et al (2017). Clinical, histological and im-munohistochemical evaluation of larynx cancer. Curr Health Sci J, 43(4):367–75.
13. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392(10159):1789-1858.
14. Li MM, Zhao S, Eskander A, et al (2021). ASO Visual Abstract: Stage Migration and Survival Trends in Laryngeal Can-cer. Annals of Surgical Oncology, 28(Suppl 3):569.
15. Abt NB, Miller LE, Parikh A, et al (2022). Insurance Status Effect on Laryngeal Cancer Survival: A Population Based Study. Ann Otol Rhinol Laryngol, 131(7):775-781.
16. Lebo NL, Khalil D, Balram A, et al (2019). Influence of Socioeconomic Status on Stage at Presentation of Laryngeal Can-cer in the United States. Otolaryngol Head Neck Surg, 161(5):800-806.
17. Perdomo S, Martin Roa G, Brennan P, et al (2016). Head and neck cancer burden and preventive measures in Central and South America. Cancer Epidemiol, 44 Suppl 1:S43-S52.
18. Bray F, Ferlay J, Soerjomataram I, et al (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 68(6):394–424.
19. Nocini R, Molteni G, Mattiuzzi C, et al (2020). Updates on larynx cancer epi-demiology. Chin J Cancer Res, 32(1):18-25.
20. Nahavandipour A, Jakobsen KK, Grønhøj C, et al (2019). Incidence and survival of laryngeal cancer in Denmark: a nation-wide study from 1980 to 2014. Acta Oncol, 58(7):977-982.
21. Ryzhov A, Bray F, Ferlay J, et al (2020). Re-cent cancer incidence trends in Ukraine and short-term predictions to 2022. Can-cer Epidemiol, 65:101663.
22. Lyhne NM, Johansen J, Kristensen CA, et al (2016). Incidence of and survival after glottic squamous cell carcinoma in Denmark from 1971 to 2011—a report from the Danish Head and Neck Cancer Group. Eur J Cancer, 59:46–56.
23. Zuo JJ, Tao ZZ, Chen C, et al (2017). Characteristics of cigarette smoking without alcohol consumption and laryngeal cancer: overall and time-risk relation. A meta-analysis of observational studies. Eur Arch Otorhinolaryngol, 274(3):1617-1631.
24. Wei KR, Zheng RS, Liang ZH, et al (2018). [Incidence and mortality of laryngeal cancer in China, 2014]. Zhonghua Zhong Liu Za Zhi, 40(10):736-743.
25. Zuniga SA, Lango MN (2018). Effect of rural and urban geography on larynx cancer incidence and survival. Laryngoscope, 128(8):1874–80.
26. Ferlay J, Laversanne M, Ervik M, et al (2022). Global Cancer Observatory: Cancer Tomorrow. Lyon, France: International Agency for Research on Cancer [cited 2022 Aug 26].
27. American Cancer Society. Cancer Facts and Figures 2019. Atlanta: American Cancer Society, 2019. Available from:
28. Chang CP, Siwakoti B, Sapkota A, et al (2020). Tobacco smoking, chewing hab-its, alcohol drinking and the risk of head and neck cancer in Nepal. Int J Cancer, 147(3):866-875.
29. Lortet-Tieulent J, Goding Sauer A, Siegel RL, et al (2016). State-Level Cancer Mortality Attributable to Cigarette Smoking in the United States. JAMA Intern Med, 176(12):1792-1798.
30. Permitasari NPAL, Satibi S, Kristina SA (2018). National Burden of Cancers Attributable to Secondhand Smoking in Indonesia. Asian Pac J Cancer Prev, 19(7):1951-1955.
31. Chang CP, Chang SC, Chuang SC, et al (2019). Age at start of using tobacco on the risk of head and neck cancer: Pooled analysis in the International Head and Neck Cancer Epidemiology Consortium (INHANCE). Cancer Epi-demiol, 63:101615.
32. Di Credico G, Edefonti V, Polesel J, et al (2019). Joint effects of intensity and du-ration of cigarette smoking on the risk of head and neck cancer: A bivariate spline model approach. Oral Oncol, 94:47-57.
33. Suliankatchi RA, Sinha DN, Rath R, et al (2019). Smokeless tobacco use is "replac-ing" the smoking epidemic in the South-East Asia region. Nicotine Tob Res, 21(1):95–100.
34. Menach OP, Patel A, Oburra HO (2014). Demography and histologic pattern of laryngeal squamous cell carcinoma in Kenya. Int J Otolaryngol, 2014:507189.
35. Allegra E, Bianco MR, Ralli M, et al (2021). Role of Clinical-Demographic Data in Survival Rates of Advanced Laryngeal Cancer. Medicina (Kaunas), 57(3):267.
