Neck Cancer Incidence Research Articles

Measured Adiposity in Relation to Head and Neck Cancer Risk in the European Prospective Investigation into Cancer and Nutrition.

Background: Emerging evidence from cohort studies indicates that adiposity is associated with greater incidence of head and neck cancer. However, most studies have used self-reported anthropometry which is prone to error.Methods: Among 363,094 participants in the European Prospective Investigation into Cancer and Nutrition study (EPIC) with measured anthropometry, there were 837 incident cases of head and neck cancer. Head and neck cancer risk was examined in relation to body mass index (BMI) [lean: <22.5 kg/m2, normal weight (reference): 22.5-24.9 kg/m2, overweight 25-29.9 kg/m2, obese: ≥30 kg/m2], waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) using Cox proportional hazards models.Results: Among men, a BMI < 22.5 kg/m2 was associated with higher head and neck cancer risk [HR 1.62; 95% confidence interval (CI), 1.23-2.12)]; BMI was not associated with head and neck cancer among women. WC and WHR were associated with greater risk of head and neck cancer among women (WC per 5 cm: HR, 1.08; 95% CI, 1.02-1.15; WHR per 0.1 unit: HR, 1.64; 95% CI, 1.38-1.93). After stratification by smoking status, the association for WHR was present only among smokers (Pinteraction = 0.004). Among men, WC and WHR were associated with head and neck cancer only upon additional adjustment for BMI (WC per 5 cm: HR 1.16; 95% CI, 1.07-1.26; WHR per 0.1 unit: HR, 1.42; 95% CI, 1.21-1.65).Conclusions: Central adiposity, particularly among women, may have a stronger association with head and neck cancer risk than previously estimated.Impact: Strategies to reduce obesity may beneficially impact head and neck cancer incidence. Cancer Epidemiol Biomarkers Prev; 26(6); 895-904. ©2017 AACR.

Patterns of head and neck cancer incidence, mortality, and survival in the U.S. Hispanic population.

e13084 Background: To compare the incidence, mortality, and survival of head and neck cancer (HNCA) in the U.S. Hispanic population to other racial/ethnic groups. Methods: Using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, we compared the incidence and mortality of cancer of the oral cavity, pharynx, and larynx between the U.S. Hispanic population versus other racial and ethnic subgroups, as well as the annual percent change between 2000-2013. A comparative analysis for different groups stratified by age and sex was performed. Survival analysis was performed using Kaplan-Meier estimate and logistic regression analysis. Results: The incidence of oral cavity, pharyngeal, and laryngeal cancers were significantly lower in Hispanics compared to Non-Hispanics (p &lt; 0.05). The incidence of laryngeal cancer decreased significantly at a rate of 2.5% annually (p &lt; 0.05), while incidence of oral cavity and pharyngeal cancers remained unchanged in U.S. Hispanics. The mortality rate for oral cavity, pharyngeal, and laryngeal cancers in the U.S. Hispanic population were 1.4 per 100,000, 1.1 per 100,000, and 1.2 per 100,000 respectively. Mortality rates in Hispanics were significantly lower compared to Non-Hispanics (p &lt; 0.05). Non-Hispanics Blacks had the highest HNCA-related mortality among all the compared groups. The mortality of HNCA was significantly declining annually in the U.S. Hispanic population (p &lt; 0.05). Conclusions: The incidence and mortality of HNCA in the U.S. Hispanic population appears to be declining and is significantly lower compared to Non-Hispanics.

Chapter 1 Neck Anatomy, Imaging-Based Level Nodal Classification and Impact of Primary Tumor Site on Patterns of Nodal Metastasis

The anatomy of the neck is complex, with many critical structures crowded together in a relatively small cross-sectional area. Many structures in the neck also have similar soft tissue density or signal that further complicates interpretation for the radiologist, who relies on tissue differences to create contrast resolution and distinguish structures. Head and neck cancer incidence exceeds 550,000 cases per year worldwide, with diagnosis, treatment, and prognosis relying highly on a thorough knowledge of this compact space. This article focuses on reviewing head and neck anatomy with special attention to nodal anatomy and on discussing the expected patterns of nodal spread in head and neck cancers.

