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Original Investigation
December 2016

Incidence of Oropharyngeal Cancer Among Elderly Patients in the United States

Author Affiliations
  • 1Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
  • 2Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
  • 3Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California
  • 4Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
  • 5Cancer Prevention and Control Program, Cedars-Sinai Medical Center, Los Angeles, California
JAMA Oncol. 2016;2(12):1617-1623. doi:10.1001/jamaoncol.2016.1804
Key Points

Question  Is the increasing incidence of oropharyngeal cancer, initially observed primarily in middle-aged patients, also occurring in elderly patients in recent years?

Findings  This study of SEER data found that the incidence of oropharyngeal cancer increased between 2000 and 2012 in patients 65 years and older, whereas smoking-associated head and neck cancers decreased in this population. This was mostly driven by cancers in white men.

Meaning  Given the rapidly increasing prevalence of oropharyngeal cancer in elderly patients, the poor representation of this group in clinical trials, and the challenges treating these patients with multimodality therapy, prospective clinical trials specifically focusing on this group should be performed.

Abstract

Importance  An escalating incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) has been reported predominantly among middle-aged adults. However, HPV infection is believed to occur many years before cancer develops, and tissue studies suggest that HPV DNA is found in the majority of OPSCC diagnosed in patients 65 years or older.

Objective  To update the trends in OPSCC incidence using US cancer registry data, with an emphasis on age-specific trends.

Design, Setting, and Participants  Data from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2012) were queried to compare changes in incidence and survival trends in OPSCC with selected tobacco-related cancers (larynx, oral cavity, hypopharynx, lung) and an HPV-related cancer (anus). A total of 40 264 patients who received a diagnosis of OPSCC from 2000 to 2012 were included. Elderly patients were defined as those 65 years or older.

Main Outcomes and Measures  The annual percentage change in OPSCC incidence from 2000 to 2012, stratified according to age group.

Results  Among the 40 264 patients who received a diagnosis of OPSCC from 2000 to 2012, 13 313 (33.1%) were aged 65 years or older and 80.3% were male. Significant increases in the age-adjusted incidence of OPSCC were observed during the study period for both younger adults aged 45 to 64 years (annual percentage change [APC], 2.31; 95% CI, 1.76-2.86; P < .001) and patients 65 years or older (APC, 2.92; 95% CI, 2.32-3.51; P < .001). These changes were driven predominantly by base-of-tongue and tonsil cancers in men. Concomitantly, the incidence of tobacco-associated head and neck cancers decreased for elderly patients (larynx: APC, −1.54; 95% CI, −2.00 to −1.08; P < .001; oral cavity: APC, −1.23; 95% CI, −1.84 to −0.62; P = .001; hypopharynx: APC, −2.44; 95% CI, −3.01 to −1.86; P < .001), whereas the incidence of anal cancer significantly increased (APC, 4.42; 95% CI, 3.28 to 5.57; P < .001). Furthermore, improved overall and cause-specific survival over time were observed for both younger and elderly patients with OPSCC. Nevertheless, absolute cause-specific survival remained worse for elderly patients (3-year CSS, 60.8%; 95% CI, 59.6%-61.9%) in comparison with those aged 45 to 64 years (75.7%; 95% CI, 75.1%-76.4%; P < .001).

Conclusions and Relevance  The incidence of OPSCC is increasing among elderly patients in the United States, likely driven by HPV-associated cancers. Given the unique challenges related to treating elderly patients with OPSCC, their limited enrollment in clinical trials, and the aging US population, clinical studies investigating improved therapeutic strategies for elderly patients with HPV-positive OPSCC should be performed.

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