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Projections of the Incidence of Pharyngeal, Tongue and Parotid Gland Cancer in Western Australia

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ABSTRACT

Aims: The aims of this study are to provide updated estimates

of the burden of pharyngeal, tongue and parotid cancer in Western Australia for the period 1982-2009, and also present the estimated projections of cases of these specific sites of cancer over the next decade.

Methods: Incidence data for the current analysis were

obtained from the Western Australian Cancer Registry for the period 1995 to 2004. Two widely acknowledged methods have been used to generate projection data for these statistics through to the year 2025.

and Parotid Gland Cancer in Western Australia

Dr. Derbi Hajer Abdelhafied, Professor Estie Kruger, Professor Marc Tennant.

International Research Colloaborative - Oral Health and Equity, The Univeristy of Western Australia, 35 Stirling Hwy, Nedlands, WA 6009, Australia.

Results: Projections indicate increasing population rates

of pharyngeal and tongue cancers and decrease in parotid gland cancer in Western Australia for the next 15 years. The projected trends in this study indicate a rise of pharyngeal cancer among men but remain stable among women. For tongue cancer, projections indicate that both female and male incidence rates remain stable or show a slight change for the next 15 years. Rates of parotid cancer are expected to decrease. The projected trends indicate a rise of parotid incidence rates in the 60-69 and 70-79 year female age groups and a marketable decrease of parotid cancer among 80+ male age group.

Conclusion: Quantifying the future burden of cancer

incidence in terms of expected numbers of cases is important in optimising the allocation of resources for screening, diagnostic, and therapeutic services, as well as providing a baseline from which the success of future interventions can be judged.

InTRoduCTIon

Head and neck cancers (including oral cancers) are strongly related to behavioural and lifestyle factors1,2.

Smoking and alcohol consumption are also associated with an increased risk of head and neck cancers as is other risk factors such as human papillomavirus (HPV) infection.3-7 In 1996, oral cancer in Australia accounted

for approximately 3% of all cancer and cancer deaths.8,9

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In comparison to other western countries, Australia had similar rates of head and neck cancers to Italy, Switzerland, Canada, and Austria, but double that of the uK.9,10 In Western Australia, in 2006, oral cancer

accounted for 2.3%, and the mortality rate accounted for 1.3% of all cancers.11 As with most developed countries,

Australia and specifically Western Australia, is facing an ageing demographic and as cancer has a higher aged incidence, it would not be unexpected to become a more significant burden.12 This is a demographic feature

that is expected to impact on the demands for health services over the next 20 years13 due to an increase in

age-related diseases. Previous research has examined lip and tongue cancer rates only, based on just 10 years of previous data, projected through the next 20 years, and finding a substantially growing demand for services.12

understanding the projected incidence of cancer is a fundamental requirement of rational planning for monitoring and treatment of cancer.14-16 Against this

backdrop the aim of this study was to analyse projected incidence rates (for pharynx, parotid and tongue) for Western Australia through to the year 2023, using over 25 years of data for robustness.

MeTHodS

Incidence data for the current analysis were obtained from the Western Australian Cancer Registry for the 27-year period 1982 to 2009. The international classification of disease (ICd10) system is used to categorize oral cancers according to site, and the following sites were included in this analysis for the incidence data (ICd10 code in brackets): Tongue (C010-C029), pharynx (C090-C149) and (C070-C079) for parotid cancer.

All incidence rates are presented as standardized rates according to the age structure of the Western Australian population and expressed per 100,000 people per annum.

Projections

Two separate methods were used to project future cases.17 The linear method uses the historical data to

estimate a line of best fit for each 5-year age group, using the method of least squares. Based on the estimated age-specific rate, the future number of cases is determined. The second method, the estimated weighted moving average (eWMA), also uses historical trends to model future estimates. unlike the linear methods that treat all the historical data points equally, this method places greater weight on more recent data. All projections were calculated using the Rates Calculator, a software package developed by the Health department of Western Australia and has been used previously.17 other data

analyses were performed using SPSS, Version 12.0.1. Significant differences between rates were based on non-overlapping 95% confidence intervals (p < 0.05).

