Air Pollution Exposure and Incidence of Upper Aerodigestive Tract Cancer in the PLCO Cohort

Monday, October 19, 2026

4:24 PM - 4:30 PM PT

Location: West Exhibit Hall A, Learning Zone 3

Presenting Author(s)

Amanda E. Dilger, MD

Assistant Professor - Department of Otorhinolaryngology, Head and Neck Surgery
Montefiore Einstein
Bronx, NY, United States

Senior Author(s)

John D. Cramer, MD

Associate Professor of Otolaryngology - Head and Neck Surgery
Wayne State University
Detroit, MI, United States

Co-Author(s)

Stella E. Lee, MD

Associate Professor of Otolaryngology–Head and Neck Surgery
Harvard Medical School
Weston, MA, United States
TD

Tanujit Dey, PhD

Director, Biostatistics
Center for Surgery and Public Health/Harvard Medical School, United States

Disclosure(s):

Amanda E. Dilger, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Stella E. Lee, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Fine particulate matter less than 2.5 micrometers (PM2.5) is linked to adverse health effects and prior analyses suggest an association between PM2.5 exposure and head and neck cancer (HNC). We evaluated the association between long-term PM2.5 exposure and incident HNC in a large prospective national cohort.

Methods: We conducted an analysis of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, which enrolled >155,000 adults aged 55-74 years. Patients included were diagnosed with HNC of the oral cavity, oropharynx, larynx, hypopharynx, sinus and nasopharynx; and patients with missing location data were excluded. Participants addresses were geocoded and linked to satellite-derived air pollution data. A time-series modeling approach was used to estimate cumulative exposure. Multivariable logistic regression assessed the association between PM2.5 exposure and incident HNC, adjusting for demographics, smoking and alcohol use.

Results: Among 1,058 participants diagnosed with HNC, 412 met inclusion criteria. Median age at enrollment was 62.1 years with 79% male, 91% White, and 77% current or former smokers. Primary sites included larynx/hypopharynx (35%), oral cavity (48%) and oropharynx (11%). Higher PM2.5 exposure was associated with increased odds of HNC (OR 1.06, p = 0.001). Analysis by anatomical subsite showed significantly increased OR of HNC in larynx/hypopharynx (OR 1.18, p < 0.001), oropharynx (OR 1.16, p = 0.009) and sinonasal subsites (OR 1.25, p = 0.013). The interaction terms between PM2.5 and smoking status were not significant for current or former smokers (p > 0.56).

Conclusions: In a large prospective cohort with individual-level smoking and alcohol data, long-term PM2.5 exposure was associated with higher incidence of all HNC and by subsite in larynx/hypopharynx, sinonasal and oropharynx cases, consistent with prior population-based studies. Notably, there was no effect modification by smoking. PM2.5 exposure and smoking status were independently and significantly associated with HNC risk, suggesting their effects are additive rather than multiplicative.