Cancer Research UK : UK Oral Cancer incidence statistics

UK Oral Cancer incidence statistics

This page presents oral cancer incidence statistics by type, age and sex, geographical variation, socio-economic deprivation , and trends over time The ICD codes for oral cancer are ICD9 140, 141, 143-146, 148 and 149, and ICD10 C00-06, C09, C10, C12-14.

In the UK in 2005, 4,926 persons were diagnosed with an oral cancer. Across countries, the highest incidence, for both males and females, is in Scotland . (Table 1.1)

Table showing the number of new cases and rates of oral cancer in the UK

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Types of oral cancer

Oral cancers are made up of:

cancer of the lip
cancer of the tongue
cancer of the mouth
cancer of the oropharynx
cancer of piriform sinus
cancer of the hypopharynx
other and ill-defined sites

Table 1.2 shows the number of new cases of these types of oral cancer.

Around one third (31%) of oral cancers are diagnosed in the mouth cavity and a slightly lower proportion (29%) on the tongue. Cancers of the oropharynx, piriform sinus and hypopharynx together account for a further quarter (28%) of cases while lip, the least frequent type of oral cancer, accounts only for 6%. 1-4. More than 90% of oral malignancies are squamous cell carcinomas.5

Table showing the number of new cases of oral cancer by type, in the UK

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Oral cancer incidence by age and sex

In the UK and most other countries, oral cancer is more common in men than women. However, the sex ratio in the UK has decreased rapidly from around 5:1 fifty years ago to less than 2:1 today (Table 1.2). The risk of developing oral cancer increases with age and in the UK the majority of cases (86%) occur in people aged 50 or over (Figure 1.1).1-4 However, in some high prevalence areas in the developing world, oral cancer is relatively common in younger people.

Figure showing the number of new cases and age-specific incidence rates for oral cancer in the UK

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Geographical variation in oral cancer incidence

As Table 1.1 shows, oral cancer incidence rates in Scotland are significantly higher than in other parts of the UK. 1-4 ,6 This result correlates with the higher rates of tobacco and alcohol consumption in Scotland than in other parts of the UK.

Studies of oral cancer incidence in minority ethnic populations in Britain have reported high rates in south Asian and Chinese populations in which the habit of areca nut or betel quid chewing is still prevalent (see Risk factors section).7

Worldwide an estimated 405,000 new cases of oral cancer (oral cavity and pharynx excluding nasopharynx) are diagnosed each year with two-thirds of these cases occur in developing countries.8 Each year an estimated 66,650 new oral cancer cases are diagnosed in the countries of the European Union (EU).8

Oral cancer incidence varies strikingly around the world (Figure 1.2).8

Figure 1.2: World age standardised male incidence rates for oral cancers, selected countries of the world,

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The highest age standardised rates (over 20 per 100,000 population) of oral cancer are reported in parts of Europe and south central Asia. In high-risk countries such as Sri Lanka, India, Pakistan and Bangladesh, oral cancer is the most common cancer in men and may account for up to 30% of all new cases of cancer compared to 3% in the UK and 6% in France.

Within the EU the highest oral cancer incidence rates for males are found in France and Hungary and the lowest rates in Greece and Cyprus (Figure 1.3).8

Figure 1.3: European age standardised incidence rates, by sex, oral and pharyngeal cancer, EU countries,

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The female oral cancer incidence rates are much lower and show less variation. The highest rates are in Hungary, Luxembourg and Germany. Oral cancer incidence rates in UK males are significantly lower than the EU average and rank 22nd out of the 25 EU countries: the oral cancer incidence rates in UK females are also lower than the EU average but rank higher at 12th.

Cancer of the lip has a different geographical distribution from other oral cancers and the highest incidence rates are reported in white populations in Canada and Australia. Cancer of the lip is rare in non-white populations. Lip cancer is particularly linked to outdoor occupations such as farming and fishing and there are twice as many male as female cases. As well as occupational differences, it is thought that the use of cosmetics helps to protect the female lip from damaging UV light.

Oral cancer incidence and socio-economic deprivation

Oral cancer incidence is strongly related to social and economic deprivation, with the highest rates occurring in the most disadvantaged sections of the population. The association is particularly strong for men.

