Smoking and the occurrence of larynx cancer in Sweden - a population analysis

Our plain-English summary of Smoking and the occurrence of larynx cancer in Sweden - a population analysis, by B. Järvholm, P. Liv, L. Hedman, et al (Scandinavian Journal of Public Health, 2026).

The study

• Authors: B. Järvholm, P. Liv, L. Hedman, M. Landström, K. Torén, A. Burdorf
• Journal: Scandinavian Journal of Public Health
• Published: 2026;54(2):157-163
• Read it: PubMed · Publisher · Free full text

Abstract

Aims: To study the importance of decreasing tobacco smoking on the occurrence of larynx cancer in men and women.

Methods: The incidence rates of larynx cancer in the Swedish population between 1970 and 2021 were retrieved from the Swedish Cancer Register for ages 50-84 years, stratified for sex, age and calendar year. Data on the population's smoking habits was retrieved from surveys and from taxation on the sale of cigarettes. The occurrence of larynx cancer was compared to smoking habits, sex and age. The time trends were compared between larynx and lung cancer.

Results: Over the years, Swedish men and women have had different smoking habits, especially older persons during the 1970s. In 1963, the prevalence of current smokers in women 50-69 years was 11%, while it was 46% in men. Around 2020, less than 10% of men and women in all age groups were current smokers. However, men had higher incidence rates of larynx cancer than women, even when their smoking habits were similar. For example, men and women 60-64 years of age in 2017-2021 had similar smoking habits during their life but the relative risk of larynx cancer in men compared to women was 3.3 (95% CI 1.7-4.8). However, pipe smoking was much more common in men.

Conclusions: The study indicates that other causes than cigarette smoking have an impact on the occurrence of larynx cancer in Sweden. Pipe smoking and occupational exposure to carcinogenic materials such as asbestos may be underlying causes of the difference in cancer risk between Swedish men and women.

In plain English

This was an ecological study: it compared national statistics, not individual people's histories. Using the Swedish Cancer Register, the authors examined squamous cell larynx cancer in Swedes aged 50–84 from 1970 to 2021, covering 7603 cases in men and 1121 in women. They compared these rates with smoking habits estimated from cigarette sales and national surveys. Men had higher rates than women throughout. Rates in men fell significantly in every age group except 80–84. In 2017–2021, men aged 60–64 had 3.3 times the rate of women that age (95% CI 2.1–5.3), and at 80–84 the ratio was 14.1 (6.5–30.5). Pipe smoking had been far more common in men: 23%–26% smoked weekly in the early 1970s, against about 1% of women around 1980. The study had no measurements of asbestos exposure. The authors concluded that smoking matters for larynx cancer, that Swedish pipe smoking may help explain the difference between the sexes, and that occupational air pollutants such as asbestos may also be a cause. They noted they lacked data on individuals' smoking.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Ecological population analysis of national cancer register data and population smoking data, using Poisson regression of time trends and men-versus-women incidence rate ratios
• Who was studied: Squamous cell larynx cancer cases aged 50–84 years in the Swedish population, from the Swedish Cancer Register, 1970–2021: 7603 males and 1121 females
• Exposure: Population tobacco smoking habits (cigarettes, plus pipe smoking), estimated from cigarette sales (taxation) and national surveys. Occupational exposure such as asbestos was discussed as a possible explanation but was not measured.
• Main results:
  • Men had a statistically significant decreasing trend in larynx cancer in all age groups except 80–84 years
  • Women had a statistically significant increasing trend in larynx cancer in age groups 65–69 and 75–79 years
  • Men aged 60–64 compared with women aged 60–64 (women as reference): RR 5.4 (95% CI 3.4–8.6) around 2000, 5.1 (3.3–7.7) around 2010, and 3.3 (2.1–5.3) in 2017–2021
  • Men aged 80–84 compared with women aged 80–84: RR 13.7 (6.6–28.5) around 2000, 8.8 (4.6–16.6) around 2010, and 14.1 (6.5–30.5) in 2017–2021. Rates in men and women became more similar at younger ages, but not among those aged 75–84.
  • In a 1963 survey, 46% of men and 11% of women aged 50–69 were current smokers
  • In the early 1970s, 23%–26% of men reported smoking a pipe at least weekly; among women in the late 1970s and early 1980s the prevalence was around 1%
• The authors' conclusion: The authors concluded that tobacco smoking is important for larynx cancer risk. They also concluded that Swedish pipe smoking may be a cause and may explain the difference between men and women, and that occupational exposure to air pollutants such as asbestos may also be a cause of that difference. They added that the benefits of quitting smoking seem to occur later than predicted.
• Limitations the authors state:
  • The study was ecological and lacked data on individual smoking habits
  • Smokers may be underrepresented in surveys, and survey participation has decreased over time
  • Few cases in women made estimates imprecise and exposure–response analysis difficult
  • No data on how many people in Sweden are both heavy smokers and heavy drinkers
  • No studies were found on the composition of smoke from Swedish pipe smoking

Topics

The National Library of Medicine indexes this study under subjects our site covers: Throat and laryngeal cancer.

Medical terms in this study, explained in our Lexicon: Laryngeal Cancer, Incidence, Habit, Lung Cancer, Relative Risk, Occupational Exposure, Carcinogenic.

Related studies

• Alcohol, smoking, and occupational factors in cancer of the larynx: a case-control study — W. Ahrens, K.H. Jöckel, et al. (1991)
• Low-dose exposure to asbestos and lung cancer: dose-response relations and interaction with smoking in a population-based case-referent study in Stockholm, Sweden — P. Gustavsson, F. Nyberg, et al. (2002)
• Emerging evidence that the ban on asbestos use is reducing the occurrence of pleural mesothelioma in Sweden — B. Järvholm, A. Burdorf (2015)
• The joint effect of asbestos exposure, tobacco smoking and alcohol drinking on laryngeal cancer risk: evidence from the French population-based case-control study, ICARE — G. Menvielle, A. Fayossé, et al. (2016)
• Occupational exposures and squamous cell carcinoma of the oral cavity, pharynx, larynx, and oesophagus: a case-control study in Sweden — P. Gustavsson, R. Jakobsson, et al. (1998)
• Occupational asbestos exposure, smoking, and laryngeal carcinoma — R.W. Morgan, P.T. Shettigara (1976)

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