Racial Disparity Among the Head and Neck Cancer Population

Abstract

Head and neck cancer is the ninth most common cancer in the USA, accounting for 3.3 % of all cancers. The incidence of head and neck cancer has plateaued recently; however, morbidity and mortality continue to remain high. Moreover, racial disparity between African-American and White patients has been studied in the head and neck community, and a vast difference still remains in mortality rate and late stage at presentation. A review of the English literature was performed using PubMed/MEDLINE for demographics, epidemiology, and studies that focused on the disparity in head and neck cancer between African-American and White patients. Age-adjusted incidence of head and neck cancer is increased in African-Americans, while the 5-year survival is decreased compared to Whites. African-American patients present with more advanced disease. When receiving similar multidisciplinary care, the overall survival was not significantly different, but racial disparity often persists in treatment regimens. Socioeconomic determinants such as insurance status play a critical role in racial disparity, along with low levels of public awareness, a lack of knowledge of specific risk factors, and a sense of mistrust that is seen in the African-American population. Disparity in the head and neck cancer community is worrisome, and although efforts have been taken to decrease the disparity, a significant difference exists. Fortunately, the disparity is reversible and can be eliminated. To do so, it is critical to extend to underserved community programs that provide appropriate screening and diagnosis, with subsequent follow-up and treatment following the standards of care.

Racial differences in head and neck squamous cell carcinomas among non-Hispanic black and white males identified through the National Cancer Database (1998–2012)

“…Compared to nH white males, nH blacks had a higher incidence of non-oropharyngeal tumors, as well as locoregional and distant tumors, all of which are indicative of more aggressive and advanced disease. These results are consistent with regional studies of nH black and white males and females that reported higher percentages of locoregional (Gourin and Podolsky 2006;Zandberg et al 2014) and distant (Daraei and Moore 2014;Ragin et al 2011) stages in nH blacks. Similar to findings across study populations (Betiol et al 2013;Chaturvedi et al 2008;Ryerson et al 2008), the majority of HPV types within NCDB were type 16 or types 16/18 combined.…”

Outcomes of head and neck cancer surgery in the geriatric population based on case volume at academic centers

“…With the growing geriatric population and the projected increased incidence of head and neck cancer until at least 2020, it is crucial to analyze the costs and outcomes for head and neck cancer specifically in the geriatric population . There is already evidence in the literature that there are racial disparities in management and outcomes in head and neck cancer . Our data demonstrate that white patients are significantly more likely to receive care at high‐ or moderate‐volume hospitals, whereas black and Hispanic patients are more likely to receive care at low‐volume hospitals.…”

“…Nevertheless, the population used in this study (n = 158) was much smaller than the populations used in the studies described above. One method to resolve racial differences in healthcare outcomes would be to increase community screening programs with subsequent follow‐up and treatment according to current standards of care …”

Epigenetic basis of cancer health disparities: Looking beyond genetic differences

“…), biological factors are also believed to play important roles in cancer health disparities [15–18]. Recent data has connected inherent genetic differences, such as those resulting in increased tumor heterogeneity in AA breast cancer patients, with more aggressive tumor biology [19].…”