Elsevier

Seminars in Oncology

Volume 36, Issue 5, October 2009, Pages 451-459
Seminars in Oncology

Impact of malignant disease on young adults II
Cancer of the Oral Cavity and Pharynx in Young Females: Increasing Incidence, Role of Human Papilloma Virus, and Lack of Survival Improvement

https://doi.org/10.1053/j.seminoncol.2009.07.005Get rights and content

From 1975 to the mid 1990s, the incidence of cancer in the oral cavity and pharynx (OC/P) declined substantively, in large part because of successful educational and medical campaigns to reduce cigarette smoking and tobacco chewing. Recent data, however, suggest that the incidence trend in young adults has reversed. The current study investigated National Cancer Institute Surveillance, Epidemiology and End Results databases for changes in the incidence of and survival from OC/P cancer. Since the mid 1990s, females in the United States, between 10 and 40 years of age, have had a steady, apparently accelerating, increase in the incidence of these cancers, particularly in females 15–34 years of age. Most of the increase occurred in the salivary glands and tongue, and were of squamous, acinar, and mucoepidermoid morphologic types. All racial/ethnic groups evaluated have shown the incidence trend pattern, with the increase most prominent in non-Hispanic whites. Five-year survival rates for females 15–39 years of age, when diagnosed to have OC/P cancer, show no improvement since 1975. In contrast, older females and males of all ages continue to demonstrate a reduction in incidence and improvement in survival. The observed patterns are consistent with changing sexual mores and increasing orogenital sexual practices in the United States, with transmission of human papillomavirus and potentially other sexually transmitted carcinogenic vectors. If so, the human papillomavirus vaccines will have cancer prevention benefits beyond cervical carcinoma and will be needed increasingly as the incidence of head and neck cancer is projected to continue to rise in young women.

Section snippets

Methods

Incidence data were obtained from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute18 via SEER*Stat.version 6.4.4 (April 26, 2008) on March 15, 2009.19 To evaluate incidence trends from 1975–2005, the original nine SEER registries (SEER9) were used, consisting of Connecticut, Iowa, New Mexico, Utah, Hawaii, the metropolitan areas of Detroit, San Francisco-Oakland, Atlanta, and 13 counties of the Seattle–Puget Sound region. In 1992, four additional

Results

In the nine original registries of the US SEER program (SEER9), females less than 40 years of age sustained an increase in OC/P cancer since the 1990s, that by 2005 was approximately 20% higher among 10- to 39-year-old females than the corresponding rates in the 1980s (Figure 1). Among 10- to 24-year-old females, the corresponding increase was 50%, and among 25- to 39-year-old females, 15% higher (data not shown). The trend is the reverse of that in older females, in whom 40- to 59-year-olds

Discussion

The American Cancer Society estimates that 35,720 Americans (25,240 males and 10,480 females) will be diagnosed to have OC/P cancer in 2009.20 Of these, approximately 6% of the cases are diagnosed before age 40.19 The American Cancer Society report continues to describe a decreasing incidence of OC/P cancers since the 1980s in both men and women.20

This study reports a reversal of this trend in females less than 40 years of age that appears to have occurred in the early 1990s and resulted in an

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