36. Voltzke KJ, Lee YA, Zhang ZF, et al (2018). Racial differences in the relationship between tobacco, alcohol, and the risk of head and neck cancer: pooled analy-sis of US studies in the INHANCE Con-sortium. Cancer Causes Control, 29(7):619-630.
37. (NIPH) NI of PH (2007). Folkesundhedsrapporten Danmark 2007 [Public Health Report, Denmark 2007]; 2007.
38. LoConte NK, Brewster AM, Kaur JS, et al (2018). Alcohol and Cancer: A Statement of the American Society of Clinical Oncology. J Clin Oncol, 36(1):83-93.
39. Klein WMP, Jacobsen PB, Helzlsouer KJ (2020). Alcohol and Cancer Risk: Clinical and Research Implications. JAMA, 323(1):23–24.
40. World Cancer Research Fund, American Institute for Cancer Research (2018). Diet, nutrition, physical activity, and cancer: a global perspective. Continuous update project expert report. London: World Cancer Research Fund.
41. Manthey J, Shield KD, Rylett M, et al (2019). Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study. Lancet, 393(10190):2493–2502.
42. Berdzuli N, Ferreira-Borges C, Gual A, et al (2020). Alcohol control policy in Eu-rope: overview and exemplary countries. Int J Environ Res Public Health, 17(21):8162.
43. Bagnardi V, Rota M, Botteri E, et al (2015). Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer, 112(3):580–593.
44. Grevers X, Ruan Y, Poirier AE, et al (2019). Estimates of the current and future burden of cancer attributable to alcohol consumption in Canada. Prev Med, 122:40-48.
45. Bradley PJ (2016). Laryngeal cancer in nondrinker nonsmoker young patients: a distinct pathological entity? Curr Opin Otolaryngol Head Neck Surg, 24(2):140-147.
46. Al-Qudah MA, Al-Shaikh AF, Haddad HK, et al (2020). Prevalence and Detection of Sexually Transmitted Cases of Laryngeal Carcinoma. Head Neck Pathol, 14(4):909-914.
47. Hernandez BY, Goodman MT, Lynch CF, et al (2014). Human papillomavirus prevalence in invasive laryngeal cancer in the United States. PLoS One, 9(12):e115931.
48. Lu Y, Li P, Luo G, et al (2020). Cancer at-tributable to human papillomavirus in-fection in China: Burden and trends. Cancer, 126(16):3719-3732.
49. Buttmann-Schweiger N, Delere Y, Klug SJ, et al (2017). Cancer incidence in Ger-many attributable to human papilloma-virus in 2013. BMC Cancer, 17(1):682.
50. Senkomago V, Henley SJ, Thomas CC, et al (2019). Human papillomavirus–attributable cancers–United States, 2012-2016. MMWR Morb Mortal Wkly Rep, 68(33):724-728.
51. Syrjänen S, Syrjänen K (2019). HPV in Head and Neck Carcinomas: Different HPV Profiles in Oropharyngeal Carcinomas - Why? Acta Cytol, 63(2):124-142.
52. Castellsagué X, Alemany L, Quer M, et al (2016). HPV Involvement in Head and Neck Cancers: Comprehensive Assess-ment of Biomarkers in 3680 Patients. J Natl Cancer Inst, 108(6):djv403.
53. Tsimplaki E, Argyri E, Sakellaridis A, et al (2017). Oropharyngeal and laryngeal but not oral cancers are strongly associated with high-risk human papillomavirus in 172 Greek patients. J Med Virol, 89(1):170-176.
54. Astl J, Holy R, Maute E, et al (2021). Genome of Helicobacter pylori and Serotype of HPV Detected in Oropharyngeal and Laryngeal Cancer and Chronic Inflammation Patients. Int J Environ Res Public Health, 18(18):9545.
55. Nahet A, Boublenza L, Hassaine H, et al (2016). [HPV DNA genotyping: A study of anogenital, head and neck and skin cancers in a population from west Alge-rian. HPV detection in different cancers from an Algerian population]. Bull Can-cer, 103(5):455-460.
56. Kariche N, Hortal MT, Benyahia S, et al (2018). Comparative assessment of HPV, alcohol and tobacco etiological frac-tions in Algerian patients with laryngeal squamous cell carcinoma. Infect Agent Cancer, 13:8.
57. Chen WC, Chuang HC, Lin YT, et al (2017). Clinical impact of human papilloma-virus in laryngeal squamous cell carci-noma: a retrospective study. Peer J, 5:e3395.
58. Yang D, Shi Y, Tang Y, et al (2019). Effect of HPV Infection on the Occurrence and Development of Laryngeal Cancer: A Review. J Cancer, 10(19):4455-4462.
59. He J, Meng H, Yao G, et al (2017). New re-search progress of HPV and Larynx cancer. Progress in Modern Biomedicine, 17:5989–92
60. Wang TH, Hsia SM, Shih YH, et al (2017). Association of Smoking, Alcohol Use, and Betel Quid Chewing with Epigenetic Aberrations in Cancers. Int J Mol Sci, 18(6):1210.
