Discusses issues affecting the definition of oral cancer and makes the case that emerging differences in the aetiology of the disease at different sites requires oral cavity cancer and oropharyngeal cancer to be clearly defined, recorded, and reported separately.
Highlights that incidence of oropharyngeal cancer is rapidly rising across the UK. Rates of oral cavity cancer are higher in Northern Ireland and higher still (and relatively stable) in Scotland, but rising in England and Wales.
Discusses how pooled international case-controlled study data are shedding increasing light not only on the causes of oral cavity and oropharyngeal cancers, but on the impact of avoiding risk factors.
Subscribe to Journal
Get full journal access for 1 year
only $20.79 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Buck C, Llopis A, Nájera E, Terris. The challenge of epidemiology: issues and selected readings. Sci Publ No. 505. Pan American Health Organisation: Washington DC, 1988.
dos Santos Silva I . Cancer Epidemiology: Principles and Methods. International Agency for Research on Cancer: Lyon, 1999. Available at http://publications.iarc.fr/Non-Series-Publications/Other-Non-Series-Publications/Cancer-Epidemiology-Principles-And-Methods-1999 (accessed July 2018).
Tapia J L, Goldberg L J . The challenges of defining oral cancer: Analysis of an ontological approach. Head Neck Pathol 2011; 5: 376–384.
Moreno Lopez L A, Esparza Gomez G C . Oral cancer versus oropharyngeal cancer versus head and neck cancer. Oral Oncol 1998; 34: 576–577.
Taberna M, Mena M, Pavón M A, Alemany L, Gillison M L, Mesía R . Human papillomavirus-related oropharyngeal cancer. Ann Oncol 2017; 28: 2386–2398.
Fritz A, Percy C, Jack A et al. (eds). International Classification of Diseases for Oncology (ICD – O). Third Edition, First Revision. World Health Organisation: Geneva, 2013.
The Northern Irish Cancer Registry. Lip Oral Cavity & Pharynx 1993–2016. Queens University Belfast, 2018. Available at https://www.qub.ac.uk/research-centres/nicr/CancerInformation/official-statistics/BySite/LipOralCavityPharynx/ (accessed July 2018).
Scottish Cancer Registry. Head and Neck Cancer Statistics. Information Services Division, NHS National Services Scotland, Edinburgh, 2018. Available at http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Head-and-Neck/ (accessed July 2018).
Welsh Cancer Intelligence and Surveillance Unit. Cancer Incidence in Wales 2016. Public Health Wales. Available at http://www.wcisu.wales.nhs.uk/definitions-icd10-codes (accessed July 2018).
Office of National Statistics. Cancer Registration Statistics, England. 2018. Available at https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/cancerregistrationstatisticscancerregistrationstatisticsengland (accessed July 2018).
International Head And Neck Epidemiology (INHANCE) consortium. University of Utah: Utah, 2018. Available at https://www.inhance.utah.edu/ (accessed July 2018).
Conway D I, Hashibe M, Boffetta P et al. Enhancing epidemiologic research on head and neck cancer: INHANCE The international head and neck cancer epidemiology consortium. Oral Oncol 2009; 45: 743–746.
Chaturvedi AK, Engels E A, Pfeiffer R M et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011; 29: 4, 294–301.
Chaturvedi A K, Anderson W F, Lortet-Tieulent J et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol 2013; 31: 4, 550–559.
Louie K S, Mehanna H, Sasieni P . Trends in head and neck cancers in England from 1995 to 2011 and projections up to 2025. Oral Oncol 2015; 51: 341–348.
Purkayastha M, McMahon A D, Gibson J, Conway D I . Trends of oral cavity, oropharyngeal and laryngeal cancer incidence in Scotland (1975–2012) – A socioeconomic perspective. Oral Oncol 2016; 61: 70–75.
Shield K D, Ferlay J, Jemal A et al. The global incidence of lip, oral cavity, and pharyngeal cancers by subsite in 2012. CA Cancer J Clin 2017; 67: 51–64.
Simard EP, Torre LA, Jemal A . International trends in head and neck cancer incidence rates: differences by country, sex and anatomic site. Oral Oncol 2014; 50: 387–403.
Hashibe M, Sturgis E M . Epidemiology of oral-cavity and oropharyngeal cancinomas: controlling a tobacco epidemic while a human papillomavirus epidemic emerges. Otolaryngol Clin North Am 2013; 46: 507–520.
Junor EJ, Kerr GR, Brewster D H . Oropharyngeal cancer. Fastest increasing cancer in Scotland, especially in men. BMJ 2010; 340: c2512.
Hashibe M, Brennan P, Benhamou S et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst 2007; 99: 777–789.
Hashibe M, Brennan P, Chuang S C et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev 2009; 18: 541–550.
Peto J . That the effects of smoking should be measured in pack-years: misconceptions 4. Br J Cancer 2012; 107: 406–407.
Lubin JH, Purdue M, Kelsey K et al. Total exposure and exposure rate effects for alcohol and smoking and risk of head and neck cancer: a pooled analysis of case-control studies. Am J Epidemiol 2009; 170: 937–947.
Berthiller J, Straif K, Agudo A et al. Low frequency of cigarette smoking and the risk of head and neck cancer in the INHANCE consortium pooled analysis. Int J Epidemiol 2016; 45: 835–845.
Gupta B, Johnson N W . Systematic review and meta-analysis of association of smokeless tobacco and of betel quid without tobacco with incidence of oral cancer in South Asia and the Pacific. PLoS One 2014; 9: e113385.
Croucher R, Dahiya M, Gowda K K . Contents and price of vendor assembled paan quid with tobacco in five London localities: a cross-sectional study. Tob Control 2013; 22: 141–143.
