Trends in incidence and prognosis for head and neck cancer in the United States: A site‐specific analysis of the SEER database

Abstract

Despite recent advances in the diagnosis and treatment of head and neck cancer, there has been little evidence of improvement in 5-year survival rates over the last few decades. To determine more accurate trends in site-specific outcomes as opposed to a more general overview of head and neck cancer patients, we analyzed the site-specific data collected in the Surveillance, Epidemiology, Population-based cancer statistics in the United States (US) for 2004 is expected to yield 28,260 new cases of oral cavity and pharynx cancer and 20,260 new cases of larynx cancer, with a mortality of 7,230 and 3,830 deaths per year, respectively. 1 Despite improvements in diagnosis and treatment, in the last 3 decades there have been no changes in the 5-year survival rate for larynx cancer patients and only a slight but significant improvement for oral cavity and pharynx cancer patients when comparing patients treated during 1973-1977 (5-year survival rate of 53%) to patients treated during 1993-1997 (5-year survival rate of 56%) according to results based on data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. 2 This slight change in survival was first noted in the 2002 publication, 2 but these data can still be interpreted as indicating that "there is no change in prognosis for the last 2 decades" for head and neck cancer (HNC). However, during the last 2 decades many articles have consistently demonstrated advances in treatment, most notably the use of combination therapy (adjuvant radiotherapy after surgery, concurrent chemotherapy and radiotherapy) with improvements in survival rates. [3][4][5][6] In addition, improvements in radiotherapy and perioperative care, as well as prevention of chemotherapy-related complications, have resulted in increased quality of life and decreased treatment-related mortality. 6 Another important factor that may influence survival includes lead-time bias. New technologies such as fiberoptic laryngoscopy, more widespread dental professional screening for oral cancer and higher-resolution radiological techniques may result in earlier stage diagnosis for some tumors, as well as more accurate staging. 7-9 Such improvements in diagnosis may also occur in a site-specific manner.In addition, treatment for head and neck cancer has evolved and become site-specific with treatment modalities individualized for specific anatomic sites and stages. 4,6 Therefore, analysis of head and neck cancer as a group may obscure important differences in survival trends for site-specific tumors that are dependent upon site-specific treatment advances.For all historical periods, specific head and neck cancer sites have had very different treatment approaches and more importantly, different 5-year survival rates. For example, lip cancer has a 5-year survival rate over 80%, while hypopharynx cancer survival rates reach only about 30%. 4 It is also possible that the stage and site distribution of cancer cases has changed over time. Unfortunately, conventional methods of ...

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“…In the last 30 years, progress in the treatment of head and neck cancer has improved the quality of life of patients via the use of innovative surgical and endoscopic techniques that are aimed at the preservation of organ function, mainly in laryngeal tumors (Allegra et al, 2012). The 5-year survival rate for these patients has remained in the range 50-60% for the last three decades (Carvalho et al, 2005). The main causes of death remain the recurrence of locoregional disease that is unresponsive to conventional treatments and distant metastases (Allegra et al, 2012).…”

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“…Even though some diseases have undergone a therapeutic revolution, such as pediatric leukemia and some lymphomas, the treatment of others has improved only slightly. For example, the stage-adjusted 5-year survival of patients with head and neck cancer has remained essentially unchanged for well over 30 years ( 1 ). Clearly, one of the most urgent challenges is to translate findings in basic biology into applicable strategies for patient care.…”

Site-Specific Molecular Signatures Predict Aggressive Disease in HNSCC

“…In 2003, the death rate per 100,000 population for laryngeal versus oral/oropharyngeal carcinomas was 2.36 versus 4.06, respectively [2]. An analysis of the Surveillance, Epidemiology, and End-Results (SEER) data for HNSCC demonstrates that this is not due to clinical stage at presentation [3]. Analysis of the SEER registry data demonstrated that site-specific survival differences remain across stages; defined as local, regional, and distant.…”

“…This site-specific difference may also be seen in the varied treatment approaches. While surgery and radiation therapy were once the only primary treatments offered, head and neck sites such as the larynx and oropharynx have seen a paradigm shift to chemotherapy and radiotherapy [4], while oral cavity tumors are still treated predominantly with surgery [3]. There is also a stage related difference in therapy, with early stage lesions often managed with single modality treatment and advanced stage disease treated with multimodality therapy.…”