Oral cancer - UK 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 2007, 5,410 persons were diagnosed with an oral cancer. Across countries, the highest incidence, for both males and females, is in Scotland. ( Table 1.1)
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 (87%) 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.
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 (30%) of oral cancers are diagnosed in the mouth cavity and a similar proportion on the tongue. Cancers of the oropharynx, piriform sinus and hypopharynx together account for a further quarter (29%) 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
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
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
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 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.
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 11 per 100,000 in 2007, an increase of more than 50% since 1989. While female oral cancer rates have remained significantly lower than male rates, their incidence trends have been similar with an average increase of 3% each year since 1989.
Trends are shown in Figure 1.4. 6
When the oral cancer incidence trends are analysed by age group, differing patterns emerge as Figures 1.5 and 1.6 illustrate. 6
For men over 80, the incidence of oral cancer has more than halved since 1975, while rates for men in their 70's 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 9.3 per 100,000 for men aged 40-49 and from 11.5 to 29.7 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
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References for oral cancer incidence
- Office for National Statistics. Cancer Statistics registrations: Registrations of cancer diagnosed in 2007, England. Series MB1 no.38. 2010
- ISD Online. 2010, Information and Statistics Division, NHS Scotland.
- Northern Ireland Cancer Registry, Cancer Incidence and Mortality. 2010
- Welsh Cancer Intelligence and Surveillance Unit 2010. 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
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