Oropharyngeal Cancer Incidence and Mortality Trends in All 50 States in the US, 2001-2017

Abstract

IMPORTANCE Oropharyngeal cancer (OPC) incidence is rising among men in the US. Comprehensive assessments of nationwide trends in OPC incidence and mortality by demographics, tumor characteristics at diagnosis, and geography are lacking.OBJECTIVE We examined secular trends in OPC incidence and mortality rates in all 50 US states and the District of Columbia (DC). DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, we used the US Cancer Statistics data set to examine OPC incidence trends from 2001 through 2017. Observed and incidence-based mortality trends were evaluated using data from the National Center for Health Statistics and Surveillance Epidemiology and End Results program, respectively. Data analysis was conducted from January to April 2021.RESULTS Nationwide, 260 182 OPC cases were identified; 209 297 (80%) occurred in men, 168 674 (65%) with regional stage, and 142 068 (55%) in the Southeast and Midwest regions, during 2001 to 2017. Incidence of OPC increased nationally 2.7% per year among men, with a notable (over 3% per year) rise among non-Hispanic White men and in men aged 65 years and older. Overall, among women, the annual percentage change was 0.5% (95% CI, −0.28% to 1.22%). Among men, with a 3.1% per year rise (95% CI, 2.4% to 3.8%), regional-stage OPC incidence increased nearly 2-fold. Among women, regional-stage OPC incidence increased 1.0% per year (95% CI, 0.3% to 1.7%). Among men, OPC incidence increased in all states and regions except Alaska, DC, and Wyoming. Among men, the most pronounced increases (more than 3.5% per year) were clustered in the Southeast and Midwest regions. Among women, a rise of more than 2% per year was also concentrated in the Southeast and Midwest regions. Among men, OPC incidence-based mortality increased 2.1% per year (95% CI, 1.0% to 3.2%) overall in recent years (from 2006 to 2017). In contrast, among women, the annual percentage change in OPC incidence-based mortality was −1.2% (95% CI, −2.5% to 0.1%). CONCLUSIONS AND RELEVANCEThe findings of this cross-sectional study suggest that the incidence of OPC has continued to increase nationally among men in the US, with rapid increases among the elderly population. The notable rise in regional-stage OPC and the concurrent recent rise in mortality among men is troubling and calls for urgent improvements in prevention. Distinct geographic patterns with notable rises in the Midwest and Southeast regions imply the need for improved and targeted prevention as well as future studies to understand etiological reasons for geographic disparities.

Current Evidence of a Deintensification Strategy for Patients with HPV-Related Oropharyngeal Cancer

“…Oropharyngeal cancer accounts for 0.5% of all solid malignancies, and the incidence of oropharyngeal cancer has increased during the past three decades in the United States (US) [ 1 , 2 ]. A study investigating all 50 states of the US reported that oropharyngeal cancer increased by an average of 2.7% per year for men and 0.5% for women from 2001 to 2017 [ 3 ]. The rise in the incidence of oropharyngeal cancer is mainly due to an increase in human papillomavirus (HPV) prevalence and HPV-related oropharyngeal cancer [ 1 , 4 ].…”

“…However, recent evidence has revealed a shift in disease burden to older age. In an epidemic study investigating all 50 states in the US, it was found that the incidence among men increased over 3% annually in a cohort of subjects aged ≥65 years between 2001 and 2017 [ 3 ]. Men aged 45–64 years showed a plateau after 2014.…”

Availability of the HPV Vaccine in Regional Pharmacies and Provider Perceptions Regarding HPV Vaccination in the Pharmacy Setting

“…For example, HPV vaccination coverage among males aged 19–26 years and Hispanic females aged 19–26 years increased, but approximately 50% of females aged 19–26 years and 70% of males aged 19–26 years remained unvaccinated [ 5 ]. Disparities in HPV vaccination coverage and HPV-cancer incidence exist in geographic locations in the United States [ 6 , 7 , 8 ]. Specifically, those living in rural areas [ 8 ] and in the Southern United States [ 6 , 7 ] have lower HPV vaccination rates and higher HPV-related cancer incidence rates.…”

“…Disparities in HPV vaccination coverage and HPV-cancer incidence exist in geographic locations in the United States [ 6 , 7 , 8 ]. Specifically, those living in rural areas [ 8 ] and in the Southern United States [ 6 , 7 ] have lower HPV vaccination rates and higher HPV-related cancer incidence rates.…”

Discourse about human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) on Twitter: Lessons for public health education about OPC and dental care

“…Approximately 260,000 OPC cases were identified from 2001 through 2017 in the United States alone [ 6 ]. The incidence of HPV-associated OPCs has increased at a rate of 30% a year [ [1] , [2] , [3] ].…”