A retrospective analysis using patient and family questionnaires and chart review was done on 269 patients with head and neck neoplasms. Sixty-nine with tumors at sites known to be unrelated to tobacco and alcohol use served as controls. Two hundred patients with epidermoid carcinoma of the oral cavity, pharynx, and larynx constituted the study group. Alcohol use alone increased the risk of acquiring the study cancer 3.6 times; smoking alone increased the risk 5.8 times. Both factors combined increased the risk 19 times. Those who continued to smoke after diagnosis had a fourfold increase in the recurrence rate over those who did not smoke, and double that of those who stopped smoking. Survival was also the lowest in those who continued to smoke, while persistent alcohol use did not affect survival.