Trends and the utilization of transoral robotic surgery with neck dissection in New York State.

The timing of neck dissection (ND) in relation to transoral robotic surgery (TORS) is controversial. This study identifies local practice patterns and economic and social access disparities during adoption of TORS. We analyzed utilization patterns of TORS and ND using the New York Statewide Planning and Research Cooperative System all-payer administrative database. Statewide head and neck cancer incidence from the Centers for Disease Control and Prevention (Bethesda, MD) was used to control for overall cancer incidence. Patient demographic, insurer, and institutional information of patients aged ≥ 18 (n = 225) years from 2008 to 2012 were evaluated. Temporal trends were analyzed with Poisson regression models for counts. Transoral robotic surgery was used in 386 procedures, and 58.3% involved ND (n = 225). Concurrent ND was most frequent (n = 173), followed by staged TORS then ND (n = 44) and staged ND preceding TORS (n = 8). Caucasians were more likely than Blacks/Hispanics to undergo TORS (P = 0.03). Medicare (26.2%) and Medicaid (2.7%) payers comprised a minority of patients compared to those commercially insured (70.2%). Only 20% of patients received care outside a major urban center, and these patients were more likely to undergo staged procedures, P = 0.02. Staged procedures resulted in higher mean hospital charges (P = 0.02). Concurrent TORS + ND, the most common practice in New York, is more cost-effective. Patients without commercial insurance, patients in racial minorities, or patients residing outside major urban centers may be targeted to improve care access disparities with respect to minimally invasive TORS technology. 2c. Laryngoscope, 127:1571-1576, 2017.

Recruitment of underserved, high-risk participants to a head and neck cancer screening program.

Early detection is essential in head and neck cancer treatment as prognosis varies greatly with stage at diagnosis. Underserved populations often present with advanced disease, and individuals with tobacco and heavy alcohol use demonstrate a higher head and neck cancer incidence. This study aims to evaluate whether various promotional methods differentially recruited behavioral risk factor positive and/or underserved populations to our screening event. Prospective cross-sectional study. A hospital-based, medical student-run, free head and neck cancer screening event for 187 participants was held in April 2015. Medical campus-based, community-based, and media-based promotions were implemented to recruit participants. Event participants filled out questionnaires to determine how they were recruited, their risk-factor history, and their socioeconomic status. Prevalence of the higher-risk population across the various promotional methods was analyzed. Community-based promotions were significantly associated with the recruitment of participants in the underserved subgroups, namely uninsured (P = .019), unemployed (P = .006), and those with an annual household income <$20,000 (P < .001). Although not statistically significant, participants with behavioral risk factors reported a higher percentage of recruitment by media-based promotions. Campus-based promotions led to the highest absolute number, but not percentage, of higher-risk participants. Community-based promotions most efficiently recruit underserved guests to participate in a hospital-based head and neck cancer screening event as compared to media and campus-based promotions. Institutions interested in recruiting higher proportions of underserved guests to these screening events should consider focusing attention and allocation of resources to community-based promotions. 4 Laryngoscope, 126:2699-2704, 2016.

Current Concepts in Osteoradionecrosis after Head and Neck Radiotherapy

Osteoradionecrosis (ORN) of the jaws is a feared complication of head and neck radiotherapy. ORN causes significant morbidity for patients and controversy among clinicians. This overview considers the variations in definition and classification of the condition that affect estimates of incidence and also the interpretation of evidence. The influence of newer radiotherapy techniques in reducing ORN through reduced dose and xerostomia is balanced against a probable increase in a vulnerable population through a rising head and neck cancer incidence. Theories of pathophysiology of ORN include radiation-induced osteomyelitis, hypoxic and hypovascular theory and fibroatrophic theory. Prevention strategies include restorative dentistry and radiation planning techniques. Treatments range from conservative ‘watch and wait’ through to more radical surgical strategies. Newer medical management strategies are available with a limited evidence base. The use of hyperbaric oxygen therapy remains controversial and the background and need for newer hyperbaric oxygen trials is discussed.

