“My voice has gone husky — it’s just a smoker’s throat”

Hoarseness persisting beyond ~3 weeks — especially progressive and in a smoker over 45 — is a red flag for laryngeal/head-and-neck cancer, NOT "a smoker’s throat" or a lingering cold, so NICE NG12 recommends considering a suspected cancer pathway referral for laryngeal cancer for persistent unexplained hoarseness (or an unexplained neck lump) in those aged 45 and over — with no smoking requirement — and treating it with a spray/antibiotics without examination is the dangerous miss. Elicit and weight the associated red flags (a neck lump, unilateral referred otalgia with a normal ear, globus, dysphagia/odynophagia, sore throat) and the combined smoking + heavy-alcohol risk, examine the throat/oral cavity/neck/ears, and recognise an unexplained persistent neck lump as itself warranting urgent referral. Reassure genuinely (early laryngeal cancer is very treatable, often voice-preserving — urgent referral is precautionary) and address smoking and alcohol supportively without a lecture that alienates. The hidden agenda is avoidance masking a noticed neck lump and an unvoiced cancer fear (and worry about voice/livelihood and being told to stop smoking/drinking); gently challenge the minimisation, name the concern honestly while reassuring, and refer.