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Recent evidence suggests that exposure to per- and polyfluoroalkyl substances (PFAS) may increase the risk of different cancer types, such as kidney and testicular cancers. Instead, evidence for lung, head and neck, and thyroid cancer is sparse. Hence, we aimed to summarize available literature on the topic. We searched Pubmed and Scopus in January 2024 to retrieve relevant studies and estimated pooled relative risks (RRs) and 95% confidence intervals (CIs) for lung, head and neck, and thyroid cancers according to PFAS exposure using restricted maximum likelihood method. Pooled RRs for occupational or environmental PFAS exposure were 1.20 (95% CI: 1.12-1.28; I 2  = 0.0%, p het  = 0.9; n. studies = 9), 1.15 (95% CI: 0.96-1.37; I 2  = 0.0%, p het  = 0.7; n. studies = 3), and 1.54 (95% CI: 0.86-2.78; I 2  = 69.0%, p het  = 0.02; n. studies = 4) for lung, head and neck, and thyroid cancer, respectively. We did not find compelling evidence of publication bias for lung cancer (p = 0.3). Studies on statistically modelled serum PFAS levels did not support associations with these cancers. We found no positive associations between measured serum levels of 6 different types of PFAS and thyroid cancer. However, the pooled RR of two case-control studies nested within cohorts on the association between natural log-unit increase of perfluorooctanesulfonic acid (PFOS) and thyroid cancer was 1.51 (95% CI: 1.11-2.05; I 2  = 21.1%, p het  = 0.3). PFAS exposure may be associated with lung and thyroid cancer. Due to the limited number of studies and their limitations, further prospective studies with appropriate account of co-exposure with other carcinogens and detailed exposure assessment are needed to establish causality of observed associations., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Paolo Boffetta acted as an expert in litigation involving PFAS exposure, unrelated to the present work. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Benzene, an aromatic hydrocarbon, is a well-known leukemogen. To date, the link between benzene exposure and solid cancers is under examination. Our objective is to perform a systematic review and meta-analysis to evaluate if the occupational exposure to benzene is associated with the incidence and mortality of head and neck cancers (HNCs)., Methods: We systematically reviewed the literature for pertinent cohort studies mentioned in the most recent IARC Monograph on benzene working exposure and other cohorts and case-controls identified via a literature search performed in PubMed, Scopus, and Embase, from their inception to March 2024. Stratified multilevel meta-analyses according to study design, cancer type, industrial sector, quality score of the articles, geographic region and risk of exposure bias were conducted., Results: A total of 29 independent studies were included in our review and multilevel meta-analysis. The findings revealed a bordeline association between exposure to occupational benzene and incidence of HNCs RR = 1.27, 95% CI = 1.00-1.64, I 2 level2 = 0%, I 2 level3 = 43.30%, P < 0.05). In addition, we found a significant increased overall risk of HNCs in females (RR = 1.68, 95% CI = 1.07-2.61; I 2 level2 = 0%, I 2 level3 = 0%, P = 0.433). Stratification analysis according to cancer sites showed a significant increase in risk of nose & sinuses cancers (RR = 3.72, 95% CI = 2.07-6.68; I 2 level2 = 34.13%, I 2 level3 = 0%, P = 0.17). European cohorts (RR = 1.31, 95% CI = 1.08-1.59, p < 0.01) and lower quality studies (RR = 1.39, 95% CI = 1.00-1.91; I 2 level2 = 0%, I 2 level3 = 45.94%, P < 0.001). No evidence of publication bias was found (Egger test P = 0.103)., Conclusions: In conclusion, this systematic review and meta-analysis provide evidence that workers with occupational exposure to benzene might be at increased risk of HNCs, in particular for nose & sinuses cancer. However, it is essential to consider the limitations of the studies, particularly residual confounding, and the areas that need further study to improve our understanding of the subject., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Paolo Boffetta acted as an expert witness in litigation involving benzene exposure and head and neck cancer, unrelated to the present work. Other authors declare no conflict of interest. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: In the United States, approximately 63,000 Americans develop head and neck cancer (HNC) annually. Our study aims were to investigate cardiovascular complications and risk factors for development of CVD among HNC survivors., Methods: Utilizing the Utah Populations Database, a total of 1,901 HNC patients diagnosed and 7,796 birth year, sex, and birth state matched individuals from the general population were identified. Multivariate Cox proportional hazard models were used., Results: Within the first two years after cancer diagnosis, HNC survivors had a higher likelihood of developing cardiovascular disease (CVD). High Charleston Comorbidity Index (CCI) score at baseline (Hazard Ratio (HR) 1.67, 95 % 1.28-2.17), stage II and IV disease (HR 1.80, 95 % 1.29-2.51), age >=65 years old (HR 2.31, 95 % 1.85-2.88), chemotherapy (HR 1.47, 95 % 1.15-1.88) were associated with increased CVD risk., Conclusions: Compared to the general population, HNC survivors were more likely to develop cardiovascular diseases, particularly if they had the following risk factors: older age, stage II or IV cancer, high baseline CCI score, and chemotherapy were risk factors for development of CVD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: This study provides an analysis of head and neck cancer (HNC) cases over a 20-year period in Ho Chi Minh City, Vietnam. It aims to shed light on HNC's characteristics and trends in this highly populated urban region., Methods: The analysis encompasses 8974 HNC cases, emphasising incidence rates, gender distribution, and the prevalence of different subtypes, including oral cavity, nasopharyngeal, oropharyngeal, and laryngeal/pharyngeal cancers. Ho Chi Minh City was chosen due to its extensive cancer reporting systems and its role as a major urban healthcare centre attracting a wide range of patients., Results: The study reveals an increasing incidence of HNC in Ho Chi Minh City, with a notable predominance of male patients (73 %). The breakdown of HNC cases shows oral cavity cancer at 34 %, nasopharyngeal at 33 %, oropharyngeal at 12 %, and laryngeal/pharyngeal at 21 %. Compared to global averages, Vietnamese patients are diagnosed at an earlier age, with a noticeable trend of decreasing mean age of diagnosis over the study period., Conclusion: This comprehensive study provides valuable insights into the HNC landscape in Ho Chi Minh City, revealing a slightly lower overall incidence but