Abstract LB-269: Nutritional effect on CD44 in head and neck cancer

Abstract Head and neck (HN) cancer incidence accounts for more than 550,000 cases annually worldwide, with an estimated of 55,000 Americans developing head and neck cancer each year. There are multiple risk factors associated with HN cancer including smoking, alcohol consumption, human papillomavirus (HPV) infection, genetic predisposition, poor oral hygiene, periodontal disease and poor diet. According to World Health Organization (WHO), 35 - 55% of human cancers and approximately 15% of oropharyngeal cancers can be attributed to dietary deficiencies or imbalances. There is convincing evidence that we can reduce the risk of cancer, including that of oral cancer through improved nutrition. CD44 is a cancer stem cell marker associated with HN cancer and poor prognosis. Protein levels in saliva are also associated with HN cancer risk. This study will investigate the relationship between nutritional effect of a balanced diet which includes fruits and vegetables and levels of CD44 and salivary protein. 150 participants diagnosed with HN cancer and 150 controls were frequency matched for tobacco use, alcohol, age, gender, race and socioeconomic status. Participants completed a lifestyle questionnaire which included questions about fruit and vegetable consumption. Oral rinse CD44 and protein levels were measured in both groups. We did a preliminary investigation on the number of servings of juice, salad, fruits, carrots, potato and other vegetables within the cancer case and control groups to determine whether there was an association between these dietary variables and CD44 and protein levels. HN cancer cases who ate salad one or more times per week were found to have significantly lower CD44 levels than those who ate salad less frequently (4.22ng/ml verses 7.09 ng/ml p = 0. 004). Since high CD44 levels are associated with worse prognosis, these findings suggest that dietary factors such as greater salad intake may be associated with better HN cancer prognosis. Citation Format: Turki M. Almuhaimid, Faisal F. Alotaibi, Erika Rearegue, William Goodwin, Elizabeth Franzmann. Nutritional effect on CD44 in head and neck cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-269. doi:10.1158/1538-7445.AM2015-LB-269

Cancers de la sphère ORL chez les patients séropositifs pour le virus de l’immunodéficience humaine

Among HIV-infected patients, head and neck cancer incidence has increased over the last few years. Head and neck cancer treatment in HIV-infected patients does not differ from the general population but those patients are exposed more frequently to radiation severe toxic effects and need close monitoring during chemoradiotherapy treatment. Close cooperation between oncologist and infectiologist is crucial to eventually adjust antiretroviral therapy. Like general population, HIV-infected patients should be advised to avoid excessive alcohol consumption and tobacco smoking.

