What are the main risk factors for head and neck cancer?

Alcohol and tobacco use are the two most important risk factors for head and neck cancers, especially cancers of the mouth, hypopharynx, and voice box. This includes secondhand smoke and smokeless tobacco. People who use both tobacco and alcohol are at greater risk than people who use only one.

The National Cancer Institute goes further. It says most of these cancers of the mouth and voice box are caused by tobacco and alcohol use. That is not a small share. It is the main story for those sites.

Why the pair matters more than either one

Tobacco and alcohol do not act separately here. Used together, they raise risk more than either does on its own.

The practical point follows from that. Cutting back on one still helps, even if the other stays. Stopping both helps most. And it is worth doing after a diagnosis, not only before one.

The other big cause, which behaves differently

Infection with cancer-causing types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for oropharyngeal cancers. Those are cancers of the tonsils or the base of the tongue.

The scale is large. NCI reports that about three-quarters of all oropharyngeal cancers are caused by long-term HPV infection.

These are not just a different cause. They act like a different disease. NCI says people with HPV-positive tumors here have a much better outlook. Their chance of complete cure is higher than for people with HPV-negative tumors.

That is why tumors from this part of the throat are tested for HPV. The result shapes staging and planning.

It also means the typical patient looks different. HPV-related throat cancer often turns up in people who never smoked heavily.

The rest of the list

Other known risk factors include the use of paan (betel quid), certain workplace exposures, past radiation to the head and neck, Epstein-Barr virus infection, some ancestry backgrounds, and certain inherited genetic disorders.

NCI names specifics worth checking against your own history:

• Betel quid, linked strongly to cancers of the mouth
• Wood dust, asbestos, synthetic fibers, nickel dust, and formaldehyde at work
• Epstein-Barr virus, tied to nasopharyngeal and salivary gland cancers
• Radiation exposure, tied to salivary gland cancer

What to do with this

There is no routine screening test for head and neck cancer in people at average risk. So prevention and symptoms carry the weight.

Prevention has three levers. Stop tobacco in every form. Cut down on alcohol. And get the HPV vaccine, which covers HPV 16, the type behind most HPV-related throat cancers. It works best when given well before any exposure.

For symptoms, what counts is how long they last. Watch for a sore in the mouth that will not heal. A lump in the neck. A hoarse voice that does not clear. Trouble swallowing. Ear pain on one side that keeps going.

Any of these is worth checking when it lasts weeks rather than days. Dentists look at this tissue more often than anyone else, which is one reason to keep dental visits on the calendar.

Your healthcare team is the best source of information about your own risk.