ReSulTS

Pharyngeal cancer incidence

In Western Australia between 1982 and 2009, 1264 persons were diagnosed with pharyngeal cancer. This ranged from 22 cases in 1982 to 79 cases in 2009. The rates were between 1.6 to 3.5. (per 100 000 persons). over the 27 years period the rates were higher in males than females, with the average incidence rate 0.9 for females and 5 for

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males. In all years the rates increased with increasing age, being highest in those aged 80+.

Pharyngeal cancer incidence projections

Projected estimates of age-adjusted incidence rates obtained from the current data were applied to changes in population predicted through to 2026. Both projection methods indicated an increase in the number of pharyngeal

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Parotid cancer incidence

In Western Australia between 1982 and 2009 417 persons were diagnosed with parotid cancer. This ranged from 17 cases in 1982 to 24 cases in 2009. The rates were between 1.3 to 1.1. The rate for males was slightly higher than that for females in most of the years. over the 27-year period the rates increased with increasing age. They were lowest in those under the age of 49 years and being highest in those aged 80+ years.

Parotid cancer incidence projections

Both projection methods indicate a slight increase of parotid cancer cases over the next 15 years (Figure 1). This will increase from 17 cases in 1982 to 27 (both linear and eWMA methods) cases in 2025. Projections for the three oldest age groups (age 60-69, 70-79 and 80+) indicated a near steady state, low number of cases through to 2026.

Tongue cancer incidence

In Western Australia between 1982 and 2009 1015 persons were diagnosed with tongue cancer, this ranged from 24 cases in 1982 to 65 in 2009. The rates (per 100 000 per annum) were between 1.8 persons to 2.9. The rate for males was higher than that for females in every year. over the 27-year period, rates of tongue cancer increased with increasing age. They were lowest in those under age of 49 years and highest in those above 60.

Tongue cancer incidence projections

Both projection methods indicate an increase in the numbers of tongue cancer cases over the next 15 years (Figure 1). This will increase from 24 cases in 1982 to between 82 (eWMA method) and 87 (linear method) in 2025. Projection for the three oldest age groups indicated a steady increase in cases in particular in the 70-79 year old age group.

Table 1. The projected number of cases for cancer of the pharynx, parotid and tongue for makes and females through to 2026.

Pharynx Parotid Tongue

Female Male Total Female Male Total Female Male Total

2014 11 67 78 7 13 20 21 43 64

2015 11 71 82 7 13 20 21 44 65

2016 12 74 86 7 13 20 23 46 69

2017 12 76 88 7 13 20 23 46 69

2018 12 78 90 7 13 20 24 48 72

2019 13 79 92 7 13 20 26 49 75

2020 13 83 96 8 13 21 26 50 76

2021 13 86 99 9 13 22 27 51 78

2022 14 87 101 10 13 23 28 52 80

2023 14 91 105 10 14 24 29 54 83

2024 14 92 106 10 14 24 31 54 85

2025 14 95 109 10 14 24 32 56 88

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dISCuSSIon

This study provides estimates of the burden of pharyngeal, tongue and parotid cancer in Western Australia for the period 1982-2009 and presents the projected changes in cases of these specific sites of cancer through to 2026 using two different statistical methods. Between 1982 and 2009, pharyngeal cancer rate increased from 1.6 to 3.5, during this period the rates were higher in males than females. This is consistent with GloBoCAn 2002 results,18 the

rates for men is higher in most developed countries than for women. The strong association between pharyngeal cancer and high consumption of alcohol and tobacco is well established.4, 5, 19, 20 In 2008 a study reported that

