Rising population of survivors of oral squamous cell cancer in the United States

Abstract

BACKGROUND:The incidence of oropharyngeal cancer (OPC) and a subset of oral cavity cancer (OCC) is increasing in the United States. To the authors' knowledge, the presumed growing prevalence of survivors of OPC and OCC has not been investigated to date. METHODS: Retrospective analysis of End Results data (1975-2012) estimated changes in incidence, 5-year cause-specific survival, and prevalence for OPC and OCC. Changes in incidence, cause-specific survival and prevalence were estimated by linear regression and expressed as the percentage change (B). Differences in incidence trends over time were determined by joinpoint analysis. RESULTS: The incidence of OPC increased by 62.6% from 1975 through 2012. Notable increases in OPC incidence were observed among men, white individuals, and those of younger ages. The 5-year survival for OPC increased significantly for all sexes, races, and individuals aged >30 years, with white individuals and males experiencing the largest increase in survival. By contrast, the incidence of OCC declined by 22.3% during the same time period. OCC incidence decreased across all groups but increased among individuals aged 30 to 39 years. Significant increases in survival were observed for OCC, except for those who were female, black, and aged <40 years. The prevalence of survivors of OPC increased from 2000 to 2012 (B, 115.1 per 100,000 individuals per year; P<.0001), whereas the prevalence of survivors of OCC significantly decreased (B, 215.8 per 100,000 individuals per year; P<.0001). CONCLUSIONS: The prevalence of survivors of OPC is increasing, whereas the prevalence of survivors of OCC is declining. These data portend significant implications for long-term care planning for survivors of OPC and OCC. Cancer 2016;122:1380-7. V C 2016 American Cancer Society.KEYWORDS: human papillomavirus, oral cancer, oropharyngeal cancer, survivors. INTRODUCTIONPopulation-based studies in the United States and developed countries have reported significant increases in oral squamous cell cancer (OSCC), which includes oropharyngeal cancer (OPC) and oral cavity cancer (OCC). 1 The epidemiologic shifts in OSCC have been attributed primarily to the increasing incidence of human papillomavirus (HPV)-related OPC. 2 Indeed, the incidence of OPC in the United States is projected to surpass that of cervical cancer and is responsible for the largest burden of HPV-related malignancy in men. 2 Patients with OPC are characteristically young and have a good prognosis. [3][4][5][6][7][8][9] Although the incidence of OCC overall is declining in the United States, 10 the incidence among young females has increased dramatically in recent decades, the etiology of which is poorly understood and does not appear to be related to HPV infection. 11-15 Improvements in survival have been limited to individuals treated with radiotherapy. 16 It is interesting to note that a shift in the treatment paradigm from single modality (surgery or radiotherapy) in the mid-1970s to primary surgery with or without radiotherapy in the late 199...

Oropharyngeal squamous cell carcinoma incidence and mortality trends in the United States, 1973–2013

“…This reversal of incidence trends may represent a transition from tobacco‐related, HPV‐unrelated tumors to predominantly HPV‐related tumors. Our study also showed that OPSCC incidence rates increased in the male population but remained stable in the female population, which is consistent with findings from other studies . These findings support HPV as the most likely driver of the rise in OPSCC incidence rates.…”

“…Our study showed that incidence rates increased in the white population, whereas incidence rates rose sharply in the black population between 1973 and 1984 and then steadily declined between 1984 and 2013. Previous studies have reported on the racial divergence in incidence trends of oropharyngeal cancer . However, no previous study had reported on the initial rise in OPSCC in the black population.…”

Head and neck squamous cell cancers in the United States are rare and the risk now is higher among white individuals compared with black individuals

“…No recent analysis has included cancers of the hypopharynx, nasal cavity, and nasopharynx to describe current incidence trends of HNSCC overall or of non-oropharyngeal HNSCCs. Prior work has shown a decline in HPV-unrelated cancers of the oral cavity and oropharynx, 1, 14, 15 and a decline in larynx cancer using data up 1997. 16 This analysis is a more accurate representation of the comprehensive changes in incidence for all HPV-unrelated cancers: incidence of non-oropharyngeal HNSCCs consistently declined between 2003-2014 in all subgroups (i.e.…”

Screening for human papillomavirus‐driven oropharyngeal cancer: Considerations for feasibility and strategies for research

“…Indeed, retrospective data have suggested that tonsillectomy (removal of the relevant lymphoid tissue and associated epithelium) reduces the risk of OPC. 48 Given the favorable long-term survival of patients with HPV-16-driven OPC, 49,50 there is interest in decreasing therapeutic intensity with the goal of reducing potential long-term sequelae of therapy. 46 In addition, tonsillectomy has its own inherent risks (life-threatening or catastrophic bleeding), and therefore optimizing the ability to predict the patient's risk of developing HPVdriven OPC becomes paramount, as does demonstrating that the benefits outweigh the harms (including considerations of quality of life and cost-effectiveness).…”