Abstract C93: Head and neck cancer trends in Trinidad and Tobago

Abstract Background: Head and neck squamous cell carcinoma (HNSCC) include tumors that arise in the oral cavity, pharynx and larynx. A steady decline in HNSCC incidence has been observed world-wide, and is likely attributed to declining prevalence of tobacco and alcohol consumption. Exceptions to this observation have been a steady increase in the incidence of cancers arising in the oropharnyx/tonsil which has been associated in the United States and Europe with an increasing incidence of HPV-positive tumors. Survival from head and neck cancer is poor, ∼50%; however HPV-related oropharyngeal cancer patients are known to have significant longer survival compared to non-oropharyngeal cancer patients. To date there are no data reported for the Caribbean Islands. Objective: To review head and neck cancer (HNSCC) incidence and outcomes in Trinidad and Tobago (TT) and compare trends to that of the United States. Methods: National cancer registry data from the Dr. Elizabeth Quamina National Cancer Registry of Trinidad and Tobago was obtained for 742 HNSCC cases diagnosed between 1995-2007. Squamous cell cancers of the oral cavity, pharynx, and larynx were analyzed. Data from the US SEER database were obtained for age adjusted incidence comparison. Kaplan-Meier survival analyses was performed on the two groups. Results: The majority (323, 43.5%) of TT patients had larynx cancer, were of African ancestry (296, 39.9%), with East Indians representing a significant minority (230, 31.0%). The male:female cancer ratio was 4.5:1. Female patients were more likely to have oral cancer (OR 3.7, CI 2.5-5.4), and less likely larynx cancers (OR 0.3, CI 0.2-0.5). The majority of African ancestry patients were diagnosed with larynx cancer (44%), while the majority of Indians were diagnosed with oral cavity tumors (38.1%). Age-adjusted incidence trends in TT and the US SEER database showed a decrease in larynx cancers until 2001 when a rise in TT larynx cancers was identified. While a rise in oropharynx prevalence was seen in the SEER data from 1995-2006, oropharynx cancer remained on the steady decline in TT. Survival in this series was poor with 16.9% 5y localized disease specific survival (DSS), and 6.3% and 8.7% regional and distant metastasis 5y DSS. No survival advantage was seen in TT oropharynx cases versus non-oropharynx cases. Conclusions: Most HNSCC in TT are diagnosed in African ancestry males with larynx cancer. Indian patients and females were more likely to have oral cancer. No increase in oropharynx cancers were seen the TT registry in recent years, a clear difference from US SEER data over the same period. HNSCC survival is uniformly poor. Citation Format: Camille Ragin, Jeffrey Liu, Elizabeth Blackman, Veronica Roach, Karthik Devarajan, Kimlin Tam Ashing, Samuel Gathere, Emanuela Taioli. Head and neck cancer trends in Trinidad and Tobago. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C93. doi:10.1158/1538-7755.DISP13-C93

International trends in head and neck cancer incidence rates: Differences by country, sex and anatomic site

To describe trends in country and sex-specific incidence rates of head and neck cancer (HNC), focusing on changes across calendar periods. Sex and country specific rates of HNC were calculated for 1998-2002 and 1983-1987 using population-based registry data assembled by the Cancer Incidence in Five Continents (CI5) data system for 83 registries representing 35 countries. HNCs were categorized into three groups: oral cavity (including tongue and mouth), oropharynx (including tonsil and oropharynx) and other HNC (including larynx and poorly-specified tumors of the lip/oral cavity/pharynx). Age-standardized rates per 100,000 persons were calculated using the 1960 world standard population. Changes in rates between 1998-2002 and 1993-1987 were assessed. During these periods there was substantial global variation in HNC incidence trends by cancer site, country/registry and sex. Rates of oral cavity cancer increased among men and women in some European and Asian countries (Czech Republic, Slovak Republic, Denmark, Estonia, Finland, the United Kingdom and Japan). In France and Italy, rates declined among men but increased among women. Oral cavity incidence rates declined among men and women in many Asian registries as well as in Canada and the United States. Oropharyngeal cancer rates increased among both men and women in a number of European countries (Belarus, Czech Republic, Denmark, Finland, Iceland, Latvia, Norway and the United Kingdom) whereas they declined in some Asian countries. The largest increase in oropharyngeal rates was among Brazilian men. Rates of other HNCs varied substantially by country and sex. From 1983-1987 to 1998-2002, trends in HNC rates differed by subtype, country and sex. Oral cavity cancer incidence rates increased in many countries with tobacco epidemics that are currently peaking and declined in areas where tobacco use peaked some time ago. In contrast, rates of oropharyngeal cancer increased in a number of countries where tobacco use has declined, perhaps due to the emerging importance of human papillomavirus infection. Continued monitoring of trends in incidence rates is needed to inform global cancer prevention strategies.