Siddiqi K, Gupta P C, Prasad V M, Croucher R, Sheikh A . Smokeless tobacco use by south Asians. Lancet Glob Health 2013; 1: e71.
Wyss AB, Hashibe M, Lee Y A et al. Smokeless tobacco use and the risk of head and neck cancer: pooled analysis of US studies in the INHANCE Consortium. Am J Epidemiol 2016; 184: 703–716.
Marron M, Boffetta P, Zhang Z F et al. Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk. Int J Epidemiol 2010; 39: 182–196.
Conway D I, Brenner D R, McMahon A D et al. Estimating and explaining the effect of education and income on head and neck cancer risk: INHANCE consortium pooled analysis of 31 case-control studies from 27 countries. Int J Cancer 2015; 136: 1125–1139.
Edefonti V, Hashibe M, Ambrogi F et al. Nutrient-based dietary patterns and the risk of head and neck cancer: a pooled analysis in the International Head and Neck Cancer Epidemiology consortium. Ann Oncol 2012; 23: 1869–1880.
Arnold M, Leitzmann M, Freisling H et al. Obesity and cancer: An update of the global impact. Cancer Epidemiol 2016; 41: 8–15.
Gaudet M M, Olshan A F, Chuang S C et al. Body mass index and risk of head and neck cancer in a pooled analysis of case-control studies in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. Int J Epidemiol 2010; 39: 1091–1102.
Winn D M, Lee Y C, Hashibe M, Boffetta P ; INHANCE consortium. The INHANCE consortium: toward a better understanding of the causes and mechanisms of head and neck cancer. Oral Dis 2015; 21: 685–693.
Negri E, Boffetta P, Berthiller J et al. Family history of cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Int J Cancer 2009; 124: 394–401.
Toporcov T N, Znaor A, Zhang Z F et al. Risk factors for head and neck cancer in young adults: a pooled analysis in the INHANCE consortium. Int J Epidemiol 2015; 44: 169–185.
Ahrens W, Pohlabeln H, Foraita R et al. Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: the ARCAGE study. Oral Oncol 2014; 50: 616–625.
Hashim D, Sartori S, Brennan P et al. The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium. Ann Oncol 2016; 27: 1619–1625.
Boffetta P, Hayes R B, Sartori S et al. Mouthwash use and cancer of the head and neck: a pooled analysis from the International Head and Neck Cancer Epidemiology Consortium. Eur J Cancer Prev 2016; 25: 344–348.
Gandini S, Negri E, Boffetta P, La Vecchia C, Boyle P . Mouthwash and oral cancer risk quantitative meta-analysis of epidemiologic studies. Ann Agric Environ Med 2012; 19: 173–180.
Gillison M L, Chaturvedi A K, Anderson W F, Fakhry C . Epidemiology of human papillomavirus-positive head and neck squamous cell carcinoma. J Clin Oncol 2015; 33: 3235–3242.
D'Souza G, Kreimer A R, Viscidi R et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 2007; 356: 1944–1956.
Gillison M L, Broutian T, Pickard R K et al. Prevalence of oral HPV infection in the United States, 2009–2010. JAMA 2012; 307: 693–703.
Conway D I, Robertson C, Grey H et al. Human Papilloma Virus (HPV) Oral Prevalence in Scotland (HOPSCOTCH): A Feasibility Study in Dental Settings. PLoS One 2016; 11: e0165847.
Heck J E, Berthiller J, Vaccarella S et al. Sexual behaviours and the risk of head and neck cancers: a pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. Int J Epidemiol 2010; 39: 166–181.
Gillison M L, Chaturvedi A K, Anderson W F, Fakhry C . Epidemiology of Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma. J Clin Oncol 2015; 33: 3, 235–242.
Mehanna H, Beech T, Nicholson T et al. The prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer: Systematic review and meta-analysis of trends by time and region. Head Neck 2013; 35: 747–755.
Anantharaman D, Abedi-Ardekani B, Beachler D C et al. Geographic heterogeneity in the prevalence of human papillomavirus in head and neck cancer. Int J Cancer. 2017; 140: 1968–1997.
Smith J S, Lindsay L, Hoots B et al. Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update. Int J Cancer 2007; 121: 621–632.
We acknowledge Professor John Gibson, University of Aberdeen Dental School, who provided clinical advice in relation to defining oral cavity and oropharyngeal cancers.
Mitana Purkayastha worked on this paper as part of her PhD studies (which she recently successfully completed) funded by NHS Education for Scotland.
David Conway is a member of the International Head and Neck Cancer Epidemiology (INHANCE) consortium.
Thanks to all involved with data collection in the UK cancer registries and a special thanks to the data providers involved in analysing the information requests from the four countries: Matthew Peet (Cancer Analysis Team, Health Analysis and Life Events, Public Policy Analysis Office for National Statistics – England); Dr Eileen Morgan (N. Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast – N. Ireland Cancer Registry is funded by the Public Health Agency; this work uses data provided by patients and collected by NHS as part of their care and support); Cavan Gallagher (Population Health, Information Services Division, NHS National Services Scotland); Ceri White and Jamie Sullivan (Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales).
About this article
Cite this article
Conway, D., Purkayastha, M. & Chestnutt, I. The changing epidemiology of oral cancer: definitions, trends, and risk factors. Br Dent J 225, 867–873 (2018). https://doi.org/10.1038/sj.bdj.2018.922
Characteristics and prognosis of primary treatment-naïve oral cavity squamous cell carcinoma in Norway, a descriptive retrospective study
PLOS ONE (2020)
Journal of Cancer Prevention (2020)
Oral Oncology (2020)
Sentinel lymph node biopsy for oral tongue squamous cell carcinoma cT1–2N0: prospective single-center study
Head and Neck Tumors (HNT) (2020)
Primary Dental Journal (2020)