Researchers have found that disparities in the incidence of head and neck cancer are driven by behavioral and environmental risk factors rather than race. They demonstrated this in the first-ever study to compare head and neck cancer incidence in Black patients in the United States, the Caribbean, and Africa, published by Auguste et al in Cancer Epidemiology.
Head and neck cancer is comprised of subsites such as the oral cavity and larynx. Different subsites are associated with different primary risk factors, with tobacco and alcohol abuse and human papillomavirus (HPV) infection being the most prevalent. Existing research shows that in the United States, Black patients have a higher incidence of head and neck cancer overall and in tobacco- and alcohol-related subsites than White patients, suggesting that race may be a factor in the incidence of head and neck cancer.
However, the new study, led by Camille Ragin, PhD, MPH, a Professor in the Cancer Prevention and Control research program at Fox Chase Cancer Center, researchers found that head and neck cancer subsites and their associated risk factors showed significant variation by geography and region.
“It tells us that a lot of the disparities in incidence that we see for head and neck cancer are being driven primarily by behavior and these risk factors, not necessarily because of Black race,” explained Dr. Ragin.
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More About the Study
The study was conducted by the head and neck cancer working group of the African Caribbean Cancer Consortium (AC3), a global effort to assess cancer burden in the African diaspora, which Dr. Ragin founded in 2006. Researchers compiled cancer registry data from the Caribbean, Africa, and the United States, collecting and analyzing data from nearly 15,000 cases of head and neck cancer that occurred between 2013 and 2015.
The researchers found that the incidence trends in head and neck cancer subsites in the United States did not hold true across Black populations in other regions. Certain risk factors for head and neck cancer, such as HPV infection and tobacco and alcohol abuse, may be specific to certain geographic regions, since incidence rates of head and neck cancer in HPV-related subsites were higher in some Caribbean and African countries, while incidence rates of head and neck cancer in alcohol- and tobacco-related subsites were higher in others.
In 2013 to 2015, compared to other countries, head and neck cancer incidence was highest among SEER states in the U.S. among men, and highest in Kenya among women. Nasopharyngeal cancer incidence was higher in Kenya for men and women; and female oral cavity cancer incidence was also notably higher in Kenya. Black patients from SEER states had higher incidence of laryngeal cancer compared to other countries
These findings can be used by public health administrators to inform their behavioral intervention efforts, such as where smoking cessation programs would be more effective vs HPV vaccination.
“It helps us to figure out how to prioritize the interventions that need to happen in order to address the burden of disease in these different countries and different regions,” Dr. Ragin said.
Disclosure: For full disclosures of the study authors, visit sciencedirect.com.