Risk of laryngeal and nasopharyngeal cancer associated with arsenic and cadmium in the Tunisian population

Chronic exposure to heavy metals has long been recognized as being capable of increasing head and neck cancer (HNC) incidence, such as laryngeal (LC) and nasopharyngeal (NPC), among exposed human populations. The aim of the present study was to evaluate the concentrations of arsenic (As) and cadmium (Cd) in the blood of 145 patients (LC and NPC) and 351 controls in order to establish a potential relationship between these factors and the occurrence of LC and NPC. Mean blood levels of As and Cd in patients (5.67 and 3.51 μg/L, respectively) were significantly higher than those of controls (1.57 and 0.74 μg/L, respectively). The blood levels of As and Cd were mostly significantly higher than those of controls (p<0.05) after controlling the other risk factors of HNC including tobacco smoking and chewing, and alcohol drinking. Cd levels in blood increase significantly with the number of occupational exposure years for patients (p<0.05). However, seafood was not found to be contributing as an exposure source. Among these risk factors, smoking (>30 pack years) and occupational exposure (>20 years) presented the most significant association with HNC (OR=10.22 and 10.38, respectively, p<0.001). Cd level in blood sample of cases that are occupationally exposed/tobacco users (smokers and chewers) were higher than that of non-occupationally exposed/nontobacco users (p<0.001). The logistic regression model illustrated that HNC (LC+NPC) was significantly associated with blood levels of As (OR=2.41, p<0.001) and Cd (OR=4.95, p<0.001).

Incidence of head and neck cancer and socioeconomic status in Canada from 1992 to 2007

To investigate the association between head and neck cancer (HNC) incidence and socioeconomic status (SES) in Canada, and investigate changes in the relationship between HNC incidence and SES from 1992 to 2007. Cases were drawn from the Canadian Cancer Registry (1992-2007), and were categorized into three subsites: oropharynx, oral cavity, and "other" (hypopharynx, larynx, and nasopharynx). Demographic and socioeconomic information were extracted from the Canadian Census of Population data for the study period (1992-2007), which included four census years. We linked cases to income quintiles (InQs) according to patients' postal codes. Incidence rates in the lowest InQs were significantly higher than in the highest InQs for all HNC subsites. The incidence of oropharyngeal cancer increased over the time period 1992-2007 for all InQs. However, the greatest increase in incidence was in the highest InQs. As a result, over the time period the gap between the incidence of the highest and lowest InQs significantly narrowed for oropharyngeal cancer. For oral cavity cancer and the other head and neck cancers, the overall incidence did not increase and the gap in incidence did not change significantly. HNC incidence was higher with lower income in all HNC subsites in Canada from 1992 to 2007. The gap in incidence between the highest and the lowest InQs narrowed for oropharyngeal cancer over the time period studied, but was unchanged for the other HNC subsites.

Blood nickel and chromium levels in association with smoking and occupational exposure among head and neck cancer patients in Tunisia

Chronic exposure to chromium (Cr) and nickel (Ni) has long been recognized as being capable to increase head and neck cancer (HNC) incidence among exposed human populations. This study represents the first biomonitoring of Cr and Ni exposure in Tunisia and focuses on a possible association with HNC risk. The aim of the present study was to evaluate the concentrations of Cr and Ni in the blood of HNC patients and controls. Metals blood levels of 169 HNC patients and 351 controls were determined using a Perkin-Elmer Analyst 800 Atomic Absorption Spectrometer. Mean blood levels of Cr and Ni in HNC cases (52.15 and 111.60 μg/L, respectively) were significantly higher than those of controls (37.04 and 30.50 μg/L, respectively). Cases' blood levels of Cr and Ni were significantly higher than those of controls after controlling for the other risk factors of HNC, including smoking, shisha consumption, occupational exposure, and nearby environment (P<0.05). Among these risk factors, smoking and occupational exposure presented the most significant association with HNC (odds ratio (OR)=6.54 and 7.66, respectively, P<0.001). Cr and Ni levels in blood sample of cases and controls that are smoker/occupationally exposed were higher than that of non-smoker/non-occupationally exposed (P<0.05). Smokers who are occupationally exposed present the most significant association with HNC (OR=25.08, P<0.0001). High levels of blood Cr (OR=2.09) and high levels of blood Ni (OR=8.87) were strongly associated with HNC after other potential confounders were controlled (P=0.004 and P<0.0001, respectively). This study suggested a potential role of Cr and Ni in the mechanism of HNC development.