an earlier age of diagnosis compared to global trends. These findings suggest the need for region-specific public health initiatives and further research to clarify the epidemiological features of HNC in Vietnam., Competing Interests: Declaration of Competing Interest No interest to declare, (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: In Brazil, regional disparities in mortality rates are evident. This study analyzes the mortality trends of head and neck squamous cell carcinoma (HNSCC) from 1998 to 2017 in Espírito Santo., Methods: Data on deaths were obtained from the Unified Health System's Department of Informatics (DATASUS), and population statistics were sourced from the Brazilian Institute of Geography and Statistics (IBGE). Annual percentage change (APC) calculations with a 95 % confidence interval were used for standardization from 1998 to 2017. The analysis considered age, geographical healthcare regions, and specific anatomical sites (C00-06; C09-10; C12-13; C32; C14). Mortality rates adjusted for age and sex were computed for spatial distribution, focusing on Espírito Santo municipalities in two periods (1998-2007 and 2008-2017)., Results: From 1998-2017, males aged 40-59 showed a rise in age-standardized mortality rate from 48.96 to 58.24/100,000. Espírito Santo experienced an increasing mortality trend in males across the health regions, whilst in females the increase was observed only in the Central region. Oral cavity, oropharynx and larynx subsites showed a mortality increase in males with APC of 1.1 %, 4.7 % and 2.6 %, respectively, while females had a rise only in oral cavity cancer deaths. Spatial analysis revealed higher mortality rates in both sexes during 2008-2017 compared to 1998-2007., Conclusions: Our data highlighted an escalating mortality trend from 1998 to 2017 among men aged 40-80 in oral cavity, oropharynx and larynx, whereas the female population experienced a rise limited to oral cavity cancer mortality. As the only study covering this period in Espírito Santo, it serves as a valuable tool for developing strategies for HNSCC management, considering the socio-economic advancements achieved in recent years., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Arsenic is a known carcinogen for the lungs, the bladder, and the skin, while systematic evidence on other cancer types is lacking, especially for occupational exposure. Thus, we aimed to systematically summarize current evidence on the association between occupational arsenic exposure and digestive cancers, including head and neck cancer (HNC). We conducted a systematic review on Pubmed, Web of Science, and Embase search engines. We computed pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) using DerSimonian and Laird random-effects model. Occurrence of publication bias was assessed using contour-enhanced funnel plots and Egger's test. Twenty-two studies on digestive cancers and 11 on HNC were included in the meta-analysis. RRs for the association with occupational exposure to arsenic of 1.23 (95% CI: 1.07-1.40; I 2  = 72.3%, p < 0.001) and 1.08 (95% CI: 0.76-1.53; I 2  = 76.6%, p < 0.001) for digestive cancer and HNC, respectively, were observed. As for specific cancer types, arsenic was associated with rectal cancer (RR: 1.51; 95% CI: 1.003-2.28; I 2  = 37.0%, p = 0.174), but not with other investigated cancer types. No clear evidence of publication bias was found. The results of our study suggest that the observed association between occupational arsenic exposure and digestive cancer might be mainly driven by a positive association for rectal cancer, while arsenic exposure did not appear to be associated with HNC. However, further high-quality studies with detailed assessment of arsenic exposure are warranted to clarify the potential association of arsenic with digestive cancers and HNC., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Paolo Boffetta reports a relationship with Arsenic Science Task Force that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: Synovial sarcoma (SS) is a rare soft-tissue cancer. Existing literature encompasses Surveillance, Epidemiology, and End Results (SEER) data-based research on SS explaining the incidence-prevalence in general, by subtypes, and by age at diagnosis. Therefore, this study aimed to fill in the gap of knowledge about measures of disease occurrence and burden of SS by tumor site using the SEER database., Methods: In this cross-sectional study, primary SS patients were selected from SEER 17 Registries, Nov. 2021 (2000-2020) using ICD-O-3 codes 9040, 9041, 9042, and 9043. Patients with additional cancers were excluded. The primary tumor site was categorized into (1) head/neck, (2) internal thorax, (3) abdomen/pelvis, (4) upper extremity, and (5) lower extremity using ICD-10CM codes. Five outcomes were analyzed: age-adjusted incidence rate, 5-year limited-duration prevalence rate, incidence-based mortality, case-fatality rate, and overall survival., Results: From 2000-2020, the overall age-adjusted incidence rate was 0.15 per 100,000; the 5-year limited duration prevalence rate was 0.56 per 100,000; and the incidence-based mortality rate was 0.06 per 100,000 people. The case-fatality and 5-year OS rates were 39.2 % and 62.9 %, respectively. Lower extremity had the highest incidence of 0.07 (estimated 1166 cases), prevalence of 0.36 (estimated 224 cases), and mortality rate of 0.025 (estimated 429 deaths) per 100,000. The other four locations had much closer rates with each other. Intrathoracic SS had the highest case-fatality rate of 71.5 % (148/207) and lowest 5-year OS of 26.0 % (95 % CI: 19.6 %, 32.9 %) than other sites., Conclusion: Based on the measures of disease frequency, the most common primary tumor site is the lower extremity, followed by the upper extremity, abdomen/pelvis, internal thorax, and head/neck. The least favorable primary location is the internal thorax. Those with a primary location of the upper extremity have the longest overall survival, followed by the head/neck, lower extremity, abdomen/pelvis, and internal thorax., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to explore the relationship between the EAT-Lancet diet (ELD) and head and neck cancers (HNCs) in 101,755 Americans enrolled in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial., Study Design: Prospective cohort study., Methods: ELD score was calculated to assess participant's adherence to ELD. Cox hazard regression models were utilised to evaluate the association of ELD and dietary components with HNC risk. Restricted cubic spline (RCS) plots were employed to explore the linearity of the relationships. Predefined subgroup analyses and sensitivity analyses were performed to identify potential effect modifiers and to assess the stability of the findings, respectively., Results: After a mean follow-up of 8.84 years, 279 cases of HNCs, including 169 cases of oral cavity and pharyngeal cancers and 110 cases of laryngeal cancer were recorded. This study observed a dose-response negative correlation between ELD and HNCs (hazard ratio [HR] Q4 vs Q1 : 0.52; 95% confidence interval [CI]: 0.34, 0.80; P-trend = 0.003; HR per SD increment : 0.80; 95% CI: 0.71, 0.91), and oral cavity and pharyngeal cancers (HR Q4 vs Q1 : 0.52; 95% CI: 0.31, 0.88; P-trend = 0.008; HR per SD increment : 0.78; 95% CI: 0.66, 0.92). Analysis using RCS plots indicated a significant linear association between adherence to the ELD and reduced risk of HNCs and oral cavity and pharyngeal cancers (P-nonlinearity > 0.05). Subgroup analysis did not reveal significant interaction factors (P-interaction > 0.05), and sensitivity analysis confirmed the robustness of this study. Additionally, negative correlations were found between the consumption of fruits and whole grains and HNCs (fruits: HR Q4 vs Q1 : 0.58; 95% CI: 0.40, 0.84; P-trend = 0.010; whole grains: HR Q4 vs Q1 : 0.51; 95% CI: 0.26, 0.97; P-trend = 0.004)., Conclusion: Adherence to ELD contributes to the prevention of HNCs., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objectives: Head and neck cancer (HNC) is the sixth most common cancer worldwide. The condition and its treatment often lead to marked morbidities and, for some patients, premature death. Inferentially, HNC imposes a significant economic burden on society. This study aims to provide a comprehensive and detailed estimation of the cost of illness of HNC for Sweden in 2019., Methods: This is a prevalence-based cost of illness study. Resource utilization and related costs are quantified using national registry data. A societal perspective is applied, including (1) direct costs for healthcare utilization, (2) costs for informal care from family and friends, and (3) costs for productivity loss due to morbidity and premature death. The human capital approach is used when estimating productivity losses., Results: The societal cost of HNC for Sweden in 2019 was estimated at €92 million, of which the direct costs, costs for informal care, and costs for productivity loss represented 34%, 2%, and 64%, respectively. Oral cavity cancer was the costliest HNC, followed by oropharyngeal cancer, whereas nasopharyngeal cancer was the costliest per person. The cost of premature mortality comprised 60% of the total cost of productivity loss. Males accounted for 65% of direct costs and 67% of costs for productivity loss., Conclusions: The societal cost of HNC is substantial and constitutes a considerable burden to Swedish society. The results of the present study may be used by policymakers for planning and allocation of resources. Furthermore, the information may be used for future cost-effectiveness analyses., Competing Interests: Author Disclosures Links to the disclosure forms provided by the authors are available here., (Copyright © 2024. Published by Elsevier Inc.)

Background: Rare cancers constitute less than 10% of head and neck cancers and lack sufficient evidence for standardized care. The French Rare Head and Neck Cancer Expert Network (REFCOR) as established a national database to collect data on these rare cancers. This study aims to describe patient and tumour characteristics in this database., Methods: Prospective data collection was conducted across multiple centers. Survival analyses were performed using Kaplan Meier method and Log Rank test. Odds ratios were used for comparing proportions., Results: A total of 7208 patients were included over a period of 10 years. The most frequent histologies were: Not Otherwise Specified (NOS) adenocarcinoma 13 %, adenoid cystic carcinoma 12 %, squamous cell carcinoma of rare locations 10 %, mucoepidermoid carcinoma 9 %, intestinal-type adenocarcinoma (8 %). Tumours were located in sinonasal area (38 %); salivary glands (32 %); oral cavity / oropharynx / nasopharynx (16 %); larynx / hypopharynx (3 %); ears (1 %); others (3 %). Tumours were predominantly classified as T4 (23 %), N0 (54 %), and M0 (62 %). Primary treatment approach involved tumour resection (78 %) and / or radiotherapy (63 %). Patients with salivary gland cancers exhibited better 5-year overall survival (OS) rates (p < 0.05), and lower recurrence rates compared to patients with sinonasal, laryngeal/ hypopharyngeal cancers. No significant differences were observed in the other comparisons. Acinar cell carcinoma demonstrated the best OS while mucous melanoma had the poorest prognosis., Conclusion: Melanoma, carcinoma NOS, and sinonasal undifferenciated carcinoma still have poor prognoses. Efforts are being made, including training and guidelines, to expand network coverage (REFCOR, EURACAN), improve data collection and contribute to personalized therapies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study investigated the association of alcohol consumption, betel nut chewing, and cigarette smoking (ABC) with mortality in patients with head and neck cancer (HNC). This nationwide population-based cohort study determined whether ABC habits were associated with overall or cancer-specific mortality in patients with HNC in Taiwan., Methods: Data from the Taiwan Cancer Registry and Taiwan's National Health Insurance Research Database were used to identify patients with HNC from 2011 to 2017. All the identified patients were monitored until the date of death or the end of 2017. Poisson regression models were employed to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs) associated with the effect of ABC habits on mortality., Results: A total of 31,246 patients with HNC were analyzed in this study. The results revealed that betel nut chewing alone exhibited the strongest effect, significantly increasing the risk of overall mortality (adjusted IRR = 1.44, 95% CI = 1.27-1.63). Additionally, betel nut chewing alone was significantly associated with cancer-specific mortality (adjusted IRR = 1.51, 95% CI = 1.30-1.44). Stratified analyses by sex and tumor location indicated that the effect of betel nut chewing alone on overall or cancer-specific mortality remained significant across both sexes, and among patients with oral cancer and patients with oropharyngeal cancer., Conclusions: ABC habits, particularly betel nut chewing, are significantly associated with diminished survival rates in patients with HNC. Accordingly, the implementation of an integrated campaign targeting the prevention of betel nut chewing would be one of the effective public health strategies for improving outcomes for HNC patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Early studies show conflicting findings regarding particulate matter ≤ 2.5 μm in diameter (PM 2.5 ) exposure and development of head and neck cancers (HNC). We analyzed the relationship