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 participants: In 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 relevance: The 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.

Figure 1.. Age-Specific and Race-Specific Incidence Rates of Oropharyngeal Cancer During 2001-2003 and 2015-2017

Panels A, B, C, D, E, and F show incidence rates according to 5-year age group among non-Hispanic White men, non-Hispanic Black men, Hispanic men, non-Hispanic White women, non-Hispanic Black women, and Hispanic women, respectively. Data were taken from the National Program of Cancer Registries and Surveillance Epidemiology and End Results program. Rates were calculated as number of cases per 100 000 person-years and age-adjusted to the 2000 US standard population. ^aData suppressed owing to <16 cases in the time interval.

Figure 2.. Trends in Annual Incidence Rates of Oropharyngeal Cancer According to Race and Ethnicity and Age at Diagnosis Among Men and Women

Data markers represent the observed incidence rates (cases per 100 000 person-years) of oropharyngeal cancer. The slope of the lines represents the annual percent change (APC). Panels A and B show incidence trends according to race/ethnicity in men and women, respectively. Panels C and D show incidence trends according to age at diagnosis in men and women, respectively. Data were taken from the National Program of Cancer Registries and Surveillance Epidemiology and End Results program. Rates were calculated as number of cases per 100 000 person-years and age-adjusted to the 2000 US standard population. Abbreviations: APC, annual percentage change; AAPC, average annual percentage change. ^aIndicates statistically significant incidence trend (P < .05).

Figure 3.. Trends in Annual Incidence Rates of Oropharyngeal Cancer According to Stage at Diagnosis Among Men and Women

Data markers represent the observed incidence rates (cases per 100 000 person-years) of oropharyngeal cancer. The slope of the lines represents the annual percent change (APC). Panels A and B show incidence trends in men and women according to the SEER summary stage at diagnosis. Data taken from the National Program of Cancer Registries and Surveillance Epidemiology and End Results program. Rates were calculated as number of cases per 100 000 person-years and age-adjusted to the 2000 US standard population. ^aIndicates statistically significant incidence trend (P < .05).

Figure 4.. Oropharyngeal Cancer Incidence Rates and Trends Among Men and Women by US State and District of Columbia

Panels A and B illustrate oropharyngeal cancer incidence rates among men in 2001-2003 and 2015-2017; panel C illustrates the average annual percentage change in incidence from 2001 to 2017. Panels D and E illustrate oropharyngeal cancer incidence rates among women in 2001-2003 and 2015-2017; panel F illustrates the average annual percentage change in incidence from 2001 to 2017. Data taken from the National Program of Cancer Registries and Surveillance Epidemiology and End Results program. Rates were calculated as number of cases per 100 000 person-years and age-adjusted to the 2000 US standard population. Abbreviations: AAPC, average annual percentage change; NA, not applicable; NR, not reported due to fewer than 16 cases diagnosed.