Epidemiology of Head and Neck Cancer

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Key points

  • The two major causes of head and neck cancer (HNC) are (1) tobacco and alcohol, and (2) human papillomavirus (HPV).

  • HPV-HNC is strongly tied to oral sexual behaviors and is most common in middle-aged white men.

  • The epidemiology of HPV-HNC can be explained in part by variations in oral sexual behaviors by race and age cohort.

  • Globally, incidence of HPV-negative HNC is associated with patterns of tobacco use, and is falling in countries with declining rates of tobacco smoking.

  • Prognosis for HNC is

Risk factors for head and neck cancer

The risk factors for HNC include some common risk factors associated with both HPV-positive and HPV-negative HNC, as well as other distinct causative factors. This section reviews risk factors for HNC overall, followed by a discussion of those specific to HPV-HNC.

Head and Neck Cancer Incidence in the United States and Globally

Although HNC as whole is the seventh most common cancer worldwide,1 the incidence varies considerably by anatomic tumor site (Table 2) and geographic region.12 Oral cavity and laryngeal SCC are the most common HNCs worldwide (age-adjusted standardized incidence rate [SIR] 3.9 per 100,000 and 2.3 per 100,000, respectively), with nasopharynx and other pharynx cancers less common (SIR 1.2 and 2.0 per 100,000, respectively).1 Notably, currently available HNC incidence statistics are limited by

Prognosis

Survival after HNC is predicted primarily by anatomic site, stage, and HPV status, with other pathologic and clinical factors influencing prognosis to a lesser degree. The American Joint Committee on Cancer (AJCC) staging system for each tumor site is the primary parameter used to predict prognosis and guide treatment.97 This system incorporates information about tumor size, cervical lymph node metastases, and distant metastases.98 Overall, 5-year survival after a diagnosis of HNC in the United

Summary

HNC is a heterogeneous disease that is caused primarily by tobacco use and HPV. Although the incidence of tobacco-related HNC is decreasing in the United States, following a decline in tobacco-smoking prevalence, the incidence of HPV-HNC is rising rapidly. HPV-HNC is mostly observed in middle-aged white men, which may be explained by patterns of oral sexual behavior in this demographic and age cohort. HNC incidence trends vary considerably by country and by patterns of tobacco use. Although

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