Global, Regional, and National Burden of Pharyngeal Cancer and Projections to 2050 in 185 Countries: A Population-Based Systematic Analysis of GLOBOCAN 2022

Abstract

Background: Pharyngeal cancer has resulted in 3.23 million disability-adjusted life years as of 2019. Based on anatomical site, pharyngeal cancers are categorized into oropharyngeal cancers (OPCs), nasopharyngeal cancers (NPCs), and hypopharyngeal cancers (HPCs). The spatiotemporal distribution of each pharyngeal cancer is related to their respective risk factors.

Methods: Using the latest updated GLOBOCAN 2022 and Cancer Incidence in Five Continents database, global, regional, and national age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) of pharyngeal cancer by anatomical site, as well as longitudinal trends since 1998 and future projections to 2050 were investigated across 185 countries and territories. We employed joinpoint regression to assess the average annual percentage change to quantify trends in the ASIR of pharyngeal cancer. We additionally present the mortality-to-incidence ratio as an indicator of disease fatality.

Results: In 2022, an estimated 313,091 people were diagnosed with pharyngeal cancer (ASIR, 3.3 per 100,000 person-years) and 166,689 people died from pharyngeal cancer worldwide (ASMR, 1.7 per 100,000 person-years). Regardless of an individual's age and anatomical site, pharyngeal cancer exhibits significantly higher incidence and mortality rates in old males, and the highest number of cases and deaths occur in individuals aged 45-59 years in both sexes. The highest ASIRs per 100,000 person-years were found in Western Europe (2.6) and Northern America (2.6) for OPC, South-Eastern Asia (4.7) for NPCs, South Central Asia (2.1) and Eastern Europe (1.5) for HPC. ASMR per 100,000 person-years were higher for OPC and HPC in Eastern Europe (OPC, 1.1; HPC, 1.0), South Central Asia (OPC, 0.9; HPC, 0.8), and for NPC in South-Eastern Asia (3.1), and Micronesia (2.1). In most countries, the incidence of OPC either increased or remained at a similar level, and NPC remained stable in most countries and HPC decreased or remained unchanged in both sexes. If the ASIR and ASMR of 2022 are maintained, in 2050, the projected number of cases will increase by 63.64% for OPC, 46.40% for NPC, and 64.23% for HPC.

Conclusion: Pharyngeal cancer represents a significant burden on global public health, with its disease burden varying across different demographic variables. These variations were closely associated with risk factors such as tobacco and alcohol use, high-risk human papillomavirus, and Epstein-Barr virus infections. To effectively manage the current and future global burden, tailored interventions aligned with unique epidemiological profiles of pharyngeal cancer in diverse populations are required.

Keywords: Global Burden; Hypopharyngeal Cancer; Incidence; Mortality; Nasopharyngeal Cancer; Oropharyngeal Cancer; Pharyngeal Cancer.

Fig. 1. Age-standardized rates (per 100,000 people) of incidence and mortality from oropharyngeal, nasopharyngeal, and HPC in 2022. (A) ASIR of oropharyngeal cancer, (B) ASIR of nasopharyngeal cancer, (C) ASIR of hypopharyngeal cancer, (D) ASMR of oropharyngeal cancer, (E) ASMR of nasopharyngeal cancer, (F) and ASMR of hypopharyngeal cancer.

ASIR = age-standardized incidence rate, ASMR = age-standardized mortality rate.

Fig. 2. Numbers and age-standardized rates (per 100,000 people) of incidence and mortality from oropharyngeal, nasopharyngeal, and hypopharyngeal cancer at the global level by age group and sex, in 2022. (A) Incidence of oropharyngeal cancer, (B) incidence of nasopharyngeal cancer, (C) incidence of HPC, (D) mortality of oropharyngeal cancer, (E) mortality of nasopharyngeal cancer, and (F) mortality of hypopharyngeal cancer.

Fig. 3. Distribution of age-standardized rates (per 100,000 people) of incidence and mortality by age group and HDI. (A) ASIR of oropharyngeal cancer, (B) ASIR of nasopharyngeal cancer, (C) ASIR of hypopharyngeal cancer, (D) ASMR of oropharyngeal cancer, (E) ASMR of nasopharyngeal cancer, (F) and ASMR of hypopharyngeal cancer.

HDI = Human Development Index, ASIR = age-standardized incidence rate, ASMR = age-standardized mortality rate.

Fig. 4. Age standardized mortality-to-incidence ratio (per 100,000 people) from oropharyngeal, nasopharyngeal, and hypopharyngeal cancer in 2022 by UN regions and HDI. (A) Oropharyngeal cancer, (B) nasopharyngeal cancer, and (C) hypopharyngeal cancer.

HDI = Human Development Index, M:I ratio = mortality-to-incidence ratio, UN = United Nations.

Fig. 5. AAPC of incidence from tonsil, oropharyngeal without tonsil, oropharyngeal without tonsil, nasopharyngeal, and hypopharyngeal cancer in the most recent 15 years (2003–2017). (A) Tonsil cancer, (B) oropharyngeal cancer without tonsil cancer, (C) nasopharyngeal cancer, and (D) hypopharyngeal cancer.

AAPC = average annual percentage change. *Statistically significant.