—Dr Garner is correct in pointing out that the major risk factors for nasopharyngeal carcinoma do not generally include alcohol and tobacco use.1 Some studies, however, have shown that heavy exposure to tobacco2 or alcohol3 may be linked to the development of nasopharyngeal carcinoma. Unfortunately, Henderson et al4 failed to address the question of the amount of exposure to tobacco and alcohol in their review of nasopharyngeal carcinoma risk factors that was referenced by Dr Garner.Was Babe Ruth's cancer caused by his lifelong heavy use of tobacco and alcohol? In light of the best information available about nasopharyngeal carcinoma risk factors and about the life of Babe Ruth, his cancer probably was tied to his lifelong vices.Given the magnitude of health risks involving alcohol and tobacco use—and particularly in view of the habits exemplified by many professional athletes of today5 and
Thomas RJ. Babe Ruth, Tobacco, Alcohol, and Cancer-Reply. JAMA. 1988;259(6):840–841. doi:10.1001/jama.1988.03720060012014
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