between PM 2.5 exposure and various types of HNC in a nationally representative ecological sample., Methods: We determined HNC incidence in 608 US counties from 2011 to 2019 using the Surveillance, Epidemiology and End Results (SEER) Program from the National Cancer Institute. We also collected information on sociodemographic factors from SEER and data on smoking and alcohol intake from CDC data frames (county level). PM 2.5 exposure levels were estimated using satellite and meteorological data via previously validated general additive models. Flexible semi-nonparametric regression models were used to test the relationship between PM 2.5 exposure levels and HNC incidence, adjusting for demographics, socioeconomic factors, and comorbidity., Results: Increased PM 2.5 exposure levels were associated with higher incidence-rates of oral cavity and pharyngeal cancers controlling for confounders in our primary analyses (IRR = 1.04, 95 % CI 1.01, 1.07, p = 0.02 per 1 μg/m 3 increase in PM 2.5 ). This relationship was maintained after adjusting for multiple testing (Holm s method, p = 0.04) and in ordinary least squares (OLS) regression (β = 0.17, 95 % CI 0.01, 0.57, p = 0.01). Increased exposure was also associated with other HNC: esophagus (IRR = 1.06, 95 % CI 1.01, 1.11, p = 0.02), lip (IRR = 1.16, 95 % CI 1.03, 1.31, p = 0.01), tonsil (IRR = 1.10, 95 % CI 1.03, 1.16, p < 0.01). However, these relationships were not maintained in secondary analyses., Conclusions: This nationally representative ecological study shows that increased levels of air pollution are associated with increased incidence of overall oral cavity and pharyngeal cancers in the US., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Despite evidence demonstrating that lung cancer screening (LCS) decreases mortality, widespread implementation is lagging. Efforts to identify and recruit patients for LCS are in need. Candidacy for LCS is based on identifiable risk factors, many of which overlap with those of head and neck malignancies. Thus, we aimed to evaluate the prevalence of candidacy for LCS in the head and neck cancer patient population., Methods: We performed a review of anonymous surveys collected from patients who presented to a head and neck cancer clinic. Variables collected from these surveys included age, biologic sex, smoking history, and head and neck cancer history. Patients' candidacy for screening was determined, and descriptive analyses were performed., Results: A total of 321 patient surveys were reviewed. Mean age was 63.7 years, and 195 (60.7%) were men. In this sample, 19 (5.91%) were current smokers, and 112 (34.9%) were former smokers, having quit an average of 19.4 years prior to completing the survey. Average pack-years was 29.3. Of the 321 patients surveyed, 60 (18.7%) would qualify for LCS using current guidelines. However, among those 60 patients who qualified for LCS, only 15 (25%) patients had been offered screening and only 14 (23.3%) had been screened., Conclusions: We have importantly demonstrated both a substantial prevalence of candidacy for LCS in the head and neck cancer population as well as disappointingly low levels of screening utilization in this group of patients. We have identified this setting as a key patient population that ought to be targeted for information about and access to LCS., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: The delivery of healthcare has changed significantly over the past decades. This study analyzes the clinicodemographic factors and treatment patterns of head and neck squamous cell carcinoma (HNSCC) patients between 2004 and 2020., Materials and Methods: Retrospective cohort analysis of HNSCC patients from the National Cancer Data Base from 2004 to 2020., Results: A total of 164,290 patients were included. Increased times from diagnosis to definitive surgery (TTS) were seen across all facility types (academic centers, AC; non-academic centers, NAC) between 2004 and 2019, with NAC affected more. TTS < 15 days (RR = 1.05, 95%CI:1.05-1.09) and > 75 days (1.07, 95%CI:1.05-1.09) were associated with increased mortality risk. This association was more prominent among HPV + HNSCC (RR = 1.45; 95%CI:1.18-1.78). Treatment in AC was associated with a decreased mortality risk (RR = 0.94, 95%CI:0.93-0.95). Despite the universal increase in wait times from 2004 to 2019, short-term mortality was significantly decreased from 2016 to 2019, relative to 2004-2007 (3-month mortality: RR = 0.77, 95%CI:0.70-0.85; 12-month mortality: RR = 0.80, 95%CI:0.77-0.84). Wait times decreased in 2020., Conclusions: TTS increased between 2004 and 2019, with NAC affected more. However, despite longer wait times, short-term survival increased significantly. Very short (<15 days) and very long (>75 days) TTS were associated with increased mortality risk. Patients with HPV + HNSCC have the highest increase among those treated > 75 days from diagnosis. Treatment at AC was associated with improved survival, which could be explained by the presence of multidisciplinary teams and subspecialists that may be less available at NAC. The 2021 NCDB data are required for a comprehensive analysis of wait times in 2020., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: To determine the prevalence of smokeless tobacco (SLT) use and its association with oral potentially malignant disorders (OPMDs) and head and neck cancer (HNC) in the Pan-American Health Organization (PAHO) region., Study Design: A literature search was conducted across 9 databases and other sources. The eligibility criteria were pediatric (0-18 years old) and adult (19 years and older) populations consuming any type of SLT. Meta-analysis was performed to determine the prevalence of SLT and the association between its use and OPMDs/HNC in the PAHO region; the Grading of Recommendations Assessment, Development, and Evaluation tool was used to verify the certainty of evidence., Results: Fifty-nine studies from 6 PAHO countries were included, of which 51 were also subjected to quantitative analysis. The pooled SLT prevalence of use was 15% (95%CI: 11.93-18.69) overall, 17% (95%CI: 13.25-22.65) in adults, and 11% (95%CI: 8.54-14.78) in the pediatric population. The highest reported SLT prevalence of use was 33.4% (95%CI: 27.17-39.93) in Venezuela. HNC was positively associated with SLT use (OR = 1.98, 95%CI: 1.54-2.55), with a moderate certainty of evidence. Among OPMDs, only leukoplakia reported a positive association with SLT use (OR = 8.38; 95%CI: 1.05-67.25). However, the quality of the evidence was very low., Conclusion: A high consumption of SLT use, chewing tobacco and snuff, is reported among the adult population residing in the PAHO region with a positive association with the development of oral leukoplakia and HNC., (Copyright © 2023. Published by Elsevier Inc.)

