Laryngeal Cancer and Asbestos Exposure: What Singing Teachers Should Know

SINGING TEACHERS COMMONLY are the primary health care resource for voice students. In addition to questions about technique, students often turn to teachers for guidance regarding issues of vocal health. While singing teachers should be very cautious about providing specific guidance without the input of a physician, the greater the teacher's knowledge base, the more likely he/she is to be able to counsel students accurately. Vocal health problems run the gamut from common colds to cancer, and many students have particular concerns about potential environmental hazards that may affect vocal health. One such hazard is asbestos exposure, which is associated clearly with serious lung disease. However, the association with laryngeal cancer is less clear. This article is derived from a prior publication (with permission) and is provided to bring singing teachers up-to-date on what we know about this important problem.1Medicine is replete with assumptions and myths based on faulty reasoning. It is important for all of us to be aware of this problem and diligent about assessing evidence to draw the best possible conclusions. One of the most frequent errors results from post hoc ergo propter hoc reasoning. This classic error in logic assumes that because Event B happens after Event A, Event B is caused by Event A. Proof of causation requires considerably more rigorous evidence. The suggestion that asbestos exposure can cause laryngeal cancer appears to be an example of this flaw in logic.It was estimated in 2008 that in the United States, laryngeal carcinoma would affect 12,250 adults, of whom 3,670 would die. The mean age of diagnosis of laryngeal carcinoma is 65 years, and the mean age of death caused by this tumor is 69 years.2 Known risk factors for laryngeal carcinoma include cigarette smoking and ethanol use. These factors have been shown to have a synergistic effect in the development of carcinoma, and singers and professional voice users should be educated early in their careers to not smoke and to moderate alcohol consumption.In the late 1970s, medical evidence determined a connection between asbestos exposure and mesothelioma, a very aggressive lung cancer. The manufacturing of building materials containing asbestos was stopped. In 1989, the United States EPA (Environmental Protection Agency) banned all new uses of asbestos; uses developed before 1989, however, were still allowed. In 2005, Senators Harry Reid and Bill Frist established a National Asbestos Awareness Day to raise public awareness of the dangers of asbestos exposure.3Asbestos is the name of a group of six naturally occurring minerals which contain long thin fibers that can be easily separated. These fibers are resistant to heat, fire, and chemicals, and they do not conduct electricity. Because asbestos is flame resistant and has excellent insulation properties, it was used extensively in building materials such as ceiling tiles, ductwork for heating and cooling systems, vinyl floor coverings, and others. Asbestos has also been used in the automobile industry, in particular in brake pads and linings and clutches. However, asbestos is usually encountered through occupational exposure including construction work, shipyards, mining, oil refineries, processing plants, chemical and power plants. Firefighters and auto mechanics may also have occupational exposure to asbestos.A possible association between asbestos exposure and laryngeal carcinoma has been evaluated throughout the years. However, there are numerous conflicting reports, and a link between asbestos and laryngeal cancer has not been proven.In 1975, Stell and McGill were the first authors to propose a link between asbestos exposure and laryngeal carcinoma.4 One hundred nineteen patients with squamous cell carcinoma of the larynx were identified. Compared to age-matched controls, a greater proportion of patients had significant asbestos exposure (27.7 vs. 2.5%; p

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