Elsevier

Oral Oncology

Volume 61, October 2016, Pages 70-75
Oral Oncology

Trends of oral cavity, oropharyngeal and laryngeal cancer incidence in Scotland (1975–2012) – A socioeconomic perspective

https://doi.org/10.1016/j.oraloncology.2016.08.015Get rights and content

Highlights

  • Incidence trends of head and neck cancer (1975–2012) in Scotland examined.

  • OPC increased rapidly, laryngeal cancer decreased, OCC stabilized.

  • Highest incidence rates consistently observed in males from most deprived areas.

  • Peak incidence of oropharyngeal cancer occurred in younger age group.

Abstract

Aim

To examine current incidence trends (1975–2012) of oral cavity (OCC), oropharyngeal (OPC) and laryngeal cancer in Scotland by socioeconomic status (SES).

Methods

We included all diagnosed cases of OCC (C00.3-C00.9, C02-C06 excluding C2.4), OPC (C01, C2.4, C09-C10, C14) and laryngeal cancer (C32) on the Scottish Cancer Registry (1975–2012) and annual midterm population estimates by age, sex, geographic region and SES indices (Carstairs 1991 and Scottish Index of Multiple Deprivation 2009). Age-standardized incidence rates were computed and adjusted Poisson regression rate-ratios (RR) compared subsites by age, sex, region, SES and year of diagnosis.

Results

We found 28,217 individuals (19,755 males and 8462 females) diagnosed with head and neck cancer (HNC) over the study period. Between 1975 and 2012, relative to the least deprived areas, those living in the most deprived areas exhibited the highest RR (>double) of OCC, OPC and laryngeal cancer, and an almost dose-like response was observed between SES and HNC incidence. Between 2001 and 2012, this socioeconomic inequality tended to increase over time for OPC and laryngeal cancer but remained relatively unchanged for OCC. Incidence rates increased markedly for OPC, decreased for laryngeal cancer and remained stable for OCC, particularly in the last decade. Males exhibited significantly higher RRs compared to females, and the peak age of incidence of OPC was slightly lower than the other subsites.

Conclusion

Contrary to reports that OPC exhibits an inverse socioeconomic profile, Scotland country-level data show that those from the most deprived areas consistently have the highest rates of head and neck cancers.

Introduction

Cancers of the oral cavity and oropharynx are amongst the most common cancers worldwide, with approximately 442,760 incident cases and 241,418 deaths reported in 2012 [1]. Collectively, these head and neck cancers are the seventh most common in terms of incidence and the ninth most common cause of death in the world [2].

Global incidence rates of oropharyngeal cancer (OPC) are rising, particularly in economically developed countries such as Canada, United States, Japan, Switzerland, Australia, England and parts of Eastern Europe [3], [4], [5], [6], [7]. Rates of oral cavity cancer (OCC) are also rising among men and women in some European countries, stabilising in certain Asian countries and decreasing in Canada and USA [4], [8].

Tobacco and alcohol consumption are the dominant risk factors for OCC [9], and are also a part of the aetiology for OPC along with human papillomavirus (HPV) infections [10]. Hashibe and Sturgis have suggested that this changing profile of head and neck cancer incidence can be explained by “controlling a tobacco epidemic while a human papillomavirus epidemic emerges” [11]. Moreover, the clinical perspective, recorded in a US case-series, is that the sociodemographic profile of head and neck cancer patients is also changing, with increasing numbers of patients, particularly with OPC diagnosis, having a younger, more socioeconomically affluent profile [12].

The most recent detailed analysis of incidence trends of oral cancer in Scotland examined rates between 1990 and 1999, and found that Scotland had the highest rates of oral cancer in the UK and also exhibited the greatest lifetime risk of developing oral cancer [13]. Overall, rates increased in both males and females between 1990 and 1999. However, this study combined both OCC and OPC into a single oral cancer definition in the trends analysis, reflecting the thinking at the time that these sites had a common aetiology.

The aim of this study was to examine the incidence burden and trends of OCC, OPC and laryngeal cancer in Scotland between 1975 and 2012 by key sociodemographic determinants available in the Scottish Cancer Registry: age, sex, area-based socioeconomic deprivation indices, geographic region and year of diagnosis. Additionally, we aimed to compute future projected rates up to 2025 by the same determinants.

Section snippets

Methods

We collated data on all diagnosed cases of OPC, OCC and laryngeal cancer registered at the Scottish Cancer Registry between 1975 and 2012. Subsites were defined using three-digit ICD-10 codes and were anatomically classified into: oropharynx OPC (base of tongue C01, lingual tonsil C2.4, tonsil C09, oropharynx C10, pharynx C14); oral cavity OCC (inner lip C00.3-C00.9, other and unspecified parts of tongue C02, gum C03, floor of mouth C04, palate C05, other and unspecified parts of mouth C06);

Results

Our study comprised of 28,217 individuals, of which 19,755 (70.2%) were males and 8462 (29.9%) were females. The mean age was 63.8 years (standard deviation: ±12.3 years). The age-standardized incidence rates of cancer per 100,000 individuals and the fully adjusted Poisson regression rate-ratios (RR) by sociodemographic characteristics are presented in Table 1, Table 2, respectively.

Peak incidence of OPC was observed in the 61–65 age-group, while that of OCC and laryngeal cancer were in the 71–75

Discussion

By 2012, the incidence rates of OPC had overtaken those of laryngeal cancer and were nearly on par with OCC incidence. Moreover, by 2025 the projected incidence rates of OPC are expected to continue to rise rapidly and bypass rates of OCC which are expected to continue to remain relatively stable. Rates of laryngeal cancer are expected to decrease over the same time period. The peak age of incidence of OPC was slightly younger (5–10 years) than for the other subsites, and rates were consistently

Conclusion

In conclusion, this study shows the changing trends in the burden and determinants of HNC. OPC is an emerging public health problem, with rates dramatically increasing in Scotland. Despite previous reports, the sociodemographic determinants of oropharyngeal cancer are not substantially different from other HNCs, particularly in relation to gender and SES profile.

Conflict of interest

All the authors declare that they have no conflicts of interest.

Acknowledgements

The authors would like to thank the Scottish Cancer Registry for data access and NHS Education for Scotland for funding this study.

References (26)

  • A.K. Chaturvedi et al.

    Human papillomavirus and rising oropharyngeal cancer incidence in the United States

    J Clin Oncol

    (2011)
  • A. Hong et al.

    Rising prevalence of human papillomavirus related oropharyngeal cancer in Australia over the last two decades

    Head Neck

    (2015)
  • T. Forte et al.

    Incidence trends in head and neck cancers and human papillomavirus (HPV)-associated oropharyngeal cancer in Canada, 1992–2009

    Cancer Cause Control

    (2012)
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