BACKGROUND: Cancers of the oral cavity and pharynx encompass a heterogeneous group of cancers for which known risk factors include smoking, alcohol consumption and human papilloma virus (HPV) infection but their influence is site-specific with HPV mainly influencing oropharyngeal cancer. Their incidence and survival rates are not well known over extended periods of time. PATIENTS/METHODS: Data were obtained for Finnish (FI) and Swedish (SE) patients from the Nordcan database recently updated through 2019. Age-adjusted incidence trends (FI from 1953, SE from 1960) and relative survival rates for years 1970 through 2019 were calculated. RESULTS: We observed a prominent increase in oral and oropharyngeal cancers in FI and SE men and women but the trend for oral cancer was interrupted for SE men in 1985 and possibly also for FI and SE women in 2015. The trend changes in male and female oral cancer was confirmed in data for Denmark and Norway. Relative survival for these cancers has improved overall but they differed for one cluster of oral, oropharyngeal and nasopharyngeal cancers with 60-70% 5-year survival in the last period and hypopharyngeal cancer with 25% male survival. In all these cancers, survival for old patients was unfavorable. DISCUSSION/CONCLUSION: We hypothesize that reduction in smoking prevalence helped to stop the increase in oral cancer especially in men. As the prevalence of smoking is decreasing, HPV is becoming a dominant risk factor, particularly for the increasing oropharyngeal cancer. Prevention needs to emphasize sexual hygiene and HPV vaccination.

Cancer Gene Therapy Group Translational Immunology Research Program University of Helsinki Helsinki Finland

Department of Otorhinolaryngology Head and Neck Surgery Helsinki University Hospital and University of Helsinki PO Box 263 00029 Helsinki Finland

Department of Urology Helsinki University Hospital and University of Helsinki Helsinki Finland

Division of Cancer Epidemiology German Cancer Research Centre 69120 Heidelberg Germany

Division of Pediatric Neurooncology German Cancer Research Center Heidelberg Germany

Faculty of Medicine and Biomedical Center in Pilsen Charles University Prague 30605 Pilsen Czech Republic

Hopp Children's Cancer Center Heidelberg Germany

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Johnson DE, Burtness B, Leemans CR, Lui VWY, Bauman JE, Grandis JR. Head and neck squamous cell carcinoma. Nat Rev Dis Primers. 2020;6(1):92. PubMed PMC

Jakobsen KK, Grønhøj C, Jensen DH, Karnov KKS, Agander TK, Specht L, et al. Increasing incidence and survival of head and neck cancers in Denmark: a nation-wide study from 1980 to 2014. Acta Oncol. 2018;57(9):1143–1151. PubMed

Li X, Koskinen AI, Hemminki O, Försti A, Sundquist J, Sundquist K, et al. Family History of Head and Neck Cancers. Cancers (Basel). 2021;13(16). PubMed PMC

IARC. Personal habits and indoor combustions, vol. 100E. Lyon, 2012.: International Agency for Research on Cancer 2012;100E:575.

IARC Biological agents Volume 100 B A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum. 2012;100(Pt B):1–441. PubMed PMC

Mroueh R, Tanskanen T, Haapaniemi A, Salo T, Malila N, Mäkitie A, et al. Familial cancer risk in family members and spouses of patients with early-onset head and neck cancer. Head Neck. 2020;42(9):2524–2532. PubMed

Sabatini ME, Chiocca S. Human papillomavirus as a driver of head and neck cancers. Br J Cancer. 2020;122(3):306–314. PubMed PMC

Leemans CR, Snijders PJF, Brakenhoff RH. The molecular landscape of head and neck cancer. Nat Rev Cancer. 2018;18(5):269–282. PubMed

Li X, Hemminki K. Familial upper aerodigestive tract cancers: incidence trends, familial clustering and subsequent cancers. Oral Oncol. 2003;39(3):232–239. PubMed

Chaturvedi AK, Anderson WF, Lortet-Tieulent J, Curado MP, Ferlay J, Franceschi S, et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol. 2013;31(36):4550–4559. PubMed PMC

Haeggblom L, Attoff T, Yu J, Holzhauser S, Vlastos A, Mirzae L, et al. Changes in incidence and prevalence of human papillomavirus in tonsillar and base of tongue cancer during 2000–2016 in the Stockholm region and Sweden. Head Neck. 2019;41(6):1583–1590. PubMed