Background: An increasing trend of oropharyngeal cancer (OPC) has been reported in several countries with different demographic characteristics, and often attributed to increases in human papillomavirus (HPV) infection. The survival of patients with OPC has steadily improved, especially for those with positive HPV status. This study assessed the incidence, trends, and survival of OPC in Aotearoa New Zealand (NZ) by age at diagnosis, sex and ethnicity., Methods: The study included all 2109 patients resident in NZ with a primary diagnosis of oropharyngeal squamous cell carcinoma from 2006 to 2020, identified from the National Cancer Registry. We assessed age-standardised incidence rate (ASR), annual percent change (APC) and overall and relative survival rates., Results: The average annual incidence of OPC was 2.2 per 100,000 population. There was a steady increase of 4.9% per year over 15 years. Although the incidence rates were higher in males over the study period, the overall rate of increase was similar in males (4.9%) and in females (4.3%). The incidence was highest in the 50-69-year group (8.8/100,000 population). This age group had an incidence that increased by 7.5% per year to 2018, and then declined. The main increase in rates was seen between the birth cohort of 1946-50 and that of 1956-60. The increase in incidence was seen in Māori and Pākehā/European populations, but no increase was seen in Pacific or Asian populations. The 5-year overall relative survival rate improved from 69% in 2006-13 to 78% in 2014-20. Survival rates were lower in older patients, females, and Māori patients., Conclusion: This study confirmed a substantial increase in OPC incidence in NZ, with some evidence to suggest a recent slowing in this increase. Māori and Pākehā/European had the highest incidence, while Pacific and Asian populations showed the lowest rates and no increase over the study period. Survival rates have improved over time, but remained lower in some demographic groups., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: There is no consensus on the optimal duration of post-treatment follow-up after head and neck cancer (HNC). To generate site-specific input for follow-up guidelines, this study describes the incidence and timing of manifestations of disease during five years of follow-up., Methods: All patients diagnosed with HNC in the Netherlands in 2015 were selected from the Netherlands Cancer Registry. The follow-up events local recurrence (LR), regional recurrence (RR), second primary tumour (SPT), distant metastasis (DM) and death were studied per follow-up-year. The cumulative incidence of these events was calculated using competing risk analyses, with LR, RR and SPT of the head and neck (SPHNC) as events and SPT outside the head-neck (SPOHN), DM and death as competing events. Analyses were performed for oral cavity-, oropharynx-, larynx- and hypopharynx squamous cell carcinoma (SCC), and all HNC patients., Results: The 1-, 1.5-, and 2-year cumulative incidence of an event (LR, RR, SPHNC) were 10% (95%CI 8-13), 12% (95%CI 10-15), and 13% (95%CI 10-16) for oral cavity SCC; 6% (95%CI 4-9), 10% (95%CI 7-14), and 11% (95%CI 8-15) for oropharynx SCC; 7% (95%CI 5-10), 11% (95%CI 9-15), and 13% (95%CI 10-16) for larynx SCC and 11% (95%CI 6-19), 19% (95%CI 12-27), and 19% (95%CI 12-27) for hypopharynx SCC., Conclusions: One year of follow-up for oral cavity SCC, and 1.5 years for oropharynx-, larynx-, and hypopharynx SCC suffices for the goal of detecting disease manifestations after treatment. More research into other aspects of follow-up care should be performed to determine the optimal follow-up regimen., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: This study aimed to demonstrate the temporal trend in incidence of head and neck cancer (HNC) in Taiwan., Materials and Methods: Patients with a HNC were retrieved from the Taiwan's Health Insurance Database. We identified 16,894 patients aged ≥20 years who had received a first-time diagnosis of cancer of the oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, sinonasal, salivary gland or thyroid gland between 2010 and 2018. We calculated the annual incidence rate per 100,000 population, overall, and classified by gender and cancer type. We also used the annual percent change (APC) to characterize trends in head and neck cancer rates over time., Results: The incidence rate showed a gradual decline during this period from 2010 to 2018 with an APC of -2.81% (p < 0.001). Within gender groups, the decline was not statistically significant among females (APC = -1.69, 95% CI = -3.58 ∼ 0.23, p = 0.080). Within cancer types, strikingly high magnitude and statistically significant declines were observed in respect of cancer of the nasopharynx (APC = -7.89%, 95% CI = -9.43%∼-6.31%, p < 0.001), sinonasal cancer (APC = -10.08%, 95% CI = -16.66%∼-2.99%, p = 0.012) and oropharyneal cancer (APC = -9.47%, 95% CI = -15.15%∼-3.42%, p = 0.013) over the study period. In contrast, there was a statistically significant increase in incidence on thyroid cancer over the study period with an APC of 4.75% (95% CI = -2.81%∼6.75%, p < 0.001)., Conclusions: HNCs in Taiwan are showing a decreasing trend, led by the upper respiratory and oropharyngeal cancers. However, there was a concurrent increasing trend of the incidence on thyroid cancer. These trends may be attributable to changing lifestyles and behavioral choices in Taiwan., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Head and neck cancer (HNC) is a major cause of cancer morbidity and mortality in Nepal. The study aims to investigate differences in risk factors for head and neck cancer by sex in Nepal., Methods: A hospital-based case-control study was conducted at the B.P. Koirala Memorial Cancer Hospital in Nepal from 2016 to 2018. A semi-structured questionnaire consisting of socio-demographic characteristics, dietary habits, reproductive factors, household air pollution, tobacco use (smoking and chewing), alcohol consumption, and second-hand smoking was used to collect the data. Odds ratios (OR) and 95 % confidence intervals (CI) were estimated using unconditional logistic regression adjusting for potential confounders., Results: A total of 549 HNC cases (438 men and 111 women) and 601 age-matched healthy controls (479 men and 122 women) were recruited in this study. An increased risk of HNC for low education level and family income were observed among men (adjusted odds ratio (AOR) for 3rd grade and less= 1.58, 95 % CI= 1.14-2.18; AOR for family monthly income < 5000 Rupees = 1.64, 95 % CI 1.20-2.24). The AORs among women were higher than the men for known risk factors (AOR for smoking 1.34 (95 % CI 0.96-1.86) for men, 2.94 (95 % CI 1.31-6.69) for women; AOR for tobacco chewing 1.76 (95 % CI 1.27-2.46) for men, 10.22 (95 % CI 4.53-23.03) for women)., Conclusion: Our results point to an effect modification by sex for HNC risk factors with high AORs observed among women., Competing Interests: Conflict of interest All authors declare no conflicts of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: This nested case-control study in the NIH-AARP Diet and Health Study was carried out to prospectively investigate the relationship of oral microbiome with