|Year : 2017 | Volume
| Issue : 1 | Page : 43-47
Pattern of the head and the neck cancer in two geographically and socioeconomically different countries
Somayyeh Azimi DDS, MSc 1, Hamed Mortazavi2, Marc Tennant1, Estie Kruger1, Babak Rezaei3, Jamileh B Taheri4, Mohammad R Tarahhomi5
1 International Research Collaborative - Oral Health and Equity, School of Anatomy, Physiology and Human Biology, University of Western Australia, WA, Australia
2 Associate Professor of Oral Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Oral Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
|Date of Web Publication||14-Jun-2017|
Honorary Research Fellow, International Research Collaborative - Oral Health and Equity, School of Anatomy, Physiology and Human Biology, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009
Source of Support: None, Conflict of Interest: None
Context: The differences in frequency of cancer among the less developed and the more developed regions continue to remain as an important problem for service planning and international action against cancers of the head and the neck. Aim: This study compares distribution of cancers of the head and the neck between two similar-sized populations from the west of Iran and Western Australia. Setting and Design: In this retrospective study, de-identified data were collected for a 10-year period from patients diagnosed with head and the neck cancers. Materials and Methods: Data were obtained from the Western Australia Cancer Registries and from major hospitals in the west of Iran. Age at diagnosis, sex, and site code were included in the data sheet. Descriptive analysis was used to describe the basic features, means (±standard deviation) were reported, and tests of significance were used as appropriate. Results: In Iran, cancer of the lip, followed by cancer of the major salivary gland, and cancer of the tongue were the three most frequent types of cancers, whereas in Australia, the most frequent types of cancer were cancer of the lip followed by cancers of the tongue and the tonsil. Distribution of malignancy by site among the patients belonging to different ages indicated that cancer of the lip was the most frequent cancer in both Iran and Australia, except among the patients belonging to the age group of 60–74 years in Iran, where cancer of the major salivary gland had the highest frequency. Both men and women were susceptible for cancers of the head and the neck in the age range of 60–74 years in Iran, whereas in Australia, it was more frequent among men belonging to the age range of 45–59 years and in women above the age of 75 years. Conclusion: This preliminary study defined differences in orofacial malignancy between Iran and Australia. Further studies in countries with different socioeconomic status are recommended.
Keywords: Epidemiology, head and neck, incidence, malignancy, retrospective study
|How to cite this article:|
Azimi S, Mortazavi H, Tennant M, Kruger E, Rezaei B, Taheri JB, Tarahhomi MR. Pattern of the head and the neck cancer in two geographically and socioeconomically different countries. J Orofac Sci 2017;9:43-7
|How to cite this URL:|
Azimi S, Mortazavi H, Tennant M, Kruger E, Rezaei B, Taheri JB, Tarahhomi MR. Pattern of the head and the neck cancer in two geographically and socioeconomically different countries. J Orofac Sci [serial online] 2017 [cited 2023 Jan 31];9:43-7. Available from: https://www.jofs.in/text.asp?2017/9/1/43/207943
| Introduction|| |
Cancer is a noncommunicable disease with a high rate of disability and death, resulting as one of the diseases with the greatest disease burden in the world. Recent global studies estimated an incidence of more than 14 million new cases of cancer in 2012. It is expected that by 2025, more than 20 million cancer patients will be diagnosed annually., Despite progress in prevention methods and treatment options, more than 8 million cancer deaths were reported in 2012., The World Health Organization (WHO) reported that deaths from cancer have been overtaking all deaths from coronary heart disease or stroke. This increase in the burden of cancer is not only because of lifestyle risk factors, but also because of aging of the global population., The increasing cancer incidence would have a significant effect on the healthcare status and the individuals’ quality of life.
Cancers of the head and the neck are a related group of cancers involving the lip and the oral cavity, the pharynx, and the larynx. From an anatomic aspect, the oral cavity and the oropharynx are distinct areas; however, there are some differences between these definitions in different databases. Therefore, complete distinction between the oral cavity and the oropharynx may not be possible.