Gillison ML, Alemany L, Snijders PJ, Chaturvedi A, Steinberg BM, Schwartz S, et al. Human papillomavirus and diseases of the upper airway: head and neck cancer and respiratory papillomatosis. Vaccine. 2012;30(Suppl 5):F34–54. PubMed

Grønhøj C, Jakobsen KK, Wingstrand VL, Jensen D, Iachina M, Egeberg A, et al. Association between head and neck cancer and sexually transmitted diseases: a Danish nationwide, case-control study. Acta Otolaryngol. 2020;140(7):615–619. PubMed

Hortlund M, Arroyo Muhr LS, Storm H, Engholm G, Dillner J, Bzhalava D. Cancer risks after solid organ transplantation and after long-term dialysis. Int J Cancer. 2017;140(5):1091–1101. PubMed

Zheng G, Sundquist K, Sundquist J, Försti A, Hemminki A, Hemminki K. Rate differences between first and second primary cancers may outline immune dysfunction as a key risk factor. Cancer medicine. 2020;9:8258-65. PubMed PMC

Zheng G, Sundquist K, Sundquist J, Försti A, Hemminki A, Hemminki K. Incidence Differences Between First Primary Cancers and Second Primary Cancers Following Skin Squamous Cell Carcinoma as Etiological Clues. Clin Epidemiol. 2020;12:857–864. PubMed PMC

Grønhøj C, Jakobsen KK, Jensen DH, Rasmussen J, Andersen E, Friborg J, et al. Pattern of and survival following loco-regional and distant recurrence in patients with HPV+ and HPV- oropharyngeal squamous cell carcinoma: A population-based study. Oral Oncol. 2018;83:127–133. PubMed

Näsman A, Du J, Dalianis T. A global epidemic increase of an HPV-induced tonsil and tongue base cancer - potential benefit from a pan-gender use of HPV vaccine. J Intern Med. 2020;287(2):134–152. PubMed

You EL, Henry M, Zeitouni AG. Human papillomavirus-associated oropharyngeal cancer: review of current evidence and management. Curr Oncol. 2019;26(2):119–123. PubMed PMC

Sørensen BS, Busk M, Olthof N, Speel EJ, Horsman MR, Alsner J, et al. Radiosensitivity and effect of hypoxia in HPV positive head and neck cancer cells. Radiother Oncol. 2013;108(3):500–505. PubMed

Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9. PubMed

Jensen JS, Jensen DH, Grønhøj C, Karnov KKS, Nørregaard C, Agander TK, et al. Incidence and survival of oropharyngeal cancer in Denmark: a nation-wide, population-based study from 1980 to 2014. Acta Oncol. 2018;57(2):269–275. PubMed

Grønlund MP, Jakobsen KK, Mirian C, Grønhøj C, Juul Nielsen K, Charabi B, et al. Nasopharyngeal malignancies in Denmark diagnosed from 1980 to 2014. Oral Oncol. 2021;122:105583. PubMed

Jakobsen KK, Wingstrand VL, Jensen JS, Grønhøj C, Jensen DH, Karnov K, et al. Incidence and survival of hypopharyngeal cancer: a Danish Nation-Wide Study from 1980 to 2014. Acta Oncol. 2019;58(11):1570–1576. PubMed

Karnov KKS, Grønhøj C, Jensen DH, Wessel I, Charabi BW, Specht L, et al. Increasing incidence and survival in oral cancer: a nationwide Danish study from 1980 to 2014. Acta Oncol. 2017;56(9):1204–1209. PubMed

Ruud Kjær EK, Jensen JS, Jakobsen KK, Lelkaitis G, Wessel I, von Buchwald C, et al. The Impact of Comorbidity on Survival in Patients With Head and Neck Squamous Cell Carcinoma: A Nationwide Case-Control Study Spanning 35 Years. Frontiers in oncology. 2020;10:617184. PubMed PMC

Hemminki K, Försti A, Hemminki A, Ljungberg B, Hemminki O. Incidence trends in lung and bladder cancers in the Nordic Countries before and after the smoking epidemic. Eur J Cancer Prev. 2021. PubMed

Engholm G, Ferlay J, Christensen N, Bray F, Gjerstorff ML, Klint A, et al. NORDCAN–a Nordic tool for cancer information, planning, quality control and research. Acta Oncol. 2010;49(5):725–736. PubMed

Pukkala E, Engholm G, Hojsgaard Schmidt LK, Storm H, Khan S, Lambe M, et al. Nordic Cancer Registries - an overview of their procedures and data comparability. Acta Oncol. 2018;57:440–455. PubMed

