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All elemental measurements were performed at that time, and the present work is based on a subsequent analysis and interpretation of the resulting dataset. The ethical validity of this cohort has been previously established and accepted in international peer-reviewed journals:The biopsy sample analysis was published in\n                      Science of The Total Environment\n                      (Khlifi et al.\n                      \n                      ):Khlifi R, Olmedo P, Gil F, Hammami B, Chakroun A, Rebai A, Hamza-Chaffai A (2013) Arsenic, cadmium, chromium and nickel in cancerous and healthy tissues from patients with head and neck cancer. Sci Total Environ 452\u2013453:58\u201367.\n                      \n                      .The blood sample analysis was published in\n                      Environmental Science and Pollution Research\n                      (khlifi et al.\n                      \n                      ; 2014):Khlifi R, Olmedo P, Gil F, Molka FT, Hammami B, Rebai A, Hamza-Chaffai A (2014) Risk of laryngeal and nasopharyngeal cancer associated with arsenic and cadmium in the Tunisian population. Environ Sci Pollut Res 21:2032\u20132042.\n                      \n                      .Khlifi R, Olmedo P, Gil F, Feki-Tounsi M, Chakroun A, Rebai A, Hamza-Chaffai A (2013) Blood nickel and chromium levels in association with smoking and occupational exposure among head and neck cancer patients in Tunisia. Environ Sci Pollut Res 20:8282\u20138294.\n                      \n                      .All procedures were performed in accordance with the ethical standards of the Institutional Review Board of\n                      Habib Bourguiba Hospital, Sfax\n                      and with the 1964 Helsinki declaration and its later amendments. Specific informed consent was obtained from all participants at the time of recruitment.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"This is not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}