Head and Neck Cancer incidence and prognosis

Interview with Ezra Cohen, MD
Associate Professor of Medicine
University of Chicago Medical Center

Q. How frequently does head and neck cancer occur?

A. The frequency or the incidence of head and neck cancer of course varies by region worldwide. There are some areas of the world where this cancer is quite common, for instance, in south-east Asia, in parts of Europe, and that's primarily related to the risk factors that are associated with this disease. Overall, we are talking about somewhere in the range of 550-560,000 cases per year. Worldwide it's about the sixth most common cancer; it's also the sixth most common cause of cancer mortality.

Q. What is the prognosis for head and neck cancer?

A. The prognosis for head and neck cancer really varies by the type of cancer that we're talking about. And again this goes back to the human papillomavirus, whether a cancer is negative or positive for that. HPV-negative is the typical tobacco related, alcohol related tumours of the hypopharynx and the larynx. HPV-positive is the non-smoker, non-drinker, younger patient who has a tumour usually of the oral pharynx, the tonsil or the base of tongue.

The HPV-negative cancers unfortunately continue to have a fairly dismal prognosis with about a 40% five-year survival, especially when we're talking about locally advanced or local regionally advanced disease. Remembering that the great majority of patients with head and neck cancer present with disease that at least we will try to cure, a 40% five-year survival is certainly quite disappointing and we need to do better there. The bright side of the story, if you will, is that for HPV-positive cancers, the prognosis is actually quite good. And there is an interaction between tobacco and HPV-positivity where HPV-positive non-smokers have a five year prognosis in the range of about 80%. 80% five-year survival.

For the smokers who are HPV-positive, we're talking about a 65% five-year survival.

Q. Is there any difference in the incidence rate between men and women?

A. Between men and women the incidence is actually different. For both HPV-negative and HPV-positive cancers, the incidence is about 3:1. Anywhere from 2:1 to 3:1. The explanation for the HPV-negative patients is that it is a tobacco related cancer and men are more frequent smokers than women. The explanation for the HPV-positive cancers is as yet unknown, and why men should be more prone to getting these cancers as opposed to women, we truly don't know.