Elsevier

Oral Oncology

Volume 45, Issue 9, September 2009, Pages e85-e89
Oral Oncology

Oral and oropharyngeal cancer in The Netherlands between 1989 and 2006: Increasing incidence, but not in young adults

https://doi.org/10.1016/j.oraloncology.2009.03.010Get rights and content

Summary

To determine incidence trends of head and neck squamous cell carcinomas (HNSCC), we analyzed site-specific data collected by The Netherlands Cancer Registry by 15 years-of-age categories from 1989–2006. The age-standardized annual incidence trends of all sites taken together showed a significant decrease of 0.6% for males and a significant increase of 1.8% for females. The trend for oropharyngeal carcinoma was most remarkable, with a significant increase of 2.5% and 3.0% per year for males and females, respectively. The incidence of oral carcinoma also significantly increased with a more pronounced effect for females than for males (2.0% vs. 0.5% per year). As for hypopharyngeal cancer, a significant annual increase for females (2.5%) and a stable situation for males was observed. Cancer of the larynx was the only site that showed a significant decline for males (2.4% per year), whereas it remained stable for females. In young (<45 years) adults incidences decreased for all sites with 0.1–4.7%. In conclusion, recent incidence trends of HNSCC in The Netherlands vary between sites with a considerable increase of oropharyngeal cancer as the most remarkable finding. The reason for the decreasing annual incidence rate at all sites observed for Dutch young adults remains to be explained.

Introduction

Head and neck cancer comprises malignancies arising in the upper respiratory and digestive tracts and is a relatively frequent type of cancer, as it is the fifth and eight most common cancer worldwide in 2002, for males and females, respectively.1 In 2002, the global incidence for cancer of the oral cavity, nasopharynx, pharynx and larynx was estimated 477,000 for males and 166,000 for females. Head and neck cancer is a heterogeneous disease, with several sites and subsites and different histologies and etiological factors. Therefore, when studying incidence, a detailed discrimination regarding site and histology should preferably be included.

Incidence and survival trends have recently been reported on various types of cancer based on 1994–2003 data from cancer registries in a large number of European countries.2 Oral cavity and pharyngeal cancer were analyzed as a group and divergent incidence trends were observed when different countries were compared. For some countries there was an increase in incidence (England, Wales and Czech Republic), whereas for other countries there was no change (a.o. Switzerland and Denmark) or a decrease (a.o. Finland, France and Germany). For The Netherlands, an annual increase of this type of cancer for females and a stable situation for males were reported. No discrimination between oral and oropharyngeal cancer was made. In the same study, the incidence trends of laryngeal cancer were reported to be decreased for males and stable for females in most European countries, including The Netherlands.

The increasing role of viral infection has recently been debated in relation to incidence trends in HNSCC.3 An infection with a high-risk type of human papilloma virus (HPV) has recently been identified as cause of HNSCC.4 The oropharynx is the predominant site where HPV-induced squamous cell carcinomas develop, in particular in the tonsil.[5], [6] Studies in Scandinavia and the U.S. showed an increasing trend for tonsillar cancer for the last 25 years.[3], [6], [7] Furthermore, there are indications that the increase of tonsillar cancer incidence must for a large part if not entirely be contributed to the oncogenic activity of the human papilloma virus.[8], [7]

Another epidemiological trend that attracts attention is the increasing incidence of squamous cell carcinomas of the oropharynx and oral cavity in the U.S. and Europe in young adults. In the period 1973–2001 an increase of squamous cancer of the oral tongue, base of tongue and tonsil has been observed in the U.S. in white adults aged 20–44 years.[9], [10] Similar trends have been observed in European countries, England, Wales, Switzerland, Scandinavia and Slovakia.[11], [12]

To determine more accurate trends in site-specific incidences as opposed to a general overview, we report on the site-specific data collected on HNSCC in The Netherlands. Incidence trends in four different age-groups were analyzed for an 18 year period from 1989 to 2006.

Section snippets

Materials and methods

Data was obtained from The Netherlands Cancer Registry covering the period between 1989 and 2006. This dataset approximates to the total population of The Netherlands. Only squamous cell carcinomas were included. We analyzed data of the oral cavity, including oral tongue (ICD-O topography code C02), gingiva (C03), floor of mouth (C04) and remaining or unspecified parts of the oral cavity (C00.3-5, C05.0, C05.8-9, C06); the oropharynx, including base of tongue (C01), palate (C05.1 and C05.2),

Results

Incidence trends in The Netherlands in the period 1989–2006 are listed for all HNSCC sites in Fig. 1. For males a decreasing annual incidences was observed with an significant EAPC of −0.6% (95% confidence intervals (CI) of −0.9% and −0.3%). This was in contrast to the increasing trend in females (significant EADT of 1.8% with CI of 1.3% and 2.4%). Results of the different HNSCC sites and subsites for both genders are shown in Table 1, Table 2 and Figure 2, Figure 3.

Discussion

This study addressed the incidence trends of different sites and subsites of HNSCC in The Netherlands in the period of 1989–2006. The most remarkable finding of this study was the significant increase of oropharyngeal cancer in the male and female population, with 2.3% and 3.0% per year, respectively. Hypopharyngeal and oral cancer increased in females and remained stable in males. For laryngeal cancer a decrease of 2.4% per year for males and a stable situation for females was observed.

Conflict of Interest Statement

None declared.

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