Detection of laryngeal carcinoma in the U.S. elderly population with gastroesophageal reflux disease

Head Neck. 2019 May;41(5):1434-1440. doi: 10.1002/hed.25600. Epub 2019 Jan 25.


Background: An association is suggested between gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) and malignancy of the larynx in elderly patients in the United States. Early detection with flexible fiberoptic laryngoscopy (FFL) or CT remains poorly defined.

Methods: The Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database was queried from 2003 to 2011.A case-cohort design evaluated patients aged 66 and older with a diagnosis of GERD and/or LPR for the occurrence of FFL or CT within 6 months of the exposure diagnosis.

Results: Of a total 156 426 Medicare beneficiaries, the relative risk of early cancer diagnosis with FFL was 14.61(95% confidence interval [CI], 13.59-15.70), corresponding to a number needed to detect (NND) a case of cancer of 13(95% CI, 13-14). The relative risk of an early cancer diagnosis with CT was 31.83 (95% CI, 29.57-34.26), with a NND of 5 (95% CI, 5-5).

Conclusions: Early FFL and CT are associated with a higher likelihood of laryngeal cancer diagnosis in elderly individuals with a diagnosis of reflux. Screening trials are necessary to establish this relationship.

Keywords: CT; flexible fiberoptic laryngoscopy; gastroesophageal reflux; laryngeal cancer; laryngopharyngeal reflux.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biopsy, Needle
  • Case-Control Studies
  • Databases, Factual
  • Female
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / diagnosis*
  • Geriatric Assessment
  • Humans
  • Immunohistochemistry
  • Incidence
  • Kaplan-Meier Estimate
  • Laryngeal Neoplasms / epidemiology*
  • Laryngeal Neoplasms / etiology*
  • Laryngeal Neoplasms / physiopathology
  • Laryngoscopy / methods*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Risk Assessment
  • SEER Program
  • Survival Analysis
  • United States