Head and Neck Cancer Incidence and Trends Differ by Site, Race, and Sex

Abstract

<h3>Purpose/Objective(s)</h3> The current literature unifies head and neck cancers (HNC) by similar histology and adjacent anatomic sites. Although the epidemiology and etiology of each HNC site differ substantially, national cancer registries often report cancer sites aggregately, rely on outdated site classification systems, and lack robust demographic data. This study aims to longitudinally compare HNC incidence trends by tumor site, race, and sex. <h3>Materials/Methods</h3> We calculated HNC incidence by site using the U.S. Cancer Statistics Public Use Database from 2001-2017. We calculated incidence rates per 100,000 and examined incidence trends by HNC site. Longitudinal site trends in incidence and absolute counts were stratified by race (White, Black, Hispanic, other) and sex and assessed using a joint-point analysis to generate annual percent changes (APCs) with 95% confidence intervals (CI). <h3>Results</h3> The overall HNC incidence increased due to rising oropharyngeal cancer (OPC) incidence among White males, with APC changing from 4.38% [95% CI: 3.6-5.1] to 2.93% [95% CI: 2.5-3.3] in 2008. OPC incidence increased to a lesser extent among White women (APC 1.16% [95% CI: 0.81-1.52]) and remained relatively stable or decreased in most other demographic subgroups. Oral cavity cancer incidence is rising significantly in other race males (APC 2.5% [95% CI:1.6-3.4]) and White females (APC 0.96% [95% CI: 0.7-1.2]). Laryngeal cancer incidence, though decreasing, remains disproportionately high among Black males (APC -1.154% [95% CI:-1.48 to -0.83]). Even in cases of decreasing incidence by site, absolute case counts hold steady or increase over time. <h3>Conclusion</h3> The overall increase in US HNC incidence was primarily driven by the rising incidence of OPC in White males, but notable differences at other sites are present in minority groups. These include high rates of oral cavity and laryngeal cancer in White females and Black males, respectively, and increasing oral cavity cancer incidence among White females and other race males. Varied rates of Human papillomavirus (HPV) exposure, HPV-vaccination, and tobacco/alcohol use and cessation in certain minority groups could account for these differences. The overall rise in HNC counts reflects national population growth collectively and among racial minorities, specifically a rapidly growing Asian and Hispanic population in the United States. Incidence trends of HNC sites in minority groups are nuanced, and analysis is necessary to understand and address disparities.