Oropharyngeal cancer incidence and mortality in Scotland: are rates still increasing?
Introduction
Cancers of the oral cavity and pharynx comprise carcinomas of the mouth, gum, tongue, salivary gland, lip, hypopharynx, nasopharynx and oropharynx. Recent reports indicate that these cancers are responsible for nearly 200,000 deaths throughout the world annually [1], and have an incidence rate of 12.1 per 100,000 in males and 4.3 per 100,000 in females [2]. Globally, cancers of the oral cavity, when considered as a group, are the twelfth most common type of carcinoma [1].
The vast majority of cases of oral and pharyngeal cancer occur in the developing world (75%). Although smaller numbers of people get these cancers in developed countries, incidence rates may be extremely high. Males in Western Europe, for example, had the highest reported regional incidence rate in the world in 1990 (21.8 per 100,000) [2]. Furthermore, despite a general decline in the mortality rate of all cancers combined in many European countries [3], both the mortality and incidence rates of oral and pharyngeal cancers appear to be increasing [4]. Amongst the most dramatic of these increases have occurred in Central European countries such as Slovakia, where the incidence of oral and pharyngeal cancers in males rose from 4.5 per 100,000 in 1968–1970 to 17.9 per 100,000 in 1987–1989 [5]. Similarly, male mortality rates associated with these cancers increased from 2.2 per 100,000 in Hungary in 1965–1996 to 16.3 per 100,000 in 1990–1994 [6]. If these increases continue unabated, the projected rate for male mortality in Hungary from oral and pharyngeal cancers is set to exceed 50 per 100,000 in the period 2005–2009 [6].
Although less dramatic than in some Central European countries, increases in the incidence and mortality rates of oral and pharyngeal cancers have also been reported in the United Kingdom. In males aged 35–64 years, the mortality rate of oral cancers in England and Wales rose from 1.67 to 2.91 per 100,000 between the time periods 1966–1970 to 1986–1990, while the incidence rate rose from 3.61 to 5.52 per 100,000 between 1962–1966 and 1982–1986 [7]. More recently, Quinn and colleagues have reported a 40% increase in the incidence rate of lip, mouth and pharyngeal cancers between 1971 and 1997 in males aged 55–64 years in England and Wales, and a 25% increase in the incidence rates in females of the same age group [8].
Increases in mortality and incidence rates for mouth and tongue cancers have also been reported in Scotland between the early seventies and late eighties for both men and women [9]. While these increases were observed to be modest in terms of absolute rates within the population, changes were much more dramatic for men and women in the age range of 35–64 years [9]. Rates of hypo and oropharyngeal cancers were also observed to rise in younger males in Scotland between 1970 and 1989 [10].
The aim of this study was to determine if the worrying trends of increasing incidence and mortality rates in younger age groups had continued to occur. The previously reported increases in oropharyngeal cancer rates in Scotland, England and Wales appear to be cohort based [7], [9], [10]. Rising incidence and mortality rates in younger age cohorts have serious implications for the future as they suggest that overall increases in the absolute numbers of cases are programmed to occur automatically within the next few decades.
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Methods
Mortality data for the period 1950–1998 for Scotland were derived from the World Health Organisation (WHO) mortality database. Population estimates for the same periods were also derived from this database. Annual figures for new registrations of cancers in Scotland for the period 1965–1997 were obtained from the Information and Statistics Division of the Scottish Health Services Common Services Agency.
Cancers of the oral cavity and pharynx included in this study were those of the lip, tongue,
Age standardised incidence rates
Age standardised incidence rates for oral and pharyngeal cancers in Scotland have increased since 1989 in both males and females of all ages (Fig. 1). During the time period 1989–1996, standardised incidence rates for all ages rose in males from 9.5 to 11.5 per 100,000, while equivalent rates rose from 3.8 to 4.8 per 100,000 in females. For the same time period, standardised incidence rates truncated for the age group 35–64 years increased from 18.0 to 23.6 per 100,000 in men, and from 7.3 to
Discussion
There have been large increases in the incidence rates of oral and pharyngeal cancers in younger age groups in Scotland between 1989 and 1996—a 31% increase for males and a 16% increase for females. These results are consistent with the previously reported increases in the incidence of these cancers in Scotland [9], [10] and mirror closely the observations made recently for England and Wales [8].
Tobacco and alcohol consumption are both important and independent risk factors for oral cancers [13]
Acknowledgements
The authors would like to thank colleagues at the Scottish Cancer Intelligence Unit, Information and Statistics Division, National Health Service in Scotland, for supplying cancer registration data, and to acknowledge the World Health Organisation as the source for mortality data. The analyses and conclusions presented in this paper are those of the authors, not of the aforementioned organisations.
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A model using concomitant markers for predicting outcome in human papillomavirus positive oropharyngeal cancer
2017, Oral OncologyCitation Excerpt :Human papillomavirus (HPV) was in 2007 accepted as a risk factor for oropharyngeal squamous cell carcinoma (OSCC), dominated by the tonsillar (TSCC) and base of tongue (BOTSCC) cancer subtypes [1]. Lately, the incidences of HPV-positive (HPV+) TSCC and BOTSCC have increased [2–8]. Notably, HPV+ TSCC and BOTSCC have better prognosis than corresponding HPV-negative tumors, with 80% vs. 40% disease-specific survival [9–14].
Epidemiology
2017, Oral, Head and Neck Oncology and Reconstructive SurgeryOral Cancer
2016, International Encyclopedia of Public HealthStudies on human papillomavirus (HPV) 16 E2, E5 and E7 mRNA in HPV-positive tonsillar and base of tongue cancer in relation to clinical outcome and immunological parameters
2015, Oral OncologyCitation Excerpt :Human papillomavirus (HPV) was acknowledged in 2007 as a risk factor for oropharyngeal squamous cell carcinoma (OSCC), where tonsillar and base of tongue cancer (TSCC and BOTSCC) account for the majority of HPV positive (HPV+) cases [1–6]. Several reports have shown that the incidences of HPV+ TSCC and BOTSCC have increased during the past 20–30 years in many western countries [7–15]. Of note, HPV+ TSCC and BOTSCC, but not necessarily other OSCC, have better 3-year disease specific survival (DSS) as compared to corresponding HPV-negative tumors and other head and neck squamous cell carcinomas (HNSCC) (80% vs. 40% 3-year DSS) [2–6,16,17].