head and neck cancer (HNC)., Materials and Methods: 56 incident HNC cases were identified, and 112 controls were incidence-density matched to cases. DNA extracted from pre-diagnostic oral wash samples was whole-genome shotgun metagenomic sequenced to measure the overall oral microbiome. ITS2 gene qPCR was used to measure the presence of fungi. ITS2 gene sequencing was performed on ITS2 gene qPCR positive samples. We computed taxonomic and functional alpha-diversity and beta-diversity metrics. The presence and relative abundance of groups of red-complex (e.g., Porphyromonas gingivalis) and/or orange-complex (e.g., Fusobacterium nucleatum) periodontal pathogens were compared between cases and controls using conditional logistic regression models and MiRKAT., Results: Participants with higher taxonomic microbial alpha-diversity had a non-statistically significant decreased risk of HNC. No case-control differences were found for beta diversity by MiRKAT model (all p > 0.05). A greater relative abundance of red-complex periodontal pathogens (OR = 0.51, 95 % CI = 0.26-1.00), orange-complex (OR = 0.38, 95 % CI = 0.18-0.83), and both complexes' pathogens (OR = 0.32, 95 % CI = 0.14-0.75), were associated with reduced risk of HNC. The presence of oral fungi was also strongly associated with reduced risk of HNC compared with controls (OR = 0.39, 95 % CI = 0.17-0.92)., Conclusion: Greater taxonomic alpha-diversity, the presence of oral fungi, and the presence or relative abundance of multiple microbial species, including the red- and orange-complex periodontal pathogens, were associated with reduced risk of HNC. Future studies with larger sample sizes are needed to evaluate these associations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Background: Head and neck cancer (HNC) encompasses malignant tumors in areas like the oral cavity, pharynx, and larynx. This analysis identifies strengths and deficiencies in HNC research, aiming to improve published papers' quality, quantity, and diversity. It also encourages more participation from oncologists, particularly in Egypt, to bridge the gap with Western healthcare standards., Methods: A systematic search was conducted in databases including PubMed, Scopus, Web of Science, and Embase. The goal was to gather research articles on HNC in Egypt published from January 1, 2000, to December 31, 2022., Results: From 2150 articles, 1329 were screened by title and abstract, leading to 193 for full-text review. Finally, 174 articles were included in the final analysis. 2020 saw the highest number of publications. The majority were primary research articles, with randomized controlled trials being prevalent. Most studies were clinical, focusing on radiotherapy, and involved adult patients, emphasizing service delivery. Publications were predominantly in non-Egyptian journals, with the Egyptian Journal of Radiology and Nuclear Medicine being the most frequent. Research was mainly conducted by Egyptian authors and at Cairo University., Conclusion: The growing prevalence of HNC in Egypt underscores the need for more comprehensive research on its various aspects, including etiology, risk factors, and prevention. There's a call for increased research outputs at different Egyptian universities, multicenter studies, and international collaborations. This approach can improve the understanding and management of HNC, contributing to global discussions and advancing treatment and prevention strategies in Egypt., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Objective: This study assesses longitudinal epidemiologic trends in the oldest head and neck cancer (HNC) patients, comparing the oropharynx to other mucosal HNC sites., Materials and Methods: Using data from the Surveillance, Epidemiology, and End Results database, trends in incidence, two-year cancer specific mortality, and percent of cases recommended for and which received surgery from 2000 to 2018 in patients ages ≥85 years were assessed using Joinpoint analysis by HNC site. Trends were quantified as annual percentage change (APC) with 95% confidence intervals (CI)., Results: Among older adults, oropharyngeal cancer (OPC) incidence increased (APC = 1.80% [95% CI: 0.94-2.67]), while mortality decreased (APC = -2.01% [95% CI: -3.26--0.74]) from 2000 to 2018. At other mucosal HNC sites, incidence and mortality remained stable. Percentage of patients who received surgery significantly changed for oropharyngeal (APC = -15.34% from 2000 to 2005 [95% CI: -24.37 to -4.79]) and laryngeal (APC = -4.61% from 2000 to 2008 [95% CI -8.28 to -0.80]) cancers. Trends in recommendation for surgery varied by site with significant decreases at the larynx, oral cavity, and oropharynx., Conclusion: OPC incidence is increasing among the oldest HNC patients. An increasing proportion of HPV-associated tumors could account for associated mortality improvement. There has been a shift towards non-surgical therapy possibly due to known favorable response of HPV-associated OPC to radiation therapy and/or poor surgical candidacy in this age group. The evolving treatment approach has not been detrimental to population-level survival outcomes, but optimal treatment has yet to be established. Future studies with pathologically confirmed HPV status are needed to better understand older adult OPC burden., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Three genera of human papillomavirus (HPV) infect the oral cavity and oropharynx- alpha (α), beta (β) and gamma (γ). While α-HPV infection is an established risk factor for head and neck cancers (HNC), the role of other genera remains unclear. We aimed to estimate the effect of α-, β-, γ-HPV on HNC using a hospital-based case-control study., Methods: We recruited incident HNC cases (396) and controls (439), frequency-matched by age and sex from four main referral hospitals in Montreal, Canada. We collected information on sociodemographic and behavior characteristics using in-person interviews, and tested rinse, brush and tumor specimens for HPV genotypes. We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the effect of HPV on HNC using logistic regression, adjusting for confounding. We conducted probabilistic bias analysis to account for potential exposure misclassification, selection bias, and residual confounding., Results: α-HPV genus had a strong effect on HNC, particularly HPV16 (aOR=22.6; 95% CI: 10.8, 47.2). β-HPV was more common among controls (aOR=0.80; 95% 0.57, 1.11). After adjustment for HPV16, we found weaker evidence for γ-HPV (aOR= 1.29; 95% CI: 0.80, 2.08). Combined bias analyses for HPV16 increased the strength of the point estimate, but added imprecision (aOR=54.2, 95% CI: 10.7, 385.9)., Conclusions: α-HPV, especially HPV16, appears to increase the risk for HNC, while there is little evidence for an effect of β- or γ-HPV. β-HPV may have a preventive effect, while γ-HPV may increase the risk of HNC, although to a lesser extent than that of α-HPV. Results for cutaneous HPV were imprecise and less conclusive. Due to possible epidemiologic biases, the true relation between HPV and HNC could be underestimated in the literature. Further improvement in current methods and more studies of the biologic mechanisms of the three genera in HNC