Oral Cavity and Oropharyngeal Cancer Disparities in Alabama and the United States: A Review

Abstract

IntroductionIn the United States, an estimated 53,000 people developed new cases of oral cavity and pharyngeal cancers (OPC) in 2019, and an estimated 10,860 deaths were associated with OPC. While oral cavity and pharyngeal cancers affect people of all ages, races, ethnicities, and genders, many recent epidemiological studies of OPC have identified significant disparities in OPC incidence and mortality rates among differing populations. There are 2 main etiologic factors that lead to the development of OPC. The first is by modifiable risk behaviors, and the second is infection by the human papillomavirus (HPV). Studies have shown that HPV not only causes cervical and anal cancers, but also causes a subset of head and neck squamous cell carcinomas (HNSCC). MethodsOPC prevalence, mortality, incidence based on gender, race, and anatomical location published by the Surveillance, Epidemiology, and End Results Program (SEER) and the Alabama Statewide Cancer Registry from 1980 to 2016 were examined. ResultsOral cancer is more common in men than women, among those with a history of tobacco or heavy alcohol use, and individuals infected with HPV. Current trends show that OC and OP cancer incidence are decreasing in African-American males, and that overall incidence rates are highest in White males. Furthermore, incidence rates in Blacks have been decreasing from 1980 from a rate of 16.82 per 100,000 to 8.64 per 100,000 in 2016. In contrast, incidence rates have been relatively unchanged for the White population in the same time period, a decrease from 12.98 to 12.64 per 100,000.According to SEER data of OC and OP cancers, mortality rates in 1980, per 100,000, are 6.97 in Blacks and 3.87 in Whites. However, over the course of the past few decades, data show a dramatic improvement in the mortality rates in Blacks from 6.97 to 2.63 per 100,000 in 2016, and slight improvement in mortality rate in Whites from 3.87 to 2.60 per 100,000 in 2016. One study published in 2009 suggested that better survival outcomes in White OP cancer patients were associated with better-prognosis HPV-positive tumors, which are rarer in the Black population.Interestingly, while overall mortality rates are similar for the White and Black populations with OC and OP cancers in 2016, there is still a significant disparity when looking at the 5-year survival rates. In the period of 1978-1980, the 5-year survival percentage for the White population with OPC is 55.4% vs. 34.9% in the Black population with OPC. In the period of 2009-2015, the 5-year survival rate for the White population with OPC is 70.3% vs. 50.9% in the Black population with OPC. In Alabama, incidence rates for OC and OP cancers have remained stable from 2005 to 2014 with rates from 13.1 to 12.9 per 100,000. Compared to overall incidence rates in the United States from 2010-2015, incidence rates in Alabama were higher for Black males, White males, and females. Mortality rates were also worse for the same patient populations in Alabama as compared to the United States. The higher incidence rates in Alabama may be associated with higher levels of tobacco use in the state as compared to the rest of the country.