Ji J, Sundquist K, Sundquist J, Hemminki K. Comparability of cancer identification among Death Registry, Cancer Registry and Hospital Discharge Registry. Int J Cancer. 2012;131:2085–2093. PubMed

Storm HH, Engholm G, Hakulinen T, Tryggvadóttir L, Klint A, Gislum M, et al. Survival of patients diagnosed with cancer in the Nordic countries up to 1999–2003 followed to the end of 2006. A critical overview of the results. Acta Oncol. 2010;49(5):532–44. PubMed

Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA. 2014;311(2):183–192. PubMed

Patja K, Hakala SM, Boström G, Nordgren P, Haglund M. Trends of tobacco use in Sweden and Finland: do differences in tobacco policy relate to tobacco use? Scand J Public Health. 2009;37(2):153–160. PubMed

Araghi M, Galanti MR, Lundberg M, Liu Z, Ye W, Lager A, et al. No association between moist oral snuff (snus) use and oral cancer: pooled analysis of nine prospective observational studies. Scand J Public Health. 2021;49(8):833–840. PubMed

Hemminki K, Försti A, Hemminki A, Ljungberg B, Hemminki O. Incidence trends in bladder and lung cancers between Denmark, Finland and Sweden may implicate oral tobacco (snuff/snus) as a possible risk factor. BMC Cancer. 2021;21(1):604. PubMed PMC

Pukkala E, Martinsen JI, Lynge E, Gunnarsdottir HK, Sparen P, Tryggvadottir L, et al. Occupation and cancer - follow-up of 15 million people in five Nordic countries. Acta Oncol. 2009;48:646–790. PubMed

Mårdh O, Quinten C, Amato-Gauci AJ, Duffell E. Mortality from liver diseases attributable to hepatitis B and C in the EU/EEA - descriptive analysis and estimation of 2015 baseline. Infect Dis (Lond) 2020;52(9):625–637. PubMed

Lehtinen T, Elfström KM, Mäkitie A, Nygård M, Vänskä S, Pawlita M, et al. Elimination of HPV-associated oropharyngeal cancers in Nordic countries. Prev Med. 2021;144:106445. PubMed

Norling R, Grau C, Nielsen MB, Homøe P, Sørensen JA, Lambertsen K, et al. Radiological imaging of the neck for initial decision-making in oral squamous cell carcinomas–a questionnaire survey in the Nordic countries. Acta Oncol. 2012;51(3):355–361. PubMed

Morgan RL, Eguchi MM, Mueller AC, Daugherty SL, Amini A, Karam SD. Imaging at diagnosis impacts cancer-specific survival among patients with cancer of the oropharynx. Cancer. 2019;125(16):2794–2802. PubMed PMC

Mäkitie A, Ruuskanen M, Bentzen J, Brun E, Gebre-Medhin M, Friesland S, et al. The management and survival outcomes of nasopharyngeal cancer in the Nordic countries<sup/>. Acta Oncol. 2018;57(4):557–560. PubMed

Mäkitie AA, Cange HH, Hammarstedt-Nordenvall L, Gudjonsson A, Jóhannsson J, Laranne J, et al. Head and neck cancer management in the Nordic countries: an effort to harmonize treatment. Eur Arch Otorhinolaryngol. 2017;274(5):2363–2365. PubMed

Dal Maso L, Panato C, Tavilla A, Guzzinati S, Serraino D, Mallone S, et al. Cancer cure for 32 cancer types: results from the EUROCARE-5 study. Int J Epidemiol. 2020;49(5):1517–1525. PubMed

Janssen-Heijnen ML, Coebergh JW. The changing epidemiology of lung cancer in Europe. Lung Cancer. 2003;41(3):245–258. PubMed

Tumban E. A Current Update on Human Papillomavirus-Associated Head and Neck Cancers. Viruses. 2019;11(10). PubMed PMC

Wierzbicka M, Klussmann JP, San Giorgi MR, Wuerdemann N, Dikkers FG. Oral and laryngeal HPV infection: Incidence, prevalence and risk factors, with special regard to concurrent infection in head, neck and genitals. Vaccine. 2021;39(17):2344–2350. PubMed

Du J, Ährlund-Richter A, Näsman A, Dalianis T. Human papilloma virus (HPV) prevalence upon HPV vaccination in Swedish youth: a review based on our findings 2008–2018, and perspectives on cancer prevention. Arch Gynecol Obstet. 2021;303(2):329–335. PubMed PMC

Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, Burger EA, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):575–590. PubMed PMC

Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):591–603. PubMed PMC