development are warranted., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Information on smoking and other health factors in head and neck cancer (HNC) patients throughout treatment, follow-up and survivorship is limited. This study explores patterns of multiple health factors during radiotherapy (RT) and naturalistic long-term follow-up in a convenience sample of patients with HNC., Methods: Smoking, alcohol use and depression were measured at baseline, 4 and 12 weeks post RT for a sub-group of 99 patients who participated in a randomised controlled trial and completed long-term follow-up. These factors plus healthy eating, physical activity and fatigue are also reported from the long-term follow-up component. Smoking was measured by self-report and biochemically, whilst all other variables were by self-report. Where variables were assessed at multiple time points logistic mixed effects regression models determined within-person changes over time., Results: There were important discrepancies between self-reported (4-7%) and biochemically verified (13-29%) rates of smoking. Rates of smoking and hazardous alcohol intake were significantly increased at follow-up compared to baseline. Depression rates were observed to be higher at end of RT compared to baseline. At long-term follow-up, fatigue was common and co-occurred with suboptimal healthy eating and hazardous alcohol use., Conclusion: Clinically important levels of smoking and alcohol consumption post RT in this sample suggest possible targets for intervention beyond treatment into long-term follow-up of patients., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Reduced tobacco consumption in the population has not been associated with reduced incidence rates of head and neck cancer in several countries., Objective: To explore the associations between HNC and sociodemographic characteristics and lifestyle of former smokers from three Brazilian cancer centers., Methods: A multicenter case-control study was conducted with 229 former smokers diagnosed with squamous cell carcinoma of the oral cavity, oropharynx, larynx, and 318 controls (former smokers without head and neck cancer). Bivariate and multiple logistic regression analyses were conducted to estimate odds ratios (ORs) with a 95% confidence interval (CI)., Results: 11-20 years after smoking cessation showed significant impact on HNC reduction (OR 0.22, 95% CI, 0.12-0.39), which reached 82% (95% CI, 0.09-0.35) among 20 + former smokers when compared to individuals who had stopped smoking for up to 5 years. A history of high-intensity smoking (>40 pack-years) increased HNC risk by 2.09 times (95% CI 1.13-3.89) when compared to subjects who smoked up to 20 pack-years. Past alcohol consumption (OR 1.99, 95% CI, 1.06-3.82) was also associated with head and neck cancer risk in former smokers when compared to no alcohol consumption. There was a decreased head and neck cancer risk in former smokers who had high school level of education (OR 0.38, 95% CI, 0.16-0.91) compared to illiterate former smokers; and former smokers with moderate intake of vegetables (OR 0.49, 95% CI, 0.28-0.85) and fruits (OR 0.43, 95% CI, 0.25-0.73) compared to those with low intake., Conclusion: Head and neck cancer risk in former smokers decreases after 11 years after smoking cessation, former smokers with past alcohol consumption showed an increased risk of HNC. High school level of education and moderate intake of vegetables and fruits reduced HNC risk among former smokers., (Copyright © 2022. Published by Elsevier Ltd.)

The aim of this study was to examine the prevalence of synchronous upper aerodigestive tract (UAT) tumors within oral squamous cell carcinoma (OSCC) patients, and to specify distinct risk groups who benefit from panendoscopy. Definite clinical and pathohistological characteristics, as well as overall and recurrence-free survival (OAS and RFS, respectively) of OSCC patients with and without synchronous second UAT tumors, carcinomas in situ, or higher-grade dysplasia/metaplasia, were evaluated based on a retrospective population-based cohort study, including alignment with cancer registry data. Out of 727 included OSCC patients, 465 cases (64.0%) received panendoscopy. Among these, 18 UAT tumors were detected, all of which were linked to patients with a positive history of nicotine abuse. Every synchronous UAT tumor was revealed by panendoscopy, which, analyzed as an independent staging procedure, was accompanied by a low complication rate (1.7%). When illuminating the impact of a second UAT tumor in OSCC patients, survival analysis revealed reduced 5-year OAS (63.9% vs 43.5%, p = 0.010) and RFS (57.1% vs 32.4%, p = 0.016) for patients with a second oncology diagnosis of the UAT. Within the limitations of the study, it seems that panendoscopy should be performed in the majority of patients suffering from OSCC, because most of them have a history of smoking and drinking, which correlates with an increased risk of developing synchronous UAT tumors., Competing Interests: Declaration of competing interest All authors disclose no actual or potential conflicts of interest, including any financial, personal, or other relationships with other people or organizations that could inappropriately influence (bias) the present paper., (Copyright © 2022 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Persistent human papillomavirus (HPV) infection is an important risk factor for a subset of head and neck cancers (HNCs). However, estimates of the HPV-attributable fraction of oropharyngeal cancers vary greatly, and the proportion is increasing. Growing evidence indicates smaller proportions of oral cavity and laryngeal cancers are also HPV-attributable, but this requires further investigation. The primary objective of the BROADEN study is to estimate the fraction of HNCs attributable to HPV in selected European and Asian countries by anatomic site. Secondary objectives are to determine HPV genotypes involved and to describe primary tumor and patient characteristics by HPV status., Methods: BROADEN is a non-interventional, cross-sectional study of patients with HNC in China, France, Germany, Italy, Japan, Portugal, and Spain. The HPV-attributable HNC fraction will be determined within pre-defined time-periods (2008-2009, 2013-2014 [China only], 2018-2019). Approximately 9000 patients from an estimated 90 hospitals with reference HNC diagnostic units and local reference pathology laboratories will participate. Sample size estimates were generated by grouped anatomic site (oropharynx, oral cavity, nasopharynx, hypopharynx, and larynx) and country. HPV testing (HPV-DNA and p16 immunohistochemistry [IHC]) will be performed at a central laboratory on formalin-fixed paraffin-embedded tissue samples. All HPV-DNA-positive samples and HPV-DNA-negative/p16 IHC-positive samples, plus 10% of remaining HPV DNA-negative (control) samples will be tested for HPV mRNA., Discussion: BROADEN is a large global epidemiologic study to estimate current and recent past HPV burden in oropharyngeal and non-oropharyngeal HNCs. BROADEN is expected to provide robust estimates of HPV attributability by anatomic site in participating countries., (Copyright © 2021. Published by Elsevier Inc.)

