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Original Investigation
December 16, 2021

Oropharyngeal Cancer Incidence and Mortality Trends in All 50 States in the US, 2001-2017

Author Affiliations
  • 1Center for Health Services Research, Department of Management, Policy, and Community Health, School of Public Health, UTHealth Science Center at Houston, Texas
  • 2Center for Healthcare Data, Department of Management, Policy and Community Health, School of Public Health, UT Health Science Center at Houston, Texas
  • 3Department of Biostatistics and Data Science, School of Public Health, UT Health Science Center at Houston, Texas
  • 4Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, UT Health Science Center at Houston, Texas
  • 5Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida
JAMA Otolaryngol Head Neck Surg. 2022;148(2):155-165. doi:10.1001/jamaoto.2021.3567
Key Points

Question  What are recent trends in oropharyngeal cancer (OPC) incidence, stage at diagnosis, and mortality in all 50 US states and the District of Columbia?

Findings  This cross-sectional study including 260 182 patients with OPC found that the incidence of OPC has increased 2.7% per year during 2001 through 2017 among men, with the most pronounced rise (3.1% per year) occurring for patients diagnosed with regional stage. Among men, increases of over 3.5% per year were largely clustered in the Southeastern and Midwestern states, and among women, an increase of over 2% per year was also mostly concentrated in the Southeast and Midwest; overall OPC incidence-based mortality increased 2.1% per year among men.

Meaning  Improved OPC prevention to combat rising disease burden and mortality is needed, and future research is also required to understand geographic disparities.

Abstract

Importance  Oropharyngeal cancer (OPC) incidence is rising among men in the US. Comprehensive assessments of nationwide trends in OPC incidence and mortality by demographics, tumor characteristics at diagnosis, and geography are lacking.

Objective  We examined secular trends in OPC incidence and mortality rates in all 50 US states and the District of Columbia (DC).

Design, Setting, and Participants  In this cross-sectional study, we used the US Cancer Statistics data set to examine OPC incidence trends from 2001 through 2017. Observed and incidence-based mortality trends were evaluated using data from the National Center for Health Statistics and Surveillance Epidemiology and End Results program, respectively. Data analysis was conducted from January to April 2021.

Results  Nationwide, 260 182 OPC cases were identified; 209 297 (80%) occurred in men, 168 674 (65%) with regional stage, and 142 068 (55%) in the Southeast and Midwest regions, during 2001 to 2017. Incidence of OPC increased nationally 2.7% per year among men, with a notable (over 3% per year) rise among non-Hispanic White men and in men aged 65 years and older. Overall, among women, the annual percentage change was 0.5% (95% CI, −0.28% to 1.22%). Among men, with a 3.1% per year rise (95% CI, 2.4% to 3.8%), regional-stage OPC incidence increased nearly 2-fold. Among women, regional-stage OPC incidence increased 1.0% per year (95% CI, 0.3% to 1.7%). Among men, OPC incidence increased in all states and regions except Alaska, DC, and Wyoming. Among men, the most pronounced increases (more than 3.5% per year) were clustered in the Southeast and Midwest regions. Among women, a rise of more than 2% per year was also concentrated in the Southeast and Midwest regions. Among men, OPC incidence-based mortality increased 2.1% per year (95% CI, 1.0% to 3.2%) overall in recent years (from 2006 to 2017). In contrast, among women, the annual percentage change in OPC incidence-based mortality was −1.2% (95% CI, −2.5% to 0.1%).

Conclusions and Relevance  The findings of this cross-sectional study suggest that the incidence of OPC has continued to increase nationally among men in the US, with rapid increases among the elderly population. The notable rise in regional-stage OPC and the concurrent recent rise in mortality among men is troubling and calls for urgent improvements in prevention. Distinct geographic patterns with notable rises in the Midwest and Southeast regions imply the need for improved and targeted prevention as well as future studies to understand etiological reasons for geographic disparities.

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