The fifth version of Global Cancer Incidence, Mortality and Prevalence (GLOBACAN) estimated more than 550,000 new cases of cancer of the head and the neck in 2012 that accounted for more than 4% of all the cancers. In addition, it was estimated that more than 300,000 people died worldwide from these types of cancers in that year.,
WHO categorized the five continents into six regions including the African region, region of the Americas, Southeast Asia, the European region, the East Mediterranean region, and the West Pacific region. The incidence and mortality of each type of cancer varied widely in each region, including cancer of the head and the neck. Recently, an evaluation by GLOBACAN found the highest age-standardized rate (ASR) for cancer of the lip/oral cavity and other pharyngeal cancers in the Southeast Asia region (6.4 and 3.6 per 100,000 people, respectively) and 4.6 and 1.1 ASR World (W), respectively, for the Eastern Mediterranean region; however, this rate was the lowest for the Western Pacific region (2.0 and 0.8, respectively).
According to the International Agency of Research on Cancer, the burden of cancer is greater in the low- and middle-income countries. In addition, there was a difference in incidence and mortality of cancer of the head and the neck in less developed versus more developed regions., This difference might be because of the acquisition of cancer-related risk factors such as tobacco smoking, alcohol consumption, and diet, environmental and occupational risk factors, acquisition of human papillomavirus (HPV) infection, or generally different socioeconomic status.,
Epidemiological studies on cancer are limited, and some of them are not of high-quality (especially in developing countries). For example, Iran as a developing country has high-quality data for incidence, but the coverage is less than 10%, and there is no availability of mortality data. Conversely, Australia (a more developed region) has high-quality data with more than 50% coverage for incidence and high-quality vital registration for mortality data.,
Although many studies have shown wide variations in cancer rates across different parts of the world, to the best of our knowledge, no study has compared in detail the incidence, age, sex of patients, and site of head and neck cancer between patients in a developing country (Iran) versus a developed country (Australia), considering that these regions differ geographically, and in terms of climate, behavioral factors and healthcare systems.,,
The comparisons of cancer incidence/types across time and geographical areas could provide important insights into the relative burden and cause of disease as a first step toward finding or elucidating cancer pattern variation. This study compared the distribution of all types of cancers of the head and the neck according to the international cancer classification between two similar-sized populations of Western Iran and Western Australia.
| Materials and Methods|| |
Ethical approval for this study was not required, because only completely de-identified data from cancer registries were used in the analysis. In this retrospective study, de-identified data on cancer of the head and the neck for a 10-year period (2002–2012) were obtained from the Western Australia Cancer Registries and from the major hospitals in the west of Iran.
Only patients from metropolitan areas were included to eliminate the issue of remoteness from services. Recurrent, metastatic, and premalignant lesions were not included.
Tumors were classified into the following subsites according to the International Classification of Diseases in Oncology: the tongue; the tonsils; the oropharynx; the gum and the cheek; the floor of the mouth; the palate and other parts of the mouth; and the internal mucosa of the lip. Age at diagnosis, sex, and site code were included in the data sheet. Descriptive analysis was used to describe the basic features, means (±standard deviation) were reported, and tests of significance were used as appropriate.
| Results|| |
Totally, 2400 oral cancers evaluated in this study were from the registries in Western Australia and Iran [Figure 1]. In Iran, cancer of the lip followed by cancers of the major salivary gland and the tongue were the three most frequent cancers, whereas in Australia, cancer of the lip followed by cancers of the tongue and the tonsil were the three most frequent cancer sites [Figure 2]. Distribution of malignancy by site among the patients belonging to different ages indicated that cancer of the lip was the most frequent cancer in both Iran and Australia [Figure 3], except among the patients belonging to the age group of 60–74 years in Iran, where cancer of the major salivary gland had the highest frequency [Figure 4]. Results also showed that both men and women were susceptible for cancer of the head and the neck in the age range of 60–74 years in Iran, whereas in Australia, cancer of the head and the neck was more frequent in men aged 45–59 years and in women above the age of 75 years [Figure 5].