Abstract 2529: A prospective cohort study of body size and risk of head and neck cancers in the NIH-AARP Diet and Health Study.

Abstract Background: The association between body size and head and neck cancers has not been well understood, partly because of the biases in case-control studies (such as reverse causation due to pre-diagnosis weight loss and use of recalled weight), and partly because of the difficulties in adjusting for confounders such as tobacco smoking. The only published cohort study on this relationship showed reduced mortality, but not incidence, among overweight and obese people, which was only significant among smokers. Methods: In the prospective NIH-AARP cohort study, 218,854 participants (132,288 men and 86,566 women) aged 50-71, were cancer-free at baseline, and had valid data on weight, height, and waist and hip circumference. Cox proportional hazards regression was used to examine the associations between overall (BMI) and abdominal (waist and waist-to-hip ratio) body size and head and neck cancers (squamous cell carcinomas of the oral cavity, oro-and hypopharynx, larynx, and nasopharynx). The analyses were adjusted for confounders, among them current and past smoking habits, alcohol intake, education, race and fruit and vegetable consumption. Additional analyses were also done separately among never- and ever-smokers. Results: During follow-up from the study baseline (1995 and 1996) to 31 December 2006, a total of 779 incident head and neck cancers accrued to the cohort, including 342 in the oral cavity, 120 in the oro- and hypo-pharynx, 265 in the larynx, 12 in the nasopharynx, and 40 in more than one site. Overweight (BMI 25-30) was associated with a decreased risk of the overall head and neck cancer incidence (HR: 0.83; 95%CI 0.70-0.97). Among never-smokers, total head and neck cancer incidence was not associated with BMI, while in ever-smokers, having a BMI over 35 was associated with a lower risk (HR: 0.42; 95%CI: 0.21-0.83), adjusted for the number of past and current cigarettes smoked. Oro-and hypo-pharyngeal cancers showed an increased risk among lean people (BMI&amp;lt; 18.5 versus normal; HR: 4.32; 95CI: 1.53-12.18). For oro- and hypo-pharyngeal cancers, leanness increased the risk both in ever and never-smokers. Waist circumference and waist-to-hip ratio did not show significant associations with any of the cancer sites studied. Conclusion: This is the first prospective study to show that overall (but not abdominal) obesity was associated with a lower risk of incident head and neck cancers, especially among smokers. Risk of oro- and hypopharyngeal cancers showed an inverse association with BMI, irrespective of smoking habits, which may be due to their stronger link to HPV infection rather than smoking. Citation Format: Arash Etemadi, Mark G. O'Doherty, Neal D. Freedman, Albert R. Hollenbeck, Sanford M. Dawsey, Christian C. Abnet. A prospective cohort study of body size and risk of head and neck cancers in the NIH-AARP Diet and Health Study. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2529. doi:10.1158/1538-7445.AM2013-2529

Arsenic, cadmium, chromium and nickel in cancerous and healthy tissues from patients with head and neck cancer

