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IMPORTANCE Melanoma is one of the most common cancers worldwide, typically diagnosed in older adults. There is an increasing incidence in the younger population (age Յ40 years) in America. In addition, approximately 1 in 5 cases of melanoma affect the head and neck. However, there are limited data on the incidence of head and neck melanoma in the pediatric, adolescent, and young adult population in North America (United States and Canada).OBJECTIVE To assess 20-year demographic and incidence changes associated with head and neck melanoma in the pediatric, adolescent, and young adult population in North America. DESIGN, SETTING, AND PARTICIPANTSA descriptive analysis of retrospective data on head and neck melanoma from the North American Association of Central Cancer Registries' Cancer in North America public use data set from 1995 to 2014 was conducted. The data set currently includes 93% of the United States and 64% of the Canadian populations. Eligible data were from 12 462 pediatric, adolescent, and young adult patients (aged 0-39 years) with a confirmed diagnosis of melanoma (International Classification of Diseases-Oncology 3 histologic types 8720-8790) in primary head and neck sites: skin of lip, not otherwise specified (C44.0); eyelid (C44.1); external ear (C44.2); skin of other/unspecified parts of face (C44.3); and skin of scalp and neck (C44.4). The study was conducted from January 26 to July 21, 2019. MAIN OUTCOMES AND MEASURESLog-linear regression was used to estimate annual percentage change in age-adjusted incidence rates (AAIRs) of head and neck melanoma. RESULTSOf the 12 462 patients with head and neck melanoma included in the study, 6810 were male (54.6%). The AAIR was 0.51 per 100 000 persons (95% CI, 0.50-0.52 per 100 000 persons). In North America, the incidence of head and neck melanoma increased by 51.1% from 1995 to 2014. The rate was higher in the United States (AAIR, 0.52; 95% CI, 0.51-0.53 per 100 000 person-years) than Canada (AAIR, 0.43; 95% CI, 0.40-0.45 per 100 000 persons). In the United States, the incidence increased 4.68% yearly from 1995 to 2000 and 1.15% yearly from 2000 to 2014. In Canada, the incidence increased 2.18% yearly from 1995 to 2014. Male sex (AAIR, 0.55; 95% CI, 0.54-0.57 per 100 000 persons), older age (AAIR, 0.79; 95% CI, 0.79-0.80 per 100 000 persons), and non-Hispanic white race/ethnicity (AAIR, 0.79; 95% CI, 0.77-0.80 per 100 000 persons) were associated with an increased incidence of head and neck melanoma. CONCLUSIONS AND RELEVANCEThe incidence of pediatric, adolescent, and young adult head and neck melanoma in North America appears to have increased by 51.1% in the past 2 decades, with males aged 15 to 39 years the main cohort associated with the increase.

2c Laryngoscope, 2017.

The prevalence of hearing loss in the United States is underestimated when considering undetected hearing loss in immigrant children. The addition of the immigrant children from only Mexico and China presents a 7.5% increase in the total number of children in the United States with hearing loss. This reinforces the importance of early detection of hearing loss in these children, resulting in more accurate estimation of the rate of childhood hearing loss in the United States and better planning for intervention programs.

Background: The United States population is aging, and cancer is the second most common cause of death in the elderly. Head and neck squamous cell carcinoma (HNSCC) incidence is increasing and contributes 2.2% of all cancer mortality. HNSCC research often excludes elderly patients due to disqualifying comorbidities, similar to many cancer sites. These patients also may not receive adequate therapy due to age despite evidence of equal survival after controlling for comorbidities. Beyond oncologic variables, demographic factors have been shown to impact HNSCC survival, including age, socioeconomic status, race, sex, poverty, insurance, and marriage. Whether these associations are maintained in elderly patients is unknown. This study aims to compare demographic predictors of HNSCC survival between age cohorts. Methods: Adult patients with squamous cell carcinoma of mucosal head and neck sites were selected from the Surveillance, Epidemiology and End Result database from 2004 to 2013. Patients were excluded with previous malignancies or missing data for follow-up, marital status, and surgical treatment. Demographic and tumor data were collected, including site, stage, treatment, age, race, sex, insurance, and median county-level income. Patients were divided into three age cohorts: younger (18-49 years), middle (50-74 years), and older (>75 years). Cohorts were compared with two-tailed chi-squared and ANOVA tests as appropriate with p < 0.05 considered significant. Previously identified predictors of HNSCC survival were assessed in each cohort using multivariate Fine and Gray competing risk models controlled for oncologic variables. Subdistribution hazard ratios (sHR) with 95% confidence intervals (CI) are reported. Sensitivity analyses were performed by (1) excluding inadequately treated patients, (2) removing adjuvant therapies from the model, and (3) varying the cutoff between age cohorts. Inadequate treatment was considered less than 1 modality for stage I-II or less than 2 modalities for stage III-IV. Results: The study cohort consisted of 69,098 patients with a majority white (75.4%), male (76.7%), married (55.2%), and insured (56.3%). The median age at diagnosis was 61.7 years with 14.3% below 50 years and 15.3% 75 years or above. Compared to the young and middle-aged cohorts, the older cohort was significantly more often female (35% vs 25.1 and 20.4%), white (78.7% vs 69.4 and 75.9%), and insured (63.5% vs 46.5% and 56.8%), but received adequate treatment less often (72.0% vs 86.3% and 82.7%) (p < 0.001 for all). In the survival models, several demographic factors showed different effects on cancer survival between age cohorts. Male sex was associated with lower mortality in the older group (sHR 0.92, CI 0.85-1.00), but not in other cohorts. In the young and middle-aged cohort, Black race was associated with increased mortality (sHR 1.43 and 1.23, CI 1.27-1.60 and 1.17-1.30, respectively), but this is not found in the older cohort (sHR 1.07, CI 0.94-1.22). In all cohorts, single marital status was associated with higher mortality, but the effect was greatest in the younger cohort (sHR 1.52, CI 1.37-1.68) and least in the oldest cohort (sHR 1.14, CI 1.01-1.28). These effects were preserved in the sensitivity analyses and with varying the age cutoff between middle and older cohorts as low as 65 years. Conclusion: A substantial proportion of HNSCC patients are elderly. These patients are less often treated with adequate curative therapy and differ demographically from their younger peers. Uniquely in the older HNSCC patients, female sex is a risk factor for cancer mortality, while the impact of race and marital status was reduced compared to the younger cohorts. While future research investigates the mechanisms by which demographics affect survival, the differences between age cohorts must be considered. Citation Format: Sean T. Massa, Lauren Cass, Sai Challapalli, Zisansha Zahirsha, Matt Simpson, Nosayaba Osazuwa-Peters, Gregory Ward. Age differences in demographic predictors of head and neck cancer survival [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A88.

