In the JournalsPerspective

Late-stage head and neck cancer incidence continues to rise in US

Rates of late-stage head and neck cancer increased in the United States between 2004 and 2015, propelled by rising incidence among white men, according to study results published in Cancer.

Results showed black patients and men had the greatest risk for a late-stage diagnosis.

“As the Healthy People 2020 initiative climaxes, we hypothesized a priori that the incidence of late-stage head and neck cancer in the United States is increasing rather than decreasing, driven by race and sex,” Adam Thompson-Harvey, MD, researcher in the department of otolaryngology and communication sciences at Medical College of Wisconsin, and colleagues wrote. “As hypothesized, we found an increasing incidence of late-stage head and neck cancer in the United States within the last decade. However, although black males still had the highest risk [for] being diagnosed with late-stage head and neck cancer, the most significant change in annual incidence patterns was driven by white males.”

Thompson-Harvey and colleagues used the SEER database to analyze age-adjusted incidence rates for 57,118 adults (mean age, 61.9 years; 78.1% men; 80.9% white) diagnosed with stage IV head and neck cancer between 2004 and 2015. About half of the patients had oropharyngeal cancer.

Results showed age-adjusted incidence rates for stage IV head and neck cancer increased by 26.1%, to 7.7 per 100,000 person-years in 2015 compared with 6.11 per 100,000 person-years in 2004.

Although the researchers observed decreased overall incidence of stage IV disease among black patients (adjusted OR [aOR] = 1.28; 95% CI, 1.22-1.34), they noted a significantly increased risk for diagnosis of late-stage head and neck cancer among black patients and among men (aOR = 3.95; 95% CI, 3.8-4.11).

Black men (14.66 per 100,000 person-years) had the highest age-adjusted incidence rate of stage IV disease during the study period, followed by white men (11.79 per 100,000 person-years) and Asian/Pacific Islander/American Indian/Alaskan Native men (6.73 per 100,000 person-years).

Similarly, black women (3.68 per 100,000 person-years) had a higher incidence rate than white women (2.9 per 100,000 person-years) and Asian/Pacific Islander/American Indian/Alaskan Native women (1.96 per 100,000 person-years). Rates for white women increased by 2.21% annually (P < .01), corresponding to a 32.2% increase from 2004 (2.51 per 100,000 person-years) to 2015 (3.32 per 100,000 person-years).

Moreover, incidence among white and Asian/Pacific Islander/American Indian/Alaskan Native patients increased significantly, with an annual percentage change for white patients of 3.03% (P < .01) and 1.95% for the other races (P < .01). Among black patients, incidence decreased significantly, with an annual percentage change of 0.89% (P = .04).

A sensitivity analysis of metastatic head and neck cancer by site showed a 22.9% increase in incidence of oropharyngeal cancer (0.21 per 100,000 person-years in 2004 vs. 0.25 per 100,000 person-years in 2015). Additionally, investigators reported significant rate increases among those aged 50 years and older.

The researchers noted several study limitations, including the lack of corresponding data in the SEER database regarding common risk factors such as HPV status, oral sexual encounters and tobacco and/or alcohol.

“However, we believe that despite these limitations, the results of the current study contribute to the cancer epidemiology and surveillance literature through the use of a well-established, long-term, population-based cancer registry that is national in scope,” the researchers wrote. “Because the diagnosis of late-stage head and neck cancer impacts survival, we hope that the results of the current study will provide targets for improving OS rates in patients with late-stage head and neck cancer.” – by Jennifer Southall

Disclosures: The authors report no relevant financial disclosures.

 

Rates of late-stage head and neck cancer increased in the United States between 2004 and 2015, propelled by rising incidence among white men, according to study results published in Cancer.

Results showed black patients and men had the greatest risk for a late-stage diagnosis.

“As the Healthy People 2020 initiative climaxes, we hypothesized a priori that the incidence of late-stage head and neck cancer in the United States is increasing rather than decreasing, driven by race and sex,” Adam Thompson-Harvey, MD, researcher in the department of otolaryngology and communication sciences at Medical College of Wisconsin, and colleagues wrote. “As hypothesized, we found an increasing incidence of late-stage head and neck cancer in the United States within the last decade. However, although black males still had the highest risk [for] being diagnosed with late-stage head and neck cancer, the most significant change in annual incidence patterns was driven by white males.”

