Current Trends Deaths from Oral Cavity and Pharyngeal Cancer -- United States, 1987

In 1987, more than 9700 deaths in the United States were caused by cancers of the oral cavity and pharynx.* Many of these deaths could have been prevented by reduction of personal risk behaviors (e.g., tobacco use and heavy alcohol consumption). This report summarizes epidemiologic data on deaths caused by oral and pharyngeal cancer in the United States in 1987.

Deaths from cancers of the oral cavity and pharynx were identified from total mentions in the multiple cause-of-death file** compiled by CDC's National Center for Health Statistics (NCHS). Denominators for 1987 rate calculations were determined from intercensal population estimates (2). Death rates were standardized to the 1970 age distribution of the U.S. population and were analyzed by age, race, sex, and state of residence.

In 1987, the national death rate for cancer of the oral cavity and pharynx was 3.6 per 100,000 persons. The death rate for males (5.6 per 100,000) was 2.8 times higher than that for females (2.0 per 100,000). The death rate for blacks (5.7 per 100,000) was 1.7 times the death rate for whites (3.4 per 100,000); the death rate for other races was 2.4 per 100,000.

Patterns of oral cavity and pharyngeal cancer mortality differed by age between blacks and whites (Figure 1). For whites, oral and pharyngeal cancer death rates steadily increased with age, peaking at ages greater than or equal to 75 years with 35.9 deaths per 100,000 males and 16.1 deaths per 100,000 females. In comparison, the death rates for blacks peaked at ages 55-64 years (35.4 per 100,000 males and 9.6 per 100,000 females), then remained at that level through ages greater than or equal to 75 years.

Oral and pharyngeal cancer death rates varied by area: they were highest in the District of Columbia (6.3 per 100,000) and lowest in South Dakota and Utah (1.4 per 100.000) (Table 1). Total deaths from oral and pharyngeal cancer for 1987 ranged from 10 deaths in Wyoming to 1053 deaths in California. Reported by: Soft Tissue, Cranio-Facial Defects, and Pain Section, Epidemiology and Oral Disease Prevention Program, National Institute of Dental Research, National Institutes of Health. Dental Disease Prevention Activity, Center for Prevention Svcs; Cancer Prevention and Control Br, Aging and Statistics Br, Div of Chronic Disease Control and Community Intervention, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The survival rate for persons with cancer of the oral cavity and pharynx is among the lowest of the major cancers, with a 5-year relative survival rate of 52% (3). In contrast to some other cancers (e.g., breast, colorectal, and prostate cancers), the overall survival rate from oral and pharyngeal cancer has not improved during the past 16 years, and survival rates for blacks have decreased (4).

Factors contributing to the risk of developing oral cavity and pharyngeal cancer include increasing age, tobacco use (smoked and smokeless), and alcohol consumption (5). The combined risks from tobacco and alcohol use appear to be substantially greater than those from tobacco or alcohol alone (6). A substantial reduction in either risk factor could dramatically reduce oral and pharyngeal cancer rates. Oral cavity and pharyngeal cancer deaths ranked 16th among all cancer deaths in the United States in 1987; the increased use of tobacco among women, adolescents, and children is likely to elevate death rates for these cancers in the next several decades (7).

As with most cancers, early detection and prompt treatment are critical to improve survival. With early detection and timely treatment, public health professionals, clinicians, and other health-care providers could reduce substantially the mortality from oral cavity and pharyngeal cancer. Historically, dental health professionals have been ascribed primary responsibility for performing thorough oral, head, and neck examinations on patients. However, surveys in 1986 show that persons at highest risk for developing oral and pharyngeal cancer seek physician services four times more frequently than dental services (8). Thus, reduction of oral and pharyngeal cancer mortality could result from intervention efforts that include greater involvement and training of all health professionals in appropriate examination methods, referrals, and follow-ups for high-risk patients. These interventions could also assist in achieving the year 2000 health objective of reducing deaths caused by cancer of the oral cavity and pharynx in men aged 45-74 years from 13.2 per 100,000 in 1987 to less than or equal to 9.4 per 100,000*** and in women aged 45-74 years from 4.7 per 100,000 in 1987 to less than or equal to 4.0 per 100,000 (9).

References

1. NCHS. Vital statistics mortality data, multiple cause of death detail, 1987 (machine-readable public-use data tape). Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1990.

2. Bureau of the Census. 1980-1990 Intercensal population estimates by race, sex, and age (machine-readable data files). Washington, DC: US Department of Commerce, Bureau of the Census, nd.

3. American Cancer Society. Cancer facts and figures--1990. Atlanta: American Cancer Society, 1990; ACS no. 5008-LE.

4. National Cancer Institute. Cancer statistics review, 1973-1987. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1990; NIH publication no. (PHS)90-2789.

5. Blot WJ, McLaughlin JK, Winn DM. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48:3282-7.

6. McCoy GD, Wynder EL. Etiological and preventive implications in alcohol carcinogenesis. Cancer Res 1979;39:2844-50.

7. US Department of Health and Human Services. The health consequences of using smokeless tobacco: a report of the Advisory Committee to the Surgeon General. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1986; DHHS publication no. (NIH)86-2874.

8. Bureau of the Census. Statistical abstract of the United States, 1990. 110th ed. Washington, DC: US Department of Commerce, Bureau of the Census, 1990.

9. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives (Draft). Washington, DC: US Department of Health and Human Services, Public Health Service, 1990.

• International Classification of Diseases, Ninth Revision, Clinical Modification, rubrics 141-149. ** A public-use tape file that contains a data record for all deaths processed by NCHS. Each data record includes multiple cause, underlying cause, and demographic data for a death (1). *** Year 2000 goals are for underlying cause of death.

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