Australia’s total per capita alcohol consumption has been increasing significantly over time.21 It had been

observed that cigarette smokers who were never drinkers had an increased risk of pharyngeal cancer, however, high frequency of alcohol consumption increase the risk of cancer of oro-pharyngeal and hypo-pharyngeal among never tobacco users.22

In the united Kingdom, between 1998 and 2002, studies reported that trends of pharyngeal cancer were increasing for men and stable for women.23, 24 The projected trends

in this study indicate a rise of pharyngeal cancer among men but remain stable among women. Changing patterns of alcohol consumption and tobacco use might contribute to the projected changes, and the role of nutrition and infection also require consideration. Incidence rates are higher in older age groups and projections indicate increases in incidence in the 70-79 year age group for men and 70-79 and 80+ year age groups for women. Within Western Australia the rapidly aging population implies demand on the health system and planning of future resource allocation should be considered.

Tongue cancer is the most common intra-oral cancer in western countries.25 over the 27 year period, the

incidence rate increased from 1.8 in 1982 to 2.9 persons/year in 2009 (2.2 and 3.5 for females and males respectively). This is much higher than national rates for Australia, however which, in 1996, were reported to be 1.4 and 2.9 for females and males respectively.11 Compared

with other Australian states, the incidence of tongue cancer especially among males in Western Australia is high.26 For example, the incidence in Victoria is 2.1 per

100 000 and between 0.89-1.15 per 100 000 per annum in South Australia,25 the reason for regional difference in the

incidence rates is not clear. Tongue cancer incidence rates in South Australia remained relatively stable over a 24 year period.25 In Western Australia over a 10 year period,

it remained relatively stable27 and this highlights the need

to use longer datasets in the analysis of low frequency conditions. In this study, tongue cancer incidence rates showed no significant change among males and females over the 27 year period.

Projections indicate that both female and male incidence rates remain stable or show a slight change for the next 15 years. The explanations for these changes are speculative. Macfarlane et al. believe this pattern is consistent with Australian trends in per capita consumption of tobacco and alcohol and an increased intake of fruits and vegetables which is considered to have a protective role against oral cancer.4

over the 27-year period, 417 persons were diagnosed with parotid cancer. The rates were decreased from 1.3 in 1982 to 1.1 in 2009, the rates were highest in those aged 80+ for both males and females. For the next 15 years, rates of parotid cancer are expected to decrease to 0.9 in 2025. The projected trends indicate a rise of parotid incidence rates in the 60-69 and 70-79 year female age groups and a marketable decrease of parotid cancer among 80+male age group, remain speculative. As the risk factors for parotid gland cancer are unknown, it is difficult to speculate about the reasons for the extraordinary decrease in the rates among men age group 80+ in Western Australia. Closer examination of this sub-population may shed light on the aetiology of parotid gland cancer.

It will be interesting to monitor the incidence of head and neck cancers for the next couple of decades in Australia and to test them against these projections. With the clear increase in vaccinations against HPV in Australia (supported by the government) it may well be the case that we see a slow offset reduction against the projections as head and neck cancers with a HBV related cause diminish. However, this will remain to be seen by future research against these baseline projection data.

ConCluSIon

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frequency are under review. Clearly, the impact of these changes in rates of disease will require clear thought as to the future workforce needs for Western Australia. Similar trends for other developed countries (as there population ages) would not be unexpected.

ACKnoWledGeMenT

The authors would like to thank Tim Trelfall at the Department of Health (Western Australia) for his assistance in providing the data.

ReFeRenCeS

1. Johnson n. Tobacco use and oral cancer: a global perspective. Jde 2001;65:328-39.

2. Mignogna Md. The World Cancer Report and the burden of oral cancer. e J Canc Prev. 2004;13:139.

3. neville B. oral cancer and precancerous lesions. Cancer 2002;52:195-215.

4. Macfarlane GJ, McCredie M, Coates M. Patterns of oral and pharyngeal cancer incidence in new South Wales, Australia. JoMoP. 1994;23:241-5.

