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Oropharynx cancer burden shifting to older individuals
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Rapid increases in the incidence of HPV-related oropharynx cancer among young white men across the United States over the past several decades appeared to have slowed, according to results of a retrospective study published in Journal of Clinical Oncology.
Researchers anticipate modest increases in oropharynx cancer cases among cohorts of individuals born after 1955, strong increases among cohorts born before 1955, and a 50% increase in the number of Americans aged 65 years or older through 2029.
This will shift the burden of HPV-related oropharynx cancer predominantly to elderly white men, according to researchers.
“HPV infection has caused an epidemic increase in the incidence of oropharynx cancer among white men in the United States,” Joseph E. Tota, PhD, of the division of cancer epidemiology and genetics at the NCI, and colleagues wrote. “Changes in sexual behaviors in cohorts of individuals born during the 1930s to 1950s are believed to be responsible for this increase. It is, however, unclear if the increasing incidence has continued into cohorts born more recently, after the sexual revolution of the 1950s and 1960s.”
Tota and colleagues analyzed data from SEER registries between 1992 and 2015 to study whether substantial increases in oropharynx cancer continued in recent birth cohorts. Researchers also projected incidence rates through 2029.
Oropharynx cancers analyzed included those with squamous cell histologies at the base of the tongue, lingual tonsil, soft palate and uvula, tonsil, oropharynx and Waldeyer ring.
Results showed that the incidence of oropharynx cancer increased rapidly among white men born between 1939 and 1955 (5.3% per 2-year birth cohort; 95% CI, 4.8-5.7) and modestly among white men born between 1955 and 1969 (1.7% per 2-year birth cohort; 95% CI, 1-2.4).
Researchers also observed slight increases among white women aged 45 to 64 years, Hispanics and other races, and older black men. Incidence declined dramatically among younger and middle-aged black men and black women of all ages.
If the trends continue, researchers project the incidence of oropharynx cancer will increase substantially from 2016 to 2029 among white men aged 65 to 74 years, from 40.7 cases per 100,000 to 71.2 cases per 100,000, and among white men aged 75 to 84 years, from 25.7 cases to 50.1 cases per 100,000.
Researchers predicted more moderate increases during that period among white men aged 55 to 64 years, with incidence rates rising from 40.3 to 52 cases per 100,000, whereas cases among white men aged 45 to 54 years would remain stable at 18 per 100,000.
Researchers projected an increase in the total number of cases in the U.S. annually, based on population growth, from 20,124 (95% CI, 19,779-20,469) in 2016 to 30,629 (95% CI, 29,413-31,845) in 2029. This increase will be driven by individuals aged 65 years or older, among whom annual incidence would rise from 7,976 (95% CI, 7,782-8,172) to 18,072 (95% CI, 17,271-18,895), and by white men, whose annual incidence would rise from 14,453 (95% CI, 14,142-14,764) to 22,241 (95% CI, 22,119-23,364).
“Our observations underscore a significant shift in the trajectory of the oropharynx cancer epidemic in the United States,” Tota and colleagues wrote. “Our results suggest the ebbing of the oropharynx cancer epidemic in younger individuals, exaggeration of the epidemic in older individuals, and a continued exponential increase in the annual number of oropharynx cancers over the next decade.” – by John DeRosier
Disclosures: Tota reports travel expenses and other relationships with Merck. Please see the study for all other authors’ relevant financial disclosures.
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