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Introduction: Among the known nonclinical prognostic factors for head and neck squamous cell carcinoma (HNSCC) survivorship, there has been recent focus on the potential benefits of being married. Several studies have shown that marriage confers a survival advantage for HNSCC patients. However, anecdotal evidence suggests that there may be marked differences in this survival benefit based on the sex of the patient. To date, no study has described how sex differences influence head and neck cancer survivorship based on marital status. Our study aimed to determine whether marital status at diagnosis impacts survivorship of HNSCC differently based on sex. Methods: In this retrospective study, we utilized a patient cohort of 27,208 confirmed HNSCC cases from the Surveillance, Epidemiology, and End Results (SEER) 18 database (2004–2014) who received chemotherapy and radiotherapy. Actuarial survival curves stratified by marital status at diagnosis (married/partnered, never married, divorced/separated, widowed) indicated cancer-specific survival from HNSCC. Survival differences between marital status groups were first assessed by log-rank tests with Bonferroni adjustments. Second, patients' demographic and clinical characteristics including sex, marital status, race/ethnicity, insurance status, HNSCC site, stage, age at diagnosis, year of diagnosis, and county-level poverty were utilized in Fine and Gray competing risk proportional hazard models to examine the potential interaction between sex and marital status and estimate adjusted hazard ratios (aHR) for death from HNSCC. Results: The cohort was mostly men (80.8%) and married/partnered (56.5%). Married/partnered patients had the best survival of any marital status group (log-rank and Bonferroni p < 0.001). The initial Fine and Gray model controlling for covariates indicated a significant interaction between sex and marital status (p < 0.05), with married women having a 13% increased hazard of death compared to married men (aHR=1.13, 95% CI: 1.04, 1.24). Final Fine and Gray models stratified by sex showed that widowed women had an increased hazard of death compared to married/partnered women (aHR=1.19, 95% CI: 1.03, 1.38), while there was no statistically significant survival difference between married and unmarried women. For men, patients who were unmarried (aHR=1.37, 95% CI: 1.27, 1.46), widowed (aHR=1.36, 95% CI: 1.20, 1.54), or divorced/separated (aHR=1.30, 95% CI: 1.21, 1.39) had an increased hazard of HNSCC death compared to men who were married/partnered at the time of diagnosis. Racial disparities persisted irrespective of marital status; non-Hispanic black women had higher hazards of HNSCC death compared with non-Hispanic white women (aHR=1.29, 95% CI: 1.12, 1.48). Hispanic men (aHR=1.12, 95% CI: 1.02, 1.23) and non-Hispanic black men (aHR =1.27, 95% CI: 1.17, 1.37) had a higher hazard of HNSCC death compared with non-Hispanic white men. Conclusions: Our study has shown for the first time in the head and neck cancer literature that while being married confers survival benefits in general, married men with HNSCC may benefit more than women. Unmarried men seemed to fare the worst compared with every marital status for both men and women. More research is needed to understand this differential marital status benefit based on sex. Additionally, efforts should focus on developing analogous support systems for men and women who are head and neck cancer patients that could improve their survival, especially unmarried men and widowed men and women. Citation Format: Nosayaba Osazuwa-Peters, Matthew C. Simpson, Lauren M. Cass, Sai Deepika Challapalli, Zisansha S. Zahirsha, Eric Adjei Boakye, Sean T. Massa. Which head and neck cancer patient benefits from being married: The man or the woman? [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A87.

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