61. Hashim D, Genden E, Posner M, et al (2019). Head and neck cancer preven-tion: from primary prevention to impact of clinicians on reducing burden. Ann Oncol, 30(5):744-756.
62. Wu Y-H, Yen C-J, Hsiao J-R , et al (2016). A comprehensive analysis on the association between tobacco-free betel quid and risk of head and neck cancer in Taiwanese men. PLoS One, 11(10): e0164937.
63. Ferster APO, Schubart J, Kim Y, et al (2017). Association Between Laryngeal Cancer and Asbestos Exposure: A Sys-tematic Review. JAMA Otolaryngol Head Neck Surg, 143(4):409-416.
64. Peng WJ, Mi J, Jiang YH (2016). Asbestos exposure and laryngeal cancer mortality. Laryngoscope, 126 (5):1169-1174.
65. Menvielle G, Fayossé A, Radoï L, et al (2016). The joint effect of asbestos ex-posure, tobacco smoking and alcohol drinking on laryngeal cancer risk: evi-dence from the French population-based case-control study, ICARE. Occup Environ Med, 73(1):28-33.
66. Hall AL, Kromhout H, Schüz J, et al (2020). Laryngeal Cancer Risks in Workers Ex-posed to Lung Carcinogens: Exposure-Effect Analyses Using a Quantitative Job Exposure Matrix. Epidemiology, 31(1):145-154.
67. Zhou J, Zhang D, Yang Y, et al (2016). Association between helicobacter pylori infection and carcinoma of the larynx or pharynx. Head Neck, 38 Suppl 1:E2291-E2296.
68. Lu YT, Hsin CH, Lu YC, et al (2021). Risk of head and neck cancer in patients with peptic ulcers and the effect of Helico-bacter pylori treatment. Sci Rep, 11(1):6229.
69. Eells AC, Mackintosh C, Marks L, et al (2020). Gastroesophageal reflux disease and head and neck cancers: A systemat-ic review and meta-analysis. Am J Oto-laryngol, 41(6):102653.
70. Parsel SM, Wu EL, Riley CA, et al (2019). Gastroesophageal and Laryngopharyn-geal Reflux Associated with Laryngeal Malignancy: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol, 17(7):1253-1264.e5.
71. Sereg-Bahar M, Jerin A, Hocevar-Boltezar I (2015). Higher levels of total pepsin and bile acids in the saliva as a possible risk factor for early laryngeal cancer. Radiol Oncol, 49(1):59-64.
72. Kim SY, Han KD, Joo YH (2019). Metabol-ic Syndrome and Incidence of Larynge-al Cancer: A Nationwide Cohort Study. Sci Rep, 9(1):667. Published 2019 Jan 24.
73. Kim HB, Kim GJ, Han KD, et al (2021). Changes in metabolic syndrome status and risk of laryngeal cancer: A nation-wide cohort study. PLoS One, 16(6):e0252872.
74. Kravietz A, Angara P, Le M, et al (2018). Disparities in screening for head and neck cancer: evidence from the NHANES, 2011-2014. Otolaryngol Head Neck Surg, 159(4):683–91.
75. Graboyes EM, Hughes-Halbert C (2019). Delivering Timely Head and Neck Can-cer Care to an Underserved Urban Pop-ulation-Better Late Than Never, but Never Late Is Better. JAMA Otolaryngol Head Neck Surg, 145(11):1010-1011.
76. McMaughan DJ, Oloruntoba O, Smith ML (2020). Socioeconomic status and access to healthcare: interrelated drivers for healthy aging. Front Public Health, 8:231.
77. Abdel-Rahman O (2019). Socioeconomic predictors of suicide risk among cancer patients in the United States: a popula-tion-based study. Cancer Epidemiol, 63:101601.
78. Fullmer T, Wilde DC, Shi JW, et al (2020). Demographic and Tumor Characteristic Impact on Laryngeal Cancer Outcomes in a Minority Underserved Patient Popu-lation. Otolaryngol Head Neck Surg, 162(6):888-896.
79. Andersson TM, Engholm G, Pukkala E, et al (2018). Avoidable cancers in the Nordic countries-The impact of alcohol consumption. Eur J Cancer, 103:299-307.
80. Wang N, Lv H, Huang M (2020). Impact of gender on survival in patients with laryngeal squamous cell carcinoma: a propensity score matching analysis. Int J Clin Exp Pathol, 13(3):573-581
IssueVol 52 No 11 (2023) QRcode
SectionReview Article(s)
Laryngeal cancer Epidemiology Etiology Prevention

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Igissin N, Zatonskikh V, Telmanova Z, Tulebaev R, Moore M. Laryngeal Cancer: Epidemiology, Etiology, and Prevention: A Narrative Review. Iran J Public Health. 2023;52(11):2248-2259.