Epidemiology and risk factors for head and neck cancer
- Kerstin M Stenson, MD, FACS
Kerstin M Stenson, MD, FACS
- Chief, Head and Neck Cancer Program, Rush University Medical Center
- Department of Otolaryngology/Head and Neck Surgery
Head and neck cancer is common in several regions of the world. The primary risk factors associated with head and neck cancer include tobacco use, alcohol consumption, human papillomavirus (HPV) infection (for oropharyngeal cancer), and Epstein-Barr virus (EBV) infection (for nasopharyngeal cancer). The relative prevalence of these risk factors contributes to the variations in the observed distribution of head and neck cancer in different areas of the world.
The chronic exposure of the upper aerodigestive tract to these and other risk factors is thought to produce field cancerization, a process in which patients with cancer or premalignant dysplastic lesions in the oropharyngeal mucosa are at significant risk for head and neck cancer. (See "Head and neck squamous cell carcinogenesis: Molecular and genetic alterations".)
The epidemiology of head and neck cancer and the risk factors for and pathogenesis of these tumors will be reviewed here. Issues related to pathology, diagnosis, staging, and therapy are considered separately. (See appropriate topic reviews).
Overall, head and neck cancer accounts for more than 550,000 cases annually worldwide . Males are affected significantly more than females with a ratio ranging from 2:1 to 4:1. The incidence rate in males exceeds 20 per 100,000 in regions of France, Hong Kong, the Indian subcontinent, central and eastern Europe, Spain, Italy, Brazil and among African Americans in the Unites States. Mouth and tongue cancers are more common in the Indian subcontinent, nasopharyngeal cancer is more common in Hong Kong, and pharyngeal and/or laryngeal cancers are more common in other populations.
In the United States, head and neck cancer accounts for 3 percent of malignancies, with almost 60,000 Americans developing head and neck cancer annually and 12,000 dying from the disease . The incidence of laryngeal cancer, but not oral cavity and pharyngeal cancer, is approximately 50 percent higher in African American men . The mortality associate with both laryngeal and oropharyngeal cancer is significantly higher in African American men, which may reflect the lower prevalence of HPV positivity . (See "Human papillomavirus associated head and neck cancer", section on 'Prognosis'.)
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