5. lewin F, norell Se, Johansson H, Gustavsson P, Wennerberg J, Biörklund A, et al. Smoking tobacco, oral snuff, and alcohol in the etiology of squamous cell carcinoma of the head and neck. Cancer. 2000;82:1367-75.

6. Morse de, Psoter WJ, Cleveland d, Cohen d, Mohit-Tabatabai M, Kosis dl, et al. Smoking and drinking in relation to oral cancer and oral epithelial dysplasia. Cancer Causes Control. 2007;18:919-29. 7. Maden C, Beckmann AM, Thomas dB, McKnight B, Sherman KJ, Ashley Rl, et al. Human papillomaviruses, herpes simplex viruses, and the risk of oral cancer in men. Am J epi. 1992;135:1093-102. 8. Chandu A, Adams G, Smith A. Factors affecting survival in patients with oral cancer: an Australian perspective. IJoMS. 2005;34:514-20.

9. 10. Sugerman PB, Savage nW. Current concepts in oral cancer. AdJ. 1999;44:147-56.

10. Boyle P, Macfarlane G, Maisonneuve P, Zheng T, Scully C, Tedesco B. epidemiology of mouth cancer in 1989: a review. JRSMed. 1990;83:724.

11. Sugerman P, Savage n. oral cancer in Australia: 1983–1996. AdJ. 2002;47:45-56.

12. Kruger e, Tennant M. Ten‐year trends and 20‐year projections of the incidence of lip and tongue cancer in Western Australia. APJ Clin oncol. 2008;4(2):91-7.

13. McMichael A, Puzio A. Time trends in upper alimentary tract cancer rates and alcohol and tobacco consumption in Australia. Com Hlth Studies. 1988;12:289-95.

14. Yang l, Parkin dM, Ferlay J, li l, Chen Y. estimates of cancer incidence in China for 2000 and projections for 2005. Cancer epi Bio Prev. 2005;14:243-50.

15. 14. Bray F, Møller B. Predicting the future burden of cancer. nature Rev Cancer. 2005;6:63-74.

16. Mistry M, Parkin d, Ahmad A, Sasieni P. Cancer incidence in the united Kingdom: projections to the year 2030. BJ Cancer. 2011;105:1795-803.

17. Gill l, Codde JP, Vasudaven M. estimating future demand for hospital services: a comparison of three projection models. epidemiology occasional paper 1. department of Health, Western Australia, Perth 1997.

18. Ferlay J. GloBoCAn 2000 [: Cancer Incidence, Mortality and Prevalence Worldwide: IARC press; 2001.

19. Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. oral oncol. 2009;45:309-16.

20. Australian Institute of Health and Welfare & Australasian Association of Cancer Registries 2010. Cancer in Australia: an overview, 2010. Cancer series no. 60. Cat. no. CAn 56. Canberra: AIHW.

21. Chikritzhs Tn, Allsop SJ, Moodie AR, Hall Wd. Per capita alcohol consumption in Australia: will the real trend please step forward. Med J Aust. 2010;193:594-7.

22. Hashibe M, Brennan P, Benhamou S, Castellsague X, Chen C, Curado MP, et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and neck Cancer epidemiology Consortium. J nat Cancer Inst. 2007;99:777-89. 23. Curado MP. Recent changes in the epidemiology of head and neck

cancer. Cur op oncol. 2009;21:194.

24. Curado MP, edwards B, Shin HR, Storm H, Ferlay J, Heanue M, et al. Cancer incidence in five continents. 2008.

25. lam l, logan RM, luke C. epidemiological analysis of tongue cancer in South Australia for the 24-year period, 1977-2001. AdJ. 2006;51:16-22.

Figure

Figure 1. The projected total number of oral cancer cases year-by-year through to 2026.
Figure 2.  The projected increase in the number of cases of malignancies of the pharynx, parotid and tongue for the three oldest age groups.
Table 1. The projected number of cases for cancer of the pharynx, parotid and tongue for makes and females through to 2026.

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