|Figure 1: (a) The distribution of orofacial malignancy by location in Iran (M: male, F: Female, T: total). (b) The distribution of orofacial malignancy by location in Australia (10× difference in scale)|
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|Figure 2: (a) The distribution of orofacial malignancy by location in Australia (A) and Iran (I). (b) The distribution of orofacial malignancy in men according to its location in Australia and Iran. (c) The distribution of orofacial malignancy in women according to its location in Australia and Iran|
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|Figure 3: The distribution of orofacial malignancy in Australia and Iran among patients belonging to different age groups|
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|Figure 4: (a) The distribution of orofacial malignancy by location in Australia and Iran (age 30–44 years). (b) The distribution of orofacial malignancy by location in Australia and Iran (age 45–59 years). (c) The distribution of orofacial malignancy by location in Australia and Iran (age 60–74 years). (d) The distribution of orofacial malignancy by location in Australia and Iran (age >75 years)|
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|Figure 5: (a) The distribution of orofacial malignancy according to sex and age in Australia. (b) The distribution of orofacial malignancy according to sex and age in Iran|
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| Discussion|| |
This study showed the difference in the distribution of cancer of the head and the neck among patients in west of Iran and Western Australia over a 10-year period. We estimated the same trends for cancer of the head and the neck in these 10 years.
The results showed that there was a large difference in the distribution of orofacial malignancy by site among the patients in Iran and Australia. The most frequent cancer was cancer of the lip in both Iran and Australia; however, cancer of the lip had a much higher incidence in Australia than Iran (39 and 26% of the total cancers of the head and the neck, respectively). In addition, this difference was higher in women (42 and 29% from total cancer incidence, respectively). It is speculated that the higher Ultra Violet (UV) index in Australia may cause this difference. In a systematic review on the epidemiology of oral cancer in Iran, cancer of the lip was reported as the second most frequent cancer, just after cancer of the tongue.
Moreover, results revealed that cancers of the major salivary gland and the gum were much more frequent in Iran. The difference in the incidence of the salivary gland malignancies might be because of differences in etiological factors. Although the contributing factors of the salivary gland neoplasms are not well recognized, it seems that smoking and drinking are not the major risk factors; low intake of some nutrients such as vitamin A and C and ionizing radiation might be affecting the development of the tumor.,,
This study found cancer of the tonsils to be reported much more frequently in Australia. Some studies reported an increase in incidence of head and neck squamous cell carcinoma (HNSCC) in Australia, especially of the oropharynx, despite a fall in the number of patients diagnosed with other smoking-related cancers. They concluded that the recent increase in HSNCC among younger patients has been attributed to the rising prevalence of HPV infection, and was hypothesized to reflect the changing sexual behaviors during the recent decades.,,,
In terms of age, most affected people in Iran were in the age group of 60–74 years, whereas in Australia, most women were in the age group of above 75 years, and most men were in the age group of 45–59 years. This increase among younger patients might be attributed to the rising prevalence of HPV infection especially in the tonsils of nonsmoking patients. Recent studies in Australia reported that 63% of HPV-positive oropharyngeal squamous cell carcinomas were found in the age group of 50–59 years, and this was in line with our studies. It was also reported that HNSCC tumors in men showed higher HPV prevalence than those from women.
According to a WHO report on the global tobacco epidemic 2015, Australia and Iran were among the countries with the highest level of achievement for effective tobacco use surveillance, strong smoke-free legislation, appropriate cessation support, health warning labels about the danger of tobacco, and anti-tobacco mass media campaigns. In addition, both had an adult daily smoking prevalence (2013) of less than 15%. However, there was a difference in smoking rates across the states and provinces in a vast country such as Australia or a populated country such as Iran. Moreover, other risk indicators such as socioeconomic disparities might contribute to the differences seen between Iran and Australia in terms of cancer of the head and the neck.
This study had some of the following limitations: data was not collected from all cancer patients in Iran but from only three major hospitals in the metropolitan area of Kermanshah province in the west of Iran because of the lack of availability of data.
Considering the fact that cancer of the lip and the oral cavity ranked globally from 16 to 14 between 1990 and 2013 and cancer of the other pharynx from 21 to 18 in terms of absolute years of life lost is an indication that these conditions should be investigated.
We conclude that differences exist in orofacial malignancy among the patients of Iran and Australia in terms of incidence, site of cancer, and age and gender. Further studies to identify the patterns of cancer of the head and the neck and ways for prevention are recommended.
Dr. Azimi acknowledges the support of postgraduate award from the University of Western Australia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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