Thompson-Harvey and colleagues used the SEER database to analyze age-adjusted incidence rates for 57,118 adults (mean age, 61.9 years; 78.1% men; 80.9% white) diagnosed with stage IV head and neck cancer between 2004 and 2015. About half of the patients had oropharyngeal cancer.

Results showed age-adjusted incidence rates for stage IV head and neck cancer increased by 26.1%, to 7.7 per 100,000 person-years in 2015 compared with 6.11 per 100,000 person-years in 2004.

Although the researchers observed decreased overall incidence of stage IV disease among black patients (adjusted OR [aOR] = 1.28; 95% CI, 1.22-1.34), they noted a significantly increased risk for diagnosis of late-stage head and neck cancer among black patients and among men (aOR = 3.95; 95% CI, 3.8-4.11).

Black men (14.66 per 100,000 person-years) had the highest age-adjusted incidence rate of stage IV disease during the study period, followed by white men (11.79 per 100,000 person-years) and Asian/Pacific Islander/American Indian/Alaskan Native men (6.73 per 100,000 person-years).

Similarly, black women (3.68 per 100,000 person-years) had a higher incidence rate than white women (2.9 per 100,000 person-years) and Asian/Pacific Islander/American Indian/Alaskan Native women (1.96 per 100,000 person-years). Rates for white women increased by 2.21% annually (P < .01), corresponding to a 32.2% increase from 2004 (2.51 per 100,000 person-years) to 2015 (3.32 per 100,000 person-years).

Moreover, incidence among white and Asian/Pacific Islander/American Indian/Alaskan Native patients increased significantly, with an annual percentage change for white patients of 3.03% (P < .01) and 1.95% for the other races (P < .01). Among black patients, incidence decreased significantly, with an annual percentage change of 0.89% (P = .04).

PAGE BREAK

A sensitivity analysis of metastatic head and neck cancer by site showed a 22.9% increase in incidence of oropharyngeal cancer (0.21 per 100,000 person-years in 2004 vs. 0.25 per 100,000 person-years in 2015). Additionally, investigators reported significant rate increases among those aged 50 years and older.

The researchers noted several study limitations, including the lack of corresponding data in the SEER database regarding common risk factors such as HPV status, oral sexual encounters and tobacco and/or alcohol.

“However, we believe that despite these limitations, the results of the current study contribute to the cancer epidemiology and surveillance literature through the use of a well-established, long-term, population-based cancer registry that is national in scope,” the researchers wrote. “Because the diagnosis of late-stage head and neck cancer impacts survival, we hope that the results of the current study will provide targets for improving OS rates in patients with late-stage head and neck cancer.” – by Jennifer Southall

Disclosures: The authors report no relevant financial disclosures.

 

    Perspective
    Cristina P. Rodriguez

    Cristina P. Rodriguez

    The authors report a steadily rising incidence of late-stage head and neck cancer among white males from 2004 to 2015, which is consistent with the well-recognized demographic distribution of the HPV-associated cohort. Additionally, they observed an increase over time of head and neck cancer diagnosed at later stages. This may be related to the propensity of HPV-associated oropharynx cancer to present with lymph node metastases. It also could be confounded by temporal changes in the use of more sensitive staging tools, such as PET scans, which were beyond the scope of the data obtained.

    Among black patients, a decline in overall incidence of head and neck cancer was noted, a phenomenon that parallels tobacco-use trends in the United States. Despite this and consistent with previously published reports, black patients remain disproportionately at risk for presenting with late-stage disease compared with nonblack counterparts. This disparity likely reflects factors related to the socioeconomic, uninsured or underinsured status associated with this demographic group, leading to delayed access to care. Emerging data show policy change can have a profound impact on this distressing observation.

    Encouraging data presented at the plenary session of last year’s ASCO Annual Meeting showed U.S. states that enacted a Medicaid expansion program in 2014 markedly reduced the time from diagnosis to treatment for black patients. Data and studies examining the impact of these programs may guide policymakers and hopefully result in meaningful outcome improvements in this underserved population.

    Reference:

    Adamson BJS, et al. Abstract LBA1. Presented at: ASCO Annual Meeting; May 31-June 4, 2019; Chicago.

    • Cristina P. Rodriguez, MD
    • HemOnc Today Editorial Board Member
      Seattle Cancer Care Alliance

    Disclosures: Rodriguez reports no relevant financial disclosures.