Africa and the Caribbean are projected to have greater increases in Head and neck cancer (HNC) burden in comparison to North America and Europe. The knowledge needed to reinforce prevention in these populations is limited. We compared for the first time, incidence rates of HNC in black populations from African, the Caribbean and USA.
Annual age-standardized incidence rates (IR) and 95% confidence intervals (95%CI) per 100,000 were calculated for 2013–2015 using population-based cancer registry data for 14,911 HNC cases from the Caribbean (Barbados, Guadeloupe, Trinidad & Tobago, N = 443), Africa (Kenya, Nigeria, N = 772) and the United States (SEER, Florida, N = 13,696). We compared rates by sub-sites and sex among countries using data from registries with high quality and completeness.
In 2013–2015, compared to other countries, HNC incidence was highest among SEER states (IR: 18.2, 95%CI = 17.6–18.8) among men, and highest in Kenya (IR: 7.5, 95%CI = 6.3–8.7) among women. Nasopharyngeal cancer IR was higher in Kenya for men (IR: 3.1, 95%CI = 2.5–3.7) and women (IR: 1.5, 95%CI = 1.0–1.9). Female oral cavity cancer was also notably higher in Kenya (IR = 3.9, 95%CI = 3.0–4.9). Blacks from SEER states had higher incidence of laryngeal cancer (IR: 5.5, 95%CI = 5.2–5.8) compared to other countries and even Florida blacks (IR: 4.4, 95%CI = 3.9–5.0).
We found heterogeneity in IRs for HNC among these diverse black populations; notably, Kenya which had distinctively higher incidence of nasopharyngeal and female oral cavity cancer. Targeted etiological investigations are warranted considering the low consumption of tobacco and alcohol among Kenyan women. Overall, our findings suggest that behavioral and environmental factors are more important determinants of HNC than race.
- • First comparison of HN Cancer incidence between blacks from USA, Caribbean and Africa.
- • USA and Guadeloupe males had the highest incidence rates.
- • Incidence of female oral cavity cancer is high in Kenya.
- • The sex ratio for HN cancer was smaller for Africa than the Caribbean and the USA.
Head and neck cancer (HNC) is the 6th most common cancer in the world but the annual incidence rates (IR) vary substantially across geographical regions . Tobacco smoking and alcohol drinking are the major risk factors of oral cavity, hypopharyngeal and laryngeal cancer ; while, the human papillomavirus (HPV) is a prominent risk factor for oropharyngeal cancer and has been linked to other HNC sites . In addition, other viral factors such as Epstein-Barr virus (EBV) and HIV are associated with HNC risk notably, nasopharyngeal cancer , in areas where these viruses are more prevalent .
Incidence rates of HNC are particularly high in North America and Europe; and they are increasing rapidly in developing countries . In 2016, the age standardized incidence rates for HNC per 100,000 men and women for cancer of the oral cavity, pharynx and larynx (HNC) were 11.2 for Europe and 10.1 for North America; whereas, rates were lowest in Latin American and the Caribbean, and in Africa (7.0 and 4.8 respectively) . Despite lower incidence rates of HNC in the Caribbean and African populations, the mortality remains high. Most Caribbean and African countries are developing countries and are particularly vulnerable to poor cancer outcomes due to lack of access to care, late presentation and few resources for treatment . Therefore, it is important to produce relevant information on the epidemiological trends to inform cancer prevention in these countries before the HNC incidence transitions to that of the developed world. Few studies have investigated HNC incidence among blacks living in various geographical regions (USA, Caribbean and Africa), who differ substantially in terms of genetics, culture and environmental exposures . In addition, global surveillance data for most Caribbean countries are based on estimates from neighboring countries . Comparative analyses among populations may provide clues on risk factors which can be further investigated in etiological studies to enhance prevention strategies in these regions.
The aim of our study was to compare for the first time, incidence rates and characteristics of HNC in black populations of Africa the Caribbean and the USA, using data from population-based cancer registries (PBCR).