Oropharyngeal cancer incidence, mortality rise across US
Oropharyngeal cancer incidence and mortality have increased steadily among men in the United States during the past 2 decades, according to study results published in JAMA Otolaryngology-Head & Neck Surgery.
Researchers additionally observed rapid increases of more than 3% among older adults and those with regional-stage disease.
Rationale
Oropharyngeal cancer is the most common cancer caused by HPV in the United States.
“We know from previous studies oropharyngeal cancer is one of the fastest-rising cancers in the U.S.,” Ashish A. Deshmukh, PhD, MPH, researcher at Center for Health Services Research and the department of management, policy and community health at University of Texas Health Science Center School of Public Health, told Healio. “However, trends in incidence rates among men and women across all 50 U.S. states and trends according to tumor diagnostic characteristics, such as stage and size, have not been comprehensively studied.”
Methodology
Deshmukh and colleagues conducted a cross-sectional study to assess oropharyngeal cancer incidence trends between 2001 and 2017. They additionally pooled data from the National Center for Health Statistics and SEER program to evaluate observed and incidence-based mortality trends.
Overall, researchers identified 260,182 cases of oropharyngeal cancer, of which 80% occurred in men. Moreover, 65% of patients had regional-stage disease and 55% of cases occurred in the Southeast and Midwest regions.
Key findings
Researchers observed a 2.7% annual increase in oropharyngeal cancer incidence among men between 2001 and 2017 and a more than 3% annual increase among white men and men aged 65 years or older.
The highest annual increases in oropharyngeal cancer incidence among men occurred mostly in states in the Midwest and Southeast, including South Dakota (6%), Kansas (4.7%), Iowa (4%), Kentucky (3.9%), Tennessee (3.8%), West Virginia (3.8%) and Ohio (3.7%).
Women experienced an overall annual increase of 0.5% (95% CI, 0.28 to 1.22).
“Our study is also the first to report that women living in the Midwest and Southeast regions are increasingly suffering from this disease, with a more than 2% annual increase in oropharyngeal cancer incidence,” Deshmukh said. “Louisiana, Arkansas and Kentucky had a 3% per year increase, whereas Indiana, Ohio and Iowa experienced a more than 2% per year increase.”
Men and women experienced an increase in oropharyngeal cancer incidence for every tumor size, with the starkest increases observed in tumors greater than 4 cm.
“Unfortunately, we also report that the oropharyngeal cancer death rate has increased 2% per year among men in recent years,” Deshmukh said.
Implications
The findings indicate a need for better prevention efforts, according to researchers.
“Unfortunately, HPV vaccination rates are some of the lowest in the Midwestern and Southern states that are seeing a pronounced increase in oropharyngeal cancer incidence. If we do not act now, the geographic disparities in oropharyngeal cancer incidence that we document will magnify,” Deshmukh said.
Future research is needed to understand distinct geographic patterns identified in the study, particularly what might be leading to the rise in oropharyngeal cancer incidence among women living in the Midwest and Southeast, he added.
Head and neck cancer clinicians should “ring out the message loud and clear” that more vaccinations of adults age 45 years and older will result in more benefit over the next 2 decades and beyond, Nosayaba Osazuwa-Peters, BDS, PhD, MPH, CHES, member of Duke Cancer Institute and assistant professor in head and neck surgery and communication sciences and population health sciences at Duke University School of Medicine, and Louise Davies, MD, MS, senior faculty of the VA Outcomes Group and chief of otolaryngology, head and neck surgery at the VA Medical Center in White River Junction, Vermont, wrote in an accompanying editorial.
“While we interpret this study with caution with respect to the HPV vaccine’s possible effects on the incidence of oropharyngeal cancer in young men, it is undoubted that vaccination remains the only primary prevention for HPV-driven oropharyngeal cancer, which is the fastest growing cause of head and neck cancer,” they wrote. “Older individuals will unfortunately remain more vulnerable,” they wrote. “However, within the next 2 decades, we will begin to observe a significant decrease among the younger generation who are currently eligible for HPV vaccination.”
References:
Damgacioglu H, et al. JAMA Otolaryngol Head Neck Surg. 2021;doi:10.1001/jamaoto.2021.3567.
Osazuwa-Peters N et al. JAMA Otolaryngol Head Neck Surg. 2021;doi:10.1001/jamaoto.2021.3786.
For more information:
Ashish A. Deshmukh, PhD, MPH, can be reached at University of Texas Health Science Center School of Public Health, 1200 Pressler St., RAS-E 329, Houston, TX 77030; email: ashish.a.deshmukh@uth.tmc.edu.
Collapse