{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T18:32:02Z","timestamp":1786386722929,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Heavy metals are established human carcinogens, and lead exposure via drinking water has been linked to esophageal cancer. This study aimed to investigate the association between various levels of lead exposure in drinking water and incidence rates of head and neck cancers (HNC) in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Ecological study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>County\u2010level data from 608 US counties included in the Surveillance, Epidemiology, and End Results (SEER) database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>County\u2010level HNC incidence rates and sociodemographic variables were obtained from SEER. Drinking water lead concentrations were sourced from the Environmental Protection Agency (EPA) and spatially interpolated using inverse distance weighting (IDW). Tobacco and alcohol use data were retrieved from the Centers for Disease Control and Prevention (CDC). Flexible semi\u2010parametric regression models were used to assess the association between lead exposure and HNC incidence, adjusting for known confounders. Multiple comparisons were addressed using Holm's method, and sensitivity analyses were performed using ordinary least squares (OLS) models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher lead concentrations were significantly associated with increased incidence of oral and pharyngeal cancers (incidence rate ratio [IRR]\u2009=\u20091.05, 95% CI 1.00\u20101.08,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.01), gum and mouth cancers (IRR\u2009=\u20091.03, 95% CI 1.00\u20101.08,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.02), and esophageal neoplasms (IRR\u2009=\u20091.01, 95% CI 1.00\u20101.03,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.02). These associations remained significant after multiple testing correction and were consistent across OLS models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This is the first study to demonstrate that even low\u2010level lead exposure below EPA limits in drinking water is associated with increased incidence of specific HNC subsites. These findings highlight the importance of continued investigation into environmental determinants of HNC.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Level of Evidence<\/jats:italic>\n                      . II\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70128","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T12:35:36Z","timestamp":1768826136000},"page":"458-464","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of Lead in Drinking Water With Head and Neck Cancer in the United States"],"prefix":"10.1002","volume":"174","author":[{"given":"Henrique Ochoa","family":"Scussiatto","sequence":"first","affiliation":[{"name":"Department of Surgery University of Illinois Chicago Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9742-4225","authenticated-orcid":false,"given":"Evan A.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Rush University Medical Center Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin M.","family":"Stenson","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Rush University Medical Center Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer","family":"Al\u2010Khudari","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Rush University Medical Center Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Jelinek","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Rush University Medical Center Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Rush University Medical Center Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa C.","family":"Stubbs","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Rush University Medical Center Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayant M.","family":"Pinto","sequence":"additional","affiliation":[{"name":"Section of Otolaryngology\u2013Head and Neck Surgery, Department of Surgery The University of Chicago Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihir K.","family":"Bhayani","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Rush University Medical Center Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2007.113555"},{"key":"e_1_2_9_3_1","volume-title":"The U.S. Experience with the Phasedown of Lead in Gasoline","author":"Newell RG","year":"2003"},{"key":"e_1_2_9_4_1","unstructured":"WIIN grant: reducing lead in drinking water. 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