The short answer
Tobacco and alcohol use are the two biggest risk factors for head and neck cancer, and using both together raises risk further. HPV infection is a separate, growing cause of oropharyngeal cancer. Having a risk factor does not mean cancer is certain.
NCI says current smokers have about 5 to 10 times the risk of oral cavity, throat and voice box cancers compared with people who never smoked.
Having 2 or more alcoholic drinks a day raises risk 2 to 6 times, and combining heavy drinking with tobacco raises risk further still.
Infection with HPV type 16 is a separate, major risk factor for oropharyngeal cancer.
Betel quid chewing is a risk factor; it contains areca nut, a cancer-causing substance.
On this page
Choose how you want to read this
The whole article, with every detail and caution.
The simple version
Head and neck cancers have a handful of well-known risk factors. The two biggest are tobacco and alcohol use. A separate cause is infection with certain types of HPV (human papillomavirus), a very common virus.
Having a risk factor, even a strong one like tobacco use, does not mean cancer is certain. And having head and neck cancer is never something to be blamed for.
Tobacco and alcohol
- Tobacco use. Current smokers have a risk of these cancers about 5 to 10 times higher than people who never smoked. All forms of tobacco can cause these cancers, including cigarettes, pipes, cigars, and smokeless tobacco.
- Alcohol use. Risk is 2 to 6 times higher in people who have 2 or more alcoholic drinks a day.
- Tobacco and alcohol together. Using both raises risk more than either alone. NCI says the risk of oral cavity and oropharyngeal cancer is about 5 to 14 times higher in people who both smoke and drink heavily.
HPV: a separate risk factor
Infection with cancer-causing types of HPV is a major risk factor for cancer of the oropharynx, which is the tonsils and the base of the tongue. HPV-16 matters most. Oral HPV-16 infection raises the risk of oropharyngeal cancer about 15 times. This is a separate risk factor from tobacco and alcohol.
Other risk factors
- Betel quid chewing. Betel quid contains areca nut, a cancer-causing substance. NCI says the risk increases with how often and how long it is chewed.
- Personal history. A past head and neck cancer raises the risk of a new one.
In short: tobacco, alcohol, and HPV infection are the three main risk factors, and they act somewhat separately from each other.
Blame does not help
If tobacco or alcohol use is part of your history, a risk factor raises the chance of cancer but does not make it certain. Blame does not help you now.
If your cancer is linked to HPV, that is also nothing to feel shame about. CDC says nearly everyone will get HPV at some point, and that most infections clear on their own within 2 years without causing health problems.
Wherever your cancer came from, the path forward is the same: good care, honest information, and support without judgment.
Sources
- CDC, About HPV
- National Cancer Institute, Head and Neck Cancers
- National Cancer Institute, Oropharyngeal Cancer Treatment (PDQ)
- National Cancer Institute, Oral Cavity, Oropharyngeal, Hypopharyngeal, and Laryngeal Cancer Prevention (PDQ®)–Patient Version
Common questions
Does everyone with head and neck cancer smoke or drink heavily?
Not necessarily. Tobacco and alcohol are the two biggest risk factors, but infection with cancer-causing HPV types, especially HPV-16, is a separate risk factor for oropharyngeal cancer, the cancer of the tonsils and base of the tongue. NCI also lists past head and neck cancer and betel quid chewing.
What is HPV-positive oropharyngeal cancer?
It is oropharyngeal cancer (cancer of the tonsils or base of the tongue) linked to infection with certain types of human papillomavirus, especially HPV type 16. NCI says oropharyngeal tumors related to HPV have a better prognosis and are less likely to recur than tumors not linked to HPV, and they are staged using their own system.
I smoked and drank for years. Did I cause my cancer?
Tobacco and alcohol use raise risk, but a risk factor does not guarantee cancer. What matters now is the care and support in front of you, not blame. Your care team can help you with quitting tobacco or cutting back on alcohol.
Can HPV vaccination help prevent this?
NCI says getting an HPV vaccination greatly lessens the risk of oral HPV infection. CDC says the vaccine series is most protective when given before exposure to the virus and recommends vaccination at ages 11 to 12. Talk with a doctor about vaccination.
What is betel quid?
Betel quid is a chewed mixture that contains areca nut, which NCI describes as a cancer-causing substance. NCI says risk increases with how often and how long it is chewed.
Questions to ask your doctor
Being prepared helps you get the most out of your appointments. Save or print these questions.
Tap a question to save it to your list (kept on this device).
Talk with a trained specialist or navigator
Cancer Explained provides educational guidance, but does not replace trained specialists, social workers, or your medical team.
Talk to a trained cancer information specialist
Free, confidential assistance from NCI Cancer Information Service via phone, chat, or email.
Contact your oncology team
Locate after-hours contact numbers, portal messages, or urgent triage phone lines.
Find a patient navigator
Get one-on-one help with appointments, logistics, translation, and care coordination.
Find a genetic counselor
Discuss inherited mutation risk, family history, and genetic testing options.
Find an oncology social worker
Access emotional counseling, family support groups, and mental health resources.
Find a financial navigator
Locate copay assistance foundations, grant programs, and lodging/travel support.
Find a clinical-trial specialist
Search matching studies and speak with NCI trial information specialists.
Get urgent help
Fever of 100.4°F (38°C) or higher during chemo, severe pain, or trouble breathing: call your cancer care team right away, day or night. Call 911 for an emergency.
Plain-language explanation of the published sources cited on this page. AI-assisted, source-checked, not clinician-reviewed.
Last updated: 2026-10-16Next planned review: 2027-08-03
Review details and limits
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes, and this is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status — Source checked. This page was written with AI assistance and then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. It is not a medical review, and it does not confirm the page is complete or right for your situation.
General education — varies by person. Answers genuinely differ between people. This page explains what commonly varies and points you to your care team for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
Words to know
Tap any term to see what it means.
How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes, and this is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
Read more about our editorial process, our use of AI, and our corrections policy.
Spotted a problem? Report an error — a factual mistake, broken or outdated source, confusing wording, or anything that seems unsafe. Please do not include names, medical record numbers, dates of birth, addresses, or other identifying medical information in your report.
After using this page, do you understand what to do next?
Anonymous — we only record the answer, never who gave it.