Elsevier

Oral Oncology

Volume 46, Issue 8, August 2010, Pages 591-596
Oral Oncology

Head and neck cancer in a developing country: A population-based perspective across 8 years

https://doi.org/10.1016/j.oraloncology.2010.05.002Get rights and content

Summary

Head and neck cancer (HNC) has been studied in different regions of the world but little is known about its incidence patterns in the Middle East and Egypt.

In this study from Egypt’s only population-based registry, we analyzed data from 1999 to 2006, to estimate incidence, incidence rate ratios (IRRs) and 95% confidence intervals (CIs) categorized by age, district and subsites.

Overall urban incidence of HNC was twice or more that of rural incidence for both males (IRR = 2.59; 95% CI = 2.26, 2.97) and females (IRR = 2.00; 95% CI = 1.64, 2.43). Highest urban–rural difference for males was seen in 40–49 years (IRR = 2.79; 95% CI = 1.92, 4.05) and for females in 30–39 years (IRR = 2.94; 95% CI = 1.60, 5.40). Among subsites, highest incidence among males was for larynx (1.53/105) and among females for gum and mouth (0.48/105). Maximum urban–rural difference in males was for paranasal sinus (IRR = 4.66; 95% CI = 1.88, 11.54) and in females for lip (IRR = 8.91; 95% CI = 1.89, 41.98).

The study underscores the patterns of HNC incidence in Egypt while indicating the need for future analytical studies investigating specific risk factors of HNC in this population.

Introduction

Head and neck cancer (HNC) are a group of malignancies involving oral cavity, pharynx, ear/nose, and larynx. Among the 10 most common incident cancers in men worldwide, 90% of HNC is squamous cell carcinomas (SCC).1 Each year there are approximately 560,000 new cases of and 300,000 deaths due to HNC.2 The highest incidences of HNC in the world are found in South Asia, and parts of central and southern Europe.2 By far, the most common risk factors associated with HNC are tobacco and alcohol use with significant interaction observed between the two.3 Other observed risk factors are poor oral hygiene4 and the human papillomavirus (HPV) 16 in tongue, tonsil and orpharyngeal HNC and, in particular, non-smoking cases of HNC.5 In South Asian countries the risk of HNC is further aggravated by smoking of bidis which increases the incidence of cancer of hypopharynx and larynx6, and chewing tobacco, betel quid and areca-nut.7

Within the Middle East, rates of smoking are high[8], [9] although alcohol consumption is limited. This is especially true for Egypt where smoking rates are increasing for both cigarettes and water-pipe.9 However, there have been very few studies depicting the magnitude or etiologic factors of HNC in the Middle East and Egypt. Previous hospital-based studies from Egypt showed that HNC constitutes about 17–20% of all malignancies.[10], [11] The majority of cases are diagnosed at advanced stages[12], [13], [14], and the suspected risk factors of subsites varied by tumor site and place of residence in small-scale hospital-based studies.[15], [16], [17] A report of the Middle East Cancer Consortium (MECC) of the National Cancer Institute in Bethesda, USA, depicted that Egypt had one of the highest overall incidence rates of cancer of oral cavity and pharynx (5.5/105) among the MECC countries, equal to the rate seen in Israeli Jews.18 As such, we conducted this study to investigate the incidence of different clinical subsites of HNC in Egypt’s only population-based cancer registry in the Province of Gharbiah. We also explored the demographic and geographical patterns of HNC to better understand the regional differences of the disease and generate hypotheses regarding the HNC etiology.

Section snippets

Study population

The study population consisted of men and women diagnosed with HNC from 1999 through 2006 from the Gharbiah population-based cancer registry (GPCR) comprising the following sites: lip, tongue, gum, mouth (floor, palate, other), salivary glands, tonsils, pharynx (oro-, naso- and hypopharynx), and nose and ear. For each case, the following information from routinely-collected registry data was obtained: registry number, age at diagnosis, address, address code, smoking status, occupation, basis of

Results

A total of 1140 cases of HNC were identified in Gharbiah, Egypt from 1999 to 2006 with 64.3% of all cases being male (Table 1). More than half of the cases were in the 50–69 year age-category (50.71%). Most cases belonged to the two largest districts of Tanta (33.07%) and El Mehalla (21.4%). Almost 40% of males were current or former smokers although more than half of the cases had missing information on smoking (52.02%). Most cases were detected at localized stage (28.42%) and had been detected

Discussion

In this first study describing the epidemiology of HNC in Egypt using data from the only population-based cancer registry, we revealed higher incidence of HNC among males than females and higher incidence in urban than rural populations. Overall, the incidence of HNC was highest in the 70+ age group in both males and females. Highest urban–rural differences were observed in the 40–49 year age group in males and 30–39 year age group in females. Among districts, the highest overall HNC incidence

Conflicts of interest statement

None declared.

Acknowledgement

This work was supported in part by the Cancer Epidemiology Education in Special Populations (CEESP) Program of the University of Michigan (R25 CA112383).

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      Citation Excerpt :

      Oral cancer is a type of head and neck malignancy located in the lip, tongue, floor of mouth, buccal mucosa, gingiva, or palate.1 More than 90% of head and neck cancers are squamous cell carcinoma (SCC), which primarily occurs in the oral cavity and oropharynx, or so-called oral squamous cell carcinoma (OSCC).2,3 OSCC patients often present with late-stage tumors, and the 5-year survival rate is less than 50%.4

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