Chronic exposure to heavy metals has long been recognized as being capable to increase head and neck cancer incidence among exposed human populations. Head and neck cancer is a significant public health issue in Tunisia. The aim of the present study was to evaluate the concentrations of As, Cd, Cr and Ni in healthy and tumor tissues of head and neck cancer patients. Metal concentrations were determined in tumor and healthy tissues of 101 head and neck cancer patients, using Atomic Absorption Spectrometry. The As, Cd, Cr, and Ni levels in tumor tissues were 3.4, 2.5, 1.3 and 1.5 times higher than those of healthy tissues (p<0.05), respectively. Tumor tissue metal levels were higher in men than in women. As and Cd levels in tumor and healthy tissue samples of patients smokers are significantly higher than those of non-smokers (p<0.05). A strong effect of cumulative smoking as expressed in the number of pack per year, and tumor tissue Cd levels were positively associated with three groups of age (<40, 51–60 and >60years) in both never-smokers and ever-smokers (<20 and ≥20 pack per year). Healthy tissue Cd levels were negatively associated with age in those three groups of smokers. The highest Cd and Cr concentrations among both workers and non-workers were observed in tumor tissues. The Cd and Cr in tissues of farmers, bricklayers and painters were all significantly higher among the workers as compared with the non-workers group. Tissue metal levels have increased due to smoking and occupational exposure. Heavy metal exposure via tobacco smoking and occupational exposures may increase the risk of head and neck in the Tunisian population.

Incidence and mortality trends of head and neck cancer in Croatia in the period 1988–2008

Conclusion: Head and neck cancer (HNC) incidence and mortality trends in men displayed a significant downward trend in Croatia during the study period. No significant changes of incidence and mortality trends were observed in women. Decreasing trends observed in men are similar to other European countries. Further decreases in HNC incidence and mortality could be achieved with more restrictive alcohol and tobacco control policies and adherence to national treatment guidelines. Objective: To describe and interpret trends in incidence and mortality of HNC in Croatia in the period 1988–2008. Methods: HNCs were defined as ICD-10 codes C00-C14, C32. Incidence data were obtained from the Croatian National Cancer Registry, while numbers of deaths were obtained from the WHO Mortality Databank. Joinpoint regression analysis of age-standardized rates (ASR, standard world population) and age-specific rates for 10-year age groups was used to estimate changes in trends of HNC incidence and mortality. Results: HNC incidence and mortality in men declined steadily during the study period (estimated annual percent change (EAPC) of –1.5% and –1.8%, respectively). The most prominent decreases of –5.7% annually for incidence and –9.3% for mortality were observed in the youngest age group, 30–39 years. A non-significant increase in incidence (EAPC 0.9%) and decrease in mortality (EAPC –1.3%) were observed in women.

Prospective Studies of Body Mass Index with Head and Neck Cancer Incidence and Mortality

Results of a pooled analysis of case-control studies show a higher risk of head and neck cancer (HNC) associated with a low body mass index (BMI) and a lower risk associated with being overweight or obese compared with being normal weight. However, these results are prone to bias due to residual confounding by smoking, a strong risk factor, and possible weight loss prior to diagnosis. Using prospectively collected data from the Cancer Prevention Study-II cohort and the Nutrition cohort, we examined the association of BMI with HNC mortality and incidence, overall and by smoking status. Mortality analyses included 1,383 cases among 1,059,153 participants; incidence analyses included 340 cases among 150,262 participants. Multivariable Cox proportional hazard models were used to estimate HRs and 95% confidence intervals (CI) for the association of BMI with HNC incidence and mortality. Overall, compared with the category of BMI 22.5-24.9 kg/m(2), the categories of BMI 25.0-29.9 kg/m(2) and ≥ 30.0 kg/m(2) were associated with a lower risk of HNC mortality but not incidence. In never smokers, there were no associations of BMI with HNC incidence or mortality. In smokers, BMI < 22.5 kg/m(2) was associated with a higher risk of HNC mortality (HR = 1.42, 95% CI, 1.20-1.67). In this prospective cohort, there was no association between BMI and HNC incidence, although BMI was inversely associated with HNC mortality in smokers. These suggest that there is no etiologic relationship between BMI and HNC.

