Oral cavity and pharynx cancer incidence rates in the United States, 1975–1998☆
Introduction
Cancers of the oral cavity and pharynx (OCP) include tumors of the lip, tongue, gingival (gums), floor of the mouth, soft and hard palate, tonsils, salivary glands, oropharynx, nasopharynx, hypopharynx, and other less frequent sites [1]. In 2001, it was estimated that OCP cancers would account for 30,100 new cases and 7800 deaths in the United States [2]. The age-adjusted (world standard) incidence rate for total OCP cancers were 8.3 per 100,000 population in 1994–1998, but varies greatly (range=4.8 to 17.7 per 100,000) according to race and sex groups [3]. These cancers represent 3% of all cancers in the United States [1].
More than 95% of all OCP cancers occur in persons 40 years of age or older, and the median age at time of diagnosis is in the sixth decade [1]. The major risk factors for OCP cancers are the use of tobacco products and excessive alcohol consumption, estimated to account for 75% of all OCP in the United States [4]. Patterns and risks associated with tobacco and alcohol use have been shown to account for nearly all of the observed racial differences in rates for OCP cancers [5]. Other risk factors are exposure to certain viruses (humanpapilloma, Epstein–Barr) [6] and use of marijuana [7]. Nutritional factors, particularly the consumption of fresh fruits and vegetables, appear to be associated with decreased risk for these cancers [8], [9]. Differences in rate patterns and risk factors for some subsites such as nasopharynx, lip, salivary glands, and other subsites also have been recognized [10], [11].
Routine Surveillance, Epidemiology and End Results (SEER) program publications present recent rates by 10 subsites within the OCP, but the subsites are often grouped together in the SEER analyses presenting more detailed rates, such as by time, geographic area, stage at diagnosis, or years of survival. During 1975–1998, total oral cavity and pharynx cancer incidence rates have been higher among men than women, higher among blacks than whites, and fairly stable among females while declining among white males since the mid-1970s and rising among black males at least until the 1980s [3]. Furthermore, SEER publications do not present data according to histologic cell type. It is known that carcinomas account for the overwhelming majority of all oral cancers (up to 96%), followed next by sarcomas [1]. Thus, the purpose of this paper is to present and evaluate age-adjusted incidence rates for cancers of oral cavity and pharynx subsites by histologic type and to explore temporal trends for these cancers by race and sex. This is the first time this information has been presented for oral cavity and pharynx cancers. This information is valuable because it identifies where disparities related to oral cancer exist.
Section snippets
Methods
Data for this analysis come from the US Surveillance, Epidemiology and End Results (SEER) program [3], [12]. Nine registries (San Francisco–Oakland, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, and Atlanta) for which data are available for cases diagnosed since 1975 were included in the analysis. Although these areas are not a random sample of the US population, they account for about 10% of the population. Population estimates were derived using data provided by the US Census
Results
During the 1978–1998 period, a total of 65,130 in-situ and malignant cancers of the OCP were diagnosed, of which 98% were microscopically confirmed and approximately 5% were carcinoma in situ; to maximize the numbers available for analysis, all cases were included (Table 2). The majority of OCP cancers (83%) were squamous cell carcinomas (SCC). Of those, 87% were SCC, 9% keratinizing SCC, approximately 2% nonkeratining SCC, 1% lymphoepithelial carcinoma, and less than 1% papillary carcinoma,
Discussion
Based on these data it appears that there are several distinct forms of OCP cancers, based on histologic type and anatomic site patterns by race, sex, and over time. Data presented here suggest that OCP cancers may be separated into five subgroups: SCC of the lip, SCC of the oral cavity, SCC of the pharynx (including nasopharynx), adenocarcinoma (including salivary glands), and Kaposi’s sarcoma.
The most frequent sites for OCP cancers continue to be tongue and floor of the mouth (SCC of the oral
Conclusions
Because the patterns and etiologies differ, routine tabulations should report rates for the oral cavity separately from those for the pharynx. Furthermore, it would be useful for the present category of gum and other oral cavity to be broken down into gingiva, cheek and vestibule, other mouth, and palate. These suggestions would be helpful in the surveillance of trends, because although these cancers are related to behavioral and environmental exposures such as use of tobacco products,
Acknowledgements
The authors appreciate the sustained high quality registry operations of the SEER program participants, the dedication of the NCI SEER staff, the computer programming and figure development by John Lahey of IMS, Inc. and the comments on the manuscript by Dr. Gina Day Stephenson of the American Health Foundation, formerly of the National Cancer Institute.
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Portions of this manuscript were presented at the meeting of the American Association of Public Health Dentistry in October 1999.