Elsevier

Oral Oncology

Volume 36, Issue 1, January 2000, Pages 106-115
Oral Oncology

Comparison of cancers of the oral cavity and pharynx worldwide: etiological clues

https://doi.org/10.1016/S1368-8375(99)00070-6Get rights and content

Abstract

We assessed separate and combined sex-specific incidence rates of oral and pharyngeal cancer for 1988–92 and oral/pharyngeal ratios from 49 different cancer registries in five continents. Incidence trends over a period of approximately 30 years were evaluated in 16 long active registries for men and four for women. Cancers of the lip, salivary glands, and nasopharynx were excluded. The incidence of both oral and pharyngeal cancer among men is highest in northern France, southern India, a few areas of central and eastern Europe, and Latin America. Among women, the highest incidence is observed in India. Oral/pharyngeal ratio is everywhere systematically lower in men compared to women. Recent trends for oral cancer are more favourable than those for pharyngeal cancer in developing countries. In developed countries, trends in oral cancer appears to be more closely correlated to changes in alcohol consumption than those of pharyngeal cancer.

Introduction

Cancers of the oral cavity and pharynx combined account worldwide, after the exclusion of nasopharynx, for approximately 220,000 new cases per year in men (5% of all cancers) and 90,000 in women (2% of all cancers) [1]. In some parts of Asia (i.e. south-central Asia), world-standardised incidence rates for cancers of the oral cavity and pharynx exceed in men those for any other tumours.

After many-year decline, incidence and/or mortality for cancers of the oral cavity and pharynx have been rising in the last two or three decades in many developed countries, particularly in southern and eastern Europe [2], though not, for instance, in US whites [3], [4]. Such increases are chiefly attributable to rises in the consumption of tobacco and/or alcoholic beverages [5]. An influence of dietary factors [5] and some infectious agent (e.g. human papillomavirus [6]) is also possible. Relatively little is known, however, on trends of cancer of the oral cavity and pharynx in countries outside Europe and the Americas [7], [8], [9] where betel chewing [10] and, possibly, dietary deficiencies [11] play a major role.

A comparison between oral cancer and pharyngeal cancer has seldom been attempted [1], [12], [13], due to the difficulty of assigning a site of origin, particularly in advanced cancers. However, there appears to be a substantial difference in the distribution of these two sites worldwide. In order to provide etiological clues, we compared, in the present article: (1) the distribution of oral and pharyngeal cancer, by means of incidence data from late 1980s to early 1990s which are available from an unprecedented variety of areas worldwide [4]; and (2) incidence trends of these two sites over the last 30 years or so in selected areas which are representative of parts of the world where the determinants of cancer of the oral cavity and pharynx vary substantially [3].

Section snippets

Materials and methods

Cancers of the oral cavity and pharynx include different tumours. Cancers of the lip (International classification of diseases [ICD]-9=140), of the salivary glands (ICD-9=142), and of the nasopharynx (ICD-9=147) were not assessed in our review on account of differences in histopathology, aetiology, and, for nasopharyngeal cancer, the substantial restriction of such neoplasm to some Asian areas [14]. Thus, we concentrated on oral cavity (i.e. tongue, ICD-9=141; gum, floor and other parts of the

Results

Incidence rates of cancers of the oral cavity and pharynx for 1988–92 by sex are shown for 49 areas (Table 1, Fig. 1). Table 1 also includes sex-specific oral/pharyngeal ratios.

In men in the Americas and the Australian Continent the highest rate (i.e. 17.8 per 100,000) were found in blacks in the USA, followed by Brazil, Porto Alegre, and Puerto Rico. The lowest rates were observed in Colombia, Cali, and Costa Rica, with an approximately three-fold variation. Corresponding range is narrower in

Discussion

In 1988–92 incidence rates for the combination of cancers of the oral cavity and pharynx worldwide varied approximately 20-fold in both sexes. The systematic comparison between oral and pharyngeal cancer discloses several interesting differences with respect to the relative frequency of these two sites, oral/pharyngeal ratios by gender, and incidence trends over the last two or three decades.

The possibility of some degree of misclassification of site of cancer origin should be kept in mind.

Acknowledgements

The authors wish to thank Dr. Jacques Ferlay for providing data and Mrs. Anna Redivo for editorial assistance. This work was supported by grants from the Italian Association for Research on Cancer.

References (30)

  • C. La Vecchia et al.

    Epidemiology and prevention of oral cancer

    European Journal of Cancer, Oral Oncology

    (1997)
  • C. La Vecchia et al.

    Trends in cancer mortality in the Americas, 1955–1989

    European Journal of Cancer

    (1993)
  • J. Östman et al.

    Malignant oral tumours in Sweden 1960–1989. An epidemiological study

    European Journal of Cancer, Oral Oncology

    (1995)
  • B. Cox et al.

    Trends in oral cancer by subsite in New Zealand

    European Journal of Cancer, Oral Oncology

    (1995)
  • D.M. Parkin et al.

    Estimates of the worldwide incidence of twenty-five major cancers in 1990

    International Journal of Cancer

    (1999)
  • C. La Vecchia et al.

    Trends of cancer mortality in Europe, 1955–1989: I. Digestive sites

    European Journal of Cancer

    (1992)
  • W.J. Blot et al.

    Oral and pharyngeal cancers

    Cancer Surveys

    (1994)
  • D.M. Parkin et al.

    Cancer incidence in five continents, vol. VII (IARC Scientific Publication No. 143)

    (1997)
  • S. Franceschi et al.

    Human papillomavirus and cancers of the upper aerodigestive tract: a review of epidemiological and experimental evidence

    Cancer Epidemiology Biomarkers and Prevention

    (1996)
  • C. La Vecchia et al.

    Trends in cancer mortality, 1955–1989: Asia, Africa and Oceania

    European Journal of Cancer

    (1993)
  • K. Jayant et al.

    Cancers of the upper alimentary and respiratory tracts in Bombay, India: a study of incidence over two decades

    British Journal of Cancer

    (1987)
  • R. Sankaranarayanan et al.

    Risk factors for cancer of the buccal and labial mucosa in Kerala, southern India

    Journal of Epidemiology and Community Health

    (1990)
  • I. Martinez

    Factors associated with cancer of the esophagus, mouth, and pharynx in Puerto Rico

    Journal of the National Cancer Institute

    (1969)
  • H. Moller

    Changing incidence of cancer of the tongue, oral cavity, and pharynx in Denmark

    Journal of Oral Pathology and Medicine

    (1989)
  • G.J. Macfarlane et al.

    Rising trends of oral cancer mortality among males worldwide: the return of an old public health problem

    Cancer Causes and Control

    (1994)
  • Cited by (0)

    View full text