For patients diagnosed in 1991-95 in Scotland, incidence rates for cancer of the head and neck were twice as high for those in the most disadvantaged category compared with the least disadvantaged.2 This reflects the higher tobacco consumption in the more disadvantaged groups.

Oral cancer incidence trends over time

The age standardised incidence of oral cancer in British males stayed at around 7 per 100,000 males between 1975 and 1989, but since then, the rate has steadily increased to reach 10 per 100,000 in 2005, an increase of 41% since 1989. Female oral cancer rates have remained significantly lower than male rates, but have still increased by around 34% since 1992.

Trends are shown in Figure 1.4.6

Figure showing the age standardised (european) incidence rates for oral cancer in GB

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When the oral cancer incidence trends are analysed by age group, differing patterns emerge as Figures 1.5 and 1.6 illustrate.6

Figure showing the age-specific incidence rates for oral cancer in males in GB

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Figure showing the percentage change in incidence rates for oral cancer in British men

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For men over 80, the incidence of oral cancer has halved since 1975, while rates for men in their late 60s and 70s have remained relatively stable. However, there have been large increases in the incidence of oral cancer diagnosed in men in their 40s and 50s whose rates have more than doubled from 3.6 to 9.2 per 100,000 for men aged 40-49 and from 11.5 to 25.3 for men aged 50-59.

Rising trends of oral cancer in young and middle-aged men, particularly of cancer of the tongue, have been reported in other European countries and the USA.9-15 This increase in a cancer that is often difficult to treat and sometimes debilitating and disfiguring, is alarming –see last section under Risk factors.

The oral cancer incidence trends for the UK are shown in figure 1.7 below. The age standardised incidence of oral cancer in the UK has increased by over a quarter from 1975 to 2005.

Figure showing the age standardised (European) incidence rates for oral cancer in the UK

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References for oral cancer incidence

Office for National Statistics. Cancer Statistics registrations: Registrations of cancer diagnosed in 2005, England. Series MB1 no.36. 2008
ISD Online. 2008, Information and Statistics Division, NHS Scotland.
Northern Ireland Cancer Registry, Cancer Incidence and Mortality. 2008
Welsh Cancer Intelligence and Surveillance Unit 2008. Cancer Incidence in Wales.
Daley, T. and M. Darling, Nonsquamous cell malignant tumours of the oral cavity: an overview. J Can Dent Assoc, 2003. 69(9): p. 577-82
Statistical Information Team, CR-UK. 2004
Warnakulasuriya, K.A., et al., Cancer of mouth, pharynx and nasopharynx in Asian and Chinese immigrants resident in Thames regions. Oral Oncol, 1999. 35(5): p. 471-5.
IARC. GLOBOCAN 2002. Cancer Incidence, Mortality and Prevalence Worldwide (2002 estimates). 2004
Macfarlane, G.J., P. Boyle, and C. Scully, Rising mortality from cancer of the tongue in young Scottish males. Lancet, 1987. 2(8564): p. 912.
Macfarlane, G.J., P. Boyle, and C. Scully, Oral cancer in Scotland: changing incidence and mortality. Bmj, 1992. 305(6862): p. 1121-3
Macfarlane, G.J., et al., Rising trends of oral cancer mortality among males worldwide: the return of an old public health problem. Cancer Causes Control, 1994. 5(3): p. 259-65
Moller, H., Changing incidence of cancer of the tongue, oral cavity, and pharynx in Denmark. J Oral Pathol Med, 1989. 18(4): p. 224-9.
Annertz, K., et al., Incidence and survival of squamous cell carcinoma of the tongue in Scandinavia, with special reference to young adults Int J Cancer, 2002. 101(1): p. 95-9
Schantz, S.P. and G.P. Yu, Head and neck cancer incidence trends in young Americans, 1973-1997, with a special analysis for tongue cancer. Arch Otolaryngol Head Neck Surg, 2002. 128(3): p. 268-74
Llewellyn, C.D., N.W. Johnson, and K.A. Warnakulasuriya, Risk factors for squamous cell carcinoma of the oral cavity in young people--a comprehensive literature review. Oral Oncol, 2001. 37(5): p. 401-18