Fastest increasing cancer in Scotland, especially in men

Mehanna and colleagues highlight the increasing incidence of oral and oropharyngeal cancer in the United Kingdom and its likely association with sexually transmitted human papilloma virus (HPV).1 However, by reporting oropharyngeal cancer along with oral cancer the true rate of increase in oropharyngeal cancer is probably being masked.

Using data from the Scottish Cancer Registry, we found that oropharyngeal cancer now has the greatest rate of increase of any cancer in Scotland. We grouped cancers of the base of the tongue (C01), palate (C05), tonsil (C09), and oropharynx (C010). These codes were selected because they relate to the anatomically defined subsites of the oropharynx, enabling analysis of all registered cases. Incidence increased for each site, most for the tonsil and base of the tongue.

The figure⇓ shows that oropharyngeal cancer has overtaken both melanoma of the skin and adenocarcinoma of the oesophagus. In contrast, the incidence of invasive cancer of the cervix is decreasing. Linear regression yields an estimated 2.9-fold increase in oropharyngeal cancer in men, and a 2.4-fold increase in women.

European age standardised (EAS) rates of various cancers by sex in Scotland, 1987-2006

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Oropharyngeal cancer associated with HPV seems to have a better prognosis than oropharyngeal cancer that is not. Population based data from the south east of Scotland showed a 34% difference in five year survival for oropharyngeal cancer in favour of women in a cohort diagnosed during 1999-2001 but no difference between men and women in a cohort diagnosed during 2003-5. Although 70% of patients present with stage IV disease, the five year survival for men in south east Scotland has now increased to 68%. Whether this change in survival relates to HPV status is unknown. However, with more younger patients surviving, the morbidity from treatment for individuals and the healthcare burden to the NHS will be significant. Perhaps vaccinating boys against HPV should be re-evaluated.