The present investigation is the first population-based study to provide incidence and clinicopathologic data for metastases to and from the upper aerodigestive tract (UAT). In a patient cohort with relatively minimal referral bias it was determined that cervical and distant metastases occurred in 21% and 2%, respectively, of UAT carcinomas by the time of diagnosis; incidence rates per 100,000 person-years for cervical and distant metastases from UAT carcinomas were 2.8 and 0.3, respectively; occult primary lesions represented 3.8% of all UAT carcinomas; 3.6% of all invasive UAT carcinomas were actually metastatic from another body site; and the clinicopathologic literature has overestimated the prevalence of metastases at diagnosis relative to UAT carcinomas.