Background: Africa and the Caribbean are projected to have greater increases in Head and neck cancer (HNC) burden in comparison to North America and Europe. The knowledge needed to reinforce prevention in these populations is limited. We compared for the first time, incidence rates of HNC in black populations from African, the Caribbean and USA., Methods: Annual age-standardized incidence rates (IR) and 95% confidence intervals (95%CI) per 100,000 were calculated for 2013-2015 using population-based cancer registry data for 14,911 HNC cases from the Caribbean (Barbados, Guadeloupe, Trinidad & Tobago, N = 443), Africa (Kenya, Nigeria, N = 772) and the United States (SEER, Florida, N = 13,696). We compared rates by sub-sites and sex among countries using data from registries with high quality and completeness., Results: In 2013-2015, compared to other countries, HNC incidence was highest among SEER states (IR: 18.2, 95%CI = 17.6-18.8) among men, and highest in Kenya (IR: 7.5, 95%CI = 6.3-8.7) among women. Nasopharyngeal cancer IR was higher in Kenya for men (IR: 3.1, 95%CI = 2.5-3.7) and women (IR: 1.5, 95%CI = 1.0-1.9). Female oral cavity cancer was also notably higher in Kenya (IR = 3.9, 95%CI = 3.0-4.9). Blacks from SEER states had higher incidence of laryngeal cancer (IR: 5.5, 95%CI = 5.2-5.8) compared to other countries and even Florida blacks (IR: 4.4, 95%CI = 3.9-5.0)., Conclusion: We found heterogeneity in IRs for HNC among these diverse black populations; notably, Kenya which had distinctively higher incidence of nasopharyngeal and female oral cavity cancer. Targeted etiological investigations are warranted considering the low consumption of tobacco and alcohol among Kenyan women. Overall, our findings suggest that behavioral and environmental factors are more important determinants of HNC than race., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Head and neck squamous cell carcinomas (HNSCC) have not been fully examined in the Asian diasporas in the US, despite certain Asian countries having the highest incidence of specific HNSCCs., Methods: National Cancer Database was used to compare 1046 Chinese, 887 South Asian (Indian/Pakistani), and 499 Filipino males to 156,927 Non-Hispanic White (NHW) males diagnosed with HNSCC between 2004-2013. Multinomial logistic regression was used to assess the association of race/ethnicity with two outcomes - site group and late-stage diagnosis. Temporal trends were explored for site groups and subsites., Results: South Asians had a greater proportion of oral cavity cancer [OCC] compared to NHWs (59 % vs. 25 %; OR adj =7.3 (95 % CI: 5.9-9.0)). In contrast, Chinese (64 % vs. 9%; OR adj =34.0 (95 % CI: 26.5-43.6)) and Filipinos (47 % vs. 9%; OR adj =10.0 (95 % CI: 7.8-12.9)) had a greater proportion of non-oropharyngeal cancer compared to NHWs. All three Asian subgroups had a higher likelihood of being diagnosed by age 40 (14 % Chinese, 10 % South Asian and 8% Filipino compared to 3% in NHW; p < 0.001). Chinese males had lower odds of late-stage diagnosis, compared to NHWs. South Asian cases doubled from 2004 to 2013 largely due to an increase in OCC cases (34 cases in 2004 to 86 in 2013)., Conclusion: Asian diasporas are at a higher likelihood of specific HNSCCs. Risk factors, screening and survival need to be studied further, and policy changes are needed to promote screening and to discourage high-risk habits in these Asian subgroups., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: The aim of this study was to determine the incidence, location and timing of second primary tumours (SPT) after diagnosis of oral squamous cell carcinoma (OSCC) and relate the risk of SPT to that after head and neck squamous cell carcinoma (HNSCC) and the risks of those tumours in the general population in order to assess the need for a separate follow-up programme for OSCC patients and to aid development of an evidence-based and individualized follow-up programme for OSCC patients., Materials and Methods: All patients diagnosed with OSCC or HNSCC in the Netherlands in 1991-2015 were selected from the Netherlands Cancer Registry. Cumulative incidence rates and Standardized Incidence Ratios (SIR) were calculated. Analyses were stratified by incidence period and age at primary diagnosis of the index tumour, follow-up time, and site of the SPT., Results: We included 11263 patients with OSCC from a population of 34244 patients with HNSCC, of which the median follow-up time was 4.0 years. OSCC SPT develop in different patterns and at different locations than after HNSCC. The 5-year risk of SPT and SIR (95% confidence intervals) were respectively 0.13 (0.13-0.14) and 3.0 (2.9-3.1) for OSCC. The risk of a SPT was continuous over follow-up time and calendar period but decreased with an increasing age at diagnosis of the index tumour up to the age of 75 and there were differences in sites of SPT., Conclusion: A specific follow-up protocol for OSCC is needed, which can be individualized on the basis of, among others, age., Competing Interests: Declaration of competing interest SG reports grants from Novartis, Roche, Pfizer and Eli Lilly NL outside the submitted work. The other authors have no conflicts of interest to declare., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: Alcohol use among survivors of head and neck cancer (HNC) negatively impacts patient outcomes and is an important risk factor for recurrent and second primary tumors. Despite recommendations from several cancer societies, alcohol consumption remains a common problem in this population., Methods: A cross-sectional study was performed with the Alcohol Use Disorders Identification Test (AUDIT) Self-Report questionnaire. Patients with HNC completed surveys at pre-treatment and follow-up appointments every 3-6 months for at least 2-years after treatment., Results: 796 surveys were available for analysis. Most participants were male (75.7%) and had either oropharyngeal (34.5%) or laryngeal (16.7%) cancer. The percentage