January 16, 2020
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Late-stage head and neck cancer incidence continues to rise in US

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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).

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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.