Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 6;115(12):1544-1554.
doi: 10.1093/jnci/djad169.

Global epidemiologic patterns of oropharyngeal cancer incidence trends

Zachary S Zumsteg  1   2 , Michael Luu  2   3 , Philip S Rosenberg  4 , Julia K Elrod  4   5 , Freddie Bray  6 , Salvatore Vaccarella  6 , Christopher Gay  7 , Diana J Lu  8 , Michelle M Chen  9 , Anil K Chaturvedi  4 , Marc T Goodman  2   10
Affiliations

Global epidemiologic patterns of oropharyngeal cancer incidence trends

Zachary S Zumsteg et al. J Natl Cancer Inst. .

Abstract

Background: The emergence of human papillomavirus (HPV)-positive oropharyngeal cancer and evolving tobacco use patterns have changed the landscape of head and neck cancer epidemiology internationally. We investigated updated trends in oropharyngeal cancer incidence worldwide.

Methods: We analyzed cancer incidence data between 1993 and 2012 from 42 countries using the Cancer Incidence in Five Continents database volumes V through XI. Trends in oropharyngeal cancer incidence were compared with oral cavity cancers and lung squamous cell carcinomas using log-linear regression and age period-cohort modeling.

Results: In total, 156 567 oropharyngeal cancer, 146 693 oral cavity cancer, and 621 947 lung squamous cell carcinoma patients were included. Oropharyngeal cancer incidence increased (P < .05) in 19 and 23 countries in men and women, respectively. In countries with increasing male oropharyngeal cancer incidence, all but 1 had statistically significant decreases in lung squamous cell carcinoma incidence, and all but 2 had decreasing or nonsignificant net drifts for oral cavity cancer. Increased oropharyngeal cancer incidence was observed both in middle-aged (40-59 years) and older (≥60 years) male cohorts, with strong nonlinear birth cohort effects. In 20 countries where oropharyngeal cancer incidence increased for women and age period-cohort analysis was possible, 13 had negative or nonsignificant lung squamous cell carcinoma net drifts, including 4 countries with higher oropharyngeal cancer net drifts vs both lung squamous cell carcinoma and oral cavity cancer (P < .05 for all comparisons).

Conclusions: Increasing oropharyngeal cancer incidence is seen among an expanding array of countries worldwide. In men, increased oropharyngeal cancer is extending to older age groups, likely driven by human papillomavirus-related birth cohort effects. In women, more diverse patterns were observed, suggesting a complex interplay of risks factors varying by country, including several countries where female oropharyngeal cancer increases may be driven by HPV.

PubMed Disclaimer

Conflict of interest statement

Dr Chaturvedi is supported by the Intramural Research Program of the National Cancer Institute. Dr Zumsteg’s spouse previously performed legal work for Johnson & Johnson, Allergan, Merck, and Boehringer Ingelheim. The other authors have nothing else to disclose.

Figures

Figure 1.
Figure 1.
Annual percentage change in incidence of oropharyngeal cancers in men and women from 1993 to 2012.
Figure 2.
Figure 2.
Net drifts calculated using age period–cohort analysis for oropharyngeal cancer, oral cavity cancer, and squamous cell carcinoma of the lung in men  for countries with increasing incidence of oropharyngeal cancer in log-linear regression. * = net drift for oropharyngeal cancer greater than squamous cell carcinoma of the lung (P < .05), † = net drift for oropharyngeal cancer greater than oral cavity cancer (P < .05). CI = confidence interval.
Figure 3.
Figure 3.
Birth cohort effects for oropharyngeal cancer and lung squamous cell carcinoma incidence in men, stratified by age for countries with statistically significant increases in oropharyngeal cancer incidence.
Figure 3.
Figure 3.
Continued.
Figure 4.
Figure 4.
Net drifts calculated using age period–cohort analysis for oropharyngeal cancer, oral cavity cancer, and squamous cell carcinoma of the lung for women in countries with increasing incidence of oropharyngeal cancer in log-linear regression and A) without or B) with significantly positive lung squamous cell carcinoma net drifts. * = net drift for oropharyngeal cancer greater than lung squamous cell carcinoma (P < .05), † = net drift for oropharyngeal cancer greater than oral cavity cancer (P < .05). CI = confidence interval.
Figure 5.
Figure 5.
Correlation of the oropharyngeal cancer net drift with the 2000 Human Development Index (HDI) for each country in A) men and B) women.
See this image and copyright information in PMC

Comment in

References

    1. Chaturvedi AK, Anderson WF, Lortet-Tieulent J, et al.Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol. 2013;31(36):4550-4559. - PMC - PubMed
    1. Marur S, D'Souza G, Westra WH, et al.HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncol. 2010;11(8):781-789. - PMC - PubMed
    1. Kreimer AR, Chaturvedi AK, Alemany L, et al.Summary from an international cancer seminar focused on human papillomavirus (HPV)-positive oropharynx cancer, convened by scientists at IARC and NCI. Oral Oncol. 2020;108:104736. - PMC - PubMed
    1. Lorenzoni V, Chaturvedi AK, Vignat J, et al.The Current Burden of Oropharyngeal Cancer: a global assessment based on GLOBOCAN 2020. Cancer Epidemiol Biomarkers Prev. 2022;31(11):2054-2062. - PubMed
    1. Hashibe M, Brennan P, Benhamou S, et al.Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst. 2007;99(10):777-789. - PubMed

Publication types