EUROGIN 2012 Prague, July 2012 The burden of head and neck cancer and the changing risk factors Jean Louis Lefebvre Centre Oscar Lambret, Lille, France 1
Head and neck cancers, a group of different diseases Nasal and paranasal cavities cancers Nasopharynx cancers Cancers of the oral cavity, pharynx, and larynx HPV associated oropharynx cancers Oral cavity cancers in patients without risk factor Nasal and paranasal cavities cancer risk factors: occupation (wood dusts, chemicals etc.) pathology: glandular tumors +++, SCC late diagnosis (endocavitary lesions) extension: local +++ Tx = surgery ++ outcome: local recurrences + 2
Incidence 1 per 1OO.000 males 0.5 per 100.000 females Professional exposures Wood dust Nickel Chromium 6 Formaldehyde Radium Textile dust Rubber Chemicals Pesticides, fertilizers Nasopharynx cancer risk factors: diet, EBV, genetic profiles pathology: UCNT +++, SCC quite late diagnosis extension: local, regional, distant Tx = chemotherapy/radiotherapy outcome: local, regional, distant failures 3
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Nasopharynx cancer World incidence/yr males females total Numbers 57852 26589 84441 Crude rate/100,000000 17 1.7 08 0.8 12 1.2 Age standardised rate/ 1.7 0.8 1.2 100,000 World mortality/tr males females total Numbers 35984 15625 51609 Crude rate/100,000 1.1 0.5 0.8 Age standardised rate/ 100,000 GLOBOCAN 2008, IARC 21.6.2012 1.1 0.4 0.8 Diet Salted fish Dried meat Rancid butter Genetic predisposition 4p15 1q12 HLA haplotypes Virus Epstein Barr Virus 5
Oral cavity, pharynx and larynx cancer risk factors: tobacco +++, alcohol ++, occupation pathology: SCC late diagnosis (socio-cultural profile) extension: local ++, regional ++, distant + Tx: surgery, radiotherapy, chemotherapy, biotherapy outcome: recurrence (local, regional, distant) + second primary cancer + comorbid illnesses 6
Males Females Lip, oral cavity, pharynx, and larynx cancer World incidence/yr males females total Numbers 408735 141584 550319 Crude rate/100,000 12.0 4.6 8.1 Age standardised rate/ 100,000 12.7 3.9 8.0 World mortality/yr males females total Numbers 229903 75193 350096 Crude rate/100,000 6.7 2.2 4.5 Age standardised rate/ 7.2 2.0 4.4 100,000 GLOBOCAN 2008, IARC 21.6.2012 7
Prospective study on 1748 new successive HNSCC pts. data from Centre Oscar Lambret, Lille France 31 % living alone, 85 % blue collar 33 % working, 33 % retired, 33 % disabled or unemployed Lifestyle 96 % alcohol + tobacco cumulated tobacco smoked before Dx 306 kgr (2-1168) cumulated pure ethanol drunk before Dx 1712 kgr (55-9855) no difference according to primary site Betel quid chewing People who chew betel nuts, drink alcohol and smoke cigarettes are 123 times more likely to get mouth cancer than those who don t, according to Taiwan s Health Department. 8
Reported occupational exposures Formaldehyde Oral/pharynx Textile dust Oral/pharynx Sulfuric acid Asbestos Oral/pharynx Machining fluids Cement dust Oral/pharynx Diesel fumes Pesticides Vitreous fiber Soldering fumes Coal dust Oral/pharynx Dry cleaning HPV associated oropharynx cancer Younger patients, better PS, better socio cultural profile Riskfactors: no orminimaltobacco tobacco, sexual behaviors Pathology: basaloid carcinoma Earlier diagnosis Tx: higher chemo/radiosensitivity Better outcome A new epidemiological, biological, and clinical entity 9
HPV associated oropharynx cancer, an emerging new entity 12 to 63 % of orophar. cancers could be attribuable to HPV i.e. 6,000 to 30,000 cases/yr In the US 60 % of oropharynx cancer are HPV associated In Scandinavia > 80 % of oropharynx cancer are HPVassociated Gupka S et al. Int J Cancer 2009 Oral cavity and oropharynx ASR (bars) and oral cavity/oropharynx rate ratio (numbers). de Camargo Cancela M, et al. Oral Oncol,2012;48:484 490 10
HPV associated oropharynx cancer, a new epidemiological entity Gillison ML et al. J Natl Cancer Inst 2008 Oral cavity cancer in patients without any risk factor Hopefully rare situation Either young +++ or elderlypatients l Risk factors: none Pathology: SCC Early diagnosis Tx: surgery/radiotherapy/chemotherapy Sometimes impressively poor outcome 11
Conclusions: a group of different epidemiological and clinical diseases an impressive geographical variability trend for a decrease in incidence in tobacco associated HNC (at least in developped countries) constant increase in incidence of HPV associated oropharynx cancer 12