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 chronic exposure of the upper aerodigestive tract to these carcinogenic factors can result in dysplastic or premalignant lesions in the oropharyngeal mucosa and ultimately result in head and neck 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 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 United 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; these factors contribute disproportionately to the overall cancer burden in these Asian countries [2,3].
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 . In Europe, there were approximately 250,000 cases (estimated 4 percent of the cancer incidence) and 63,500 deaths in 2012 . 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 human papillomavirus (HPV) positivity . (See "Human papillomavirus associated head and neck cancer", section on 'Prognosis'.)
The risk factors most frequently associated with head and neck cancer include smoking, alcohol consumption, human papillomavirus (HPV) infection (especially for oropharyngeal cancers), and Epstein-Barr virus (EBV) infection (for nasopharyngeal cancers in Asia) .
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