Dietary fiber and grain consumption in relation to head and neck cancer in the NIH-AARP Diet and Health Study

Dietary fiber and grain consumption may reduce the risk of head and neck cancer; however, the epidemiological evidence is limited. We investigated this relationship in the National Institutes of Health (NIH)-AARP Diet and Health Study. Cox proportional hazards models were used to calculate multivariable hazard ratios (HR) and 95% confidence intervals (CI) to investigate dietary fiber and grain intake in relation to head and neck cancer. During approximately 11 years of follow-up, 1,867 (401 women/1,466 men) cases of head and neck cancer were diagnosed. Our data indicated that the relationship between fiber and grain intake and head and neck cancer is modified by sex (p-interactions < 0.001 and 0.001, respectively). Women with higher intake of total fiber and total grains had a lower risk of head and neck cancer (HR (10 g/day) = 0.77, 95% CI = 0.64-0.93; HR (serving/1,000 kcal) = 0.89, 95% CI = 0.80-0.99, respectively); this inverse relation was consistent across subtypes of fiber and grains. Conversely in men, the inverse associations were weaker and nonsignificant. In the largest prospective cohort study to investigate this relation to date, intake of total fiber and grain foods was inversely associated with head and neck cancer incidence among women, but not among men.

Head and neck cancers manifested as deep neck infection

The incidence of head and neck cancers in patients with an initial presentation of deep neck infection is unclear and may be underestimated. Thus, the aim of this study was to assess the incidence of head and neck cancers initially manifested as deep neck infection. Also, the possible risk factors and pathophysiology are discussed. This study was a retrospective medical chart review in a tertiary referral center. A total of 81 consecutive patients admitted with a diagnosis of deep neck infection over a 46-month period were analyzed. The demographic data, physical examinations, laboratory findings, radiographic studies, and pathology report were analyzed. Among the 81 deep neck infection patients, head and neck cancers were histologically demonstrated in four patients (4.9%) with the initial symptom of a painful neck mass. The incidence of head and neck cancer initially manifested as deep neck infection was found to increase in patients aged over 40 years (6.7%; 3/45 vs. 2.8%; 1/36). A detailed history of all patients with deep neck infection should be taken. Furthermore, endoscopic examination, thyroid examination and routine pathological examination should be performed, especially in those aged over 40. Also, careful explanation to the patient and his/her family about the possibility of underlying head and neck cancer (incidence 1-5%) may be needed. If the neck swelling diminishes, but does not disappear completely after full course of antibiotics, repeated fine needle aspiration, endoscopy, or image study should be considered.

Trends in head and neck cancer incidence in Denmark, 1978–2007: Focus on human papillomavirus associated sites

The aim of our study was to assess the overall trends in the incidence of head-and-neck cancer (HNC) among Danish men and women in 1978-2007, to describe the distribution and incidences of HNCs at different anatomical sites, and to determine whether the incidence of human papillomavirus (HPV)-associated cancers is increasing. Data were extracted from the nationwide Cancer Registry database. To assess the possible impact of HPV infection, the sites of squamous cell carcinomas were categorized as HPV-associated, potentially HPV-associated or HPV-unrelated. In total, 26,474 incident cases were identified and the overall incidence increased throughout the period. Significantly increasing incidence rates were notably seen for tumors in the oral cavity (2.2% per year), tonsils (4.8% per year), oropharynx (3.5% per year) and hypopharynx (4.4% per year). A significantly decreasing incidence of lip cancer was observed among men (-5.0% per year). Cancers at HPV-associated sites (n = 3650) showed strongly increasing incidence rates, primarily in individuals < 60 years. In contrast, HNCs at sites not related to HPV infection showed a significant decrease (in men) or virtually no change in incidence (in women). Our results suggest a marked impact of HPV infection on the epidemiology of HNCs in Denmark. HPV16 is the type most often found in HNCs; thus, the recent introduction of vaccination against HPV may in the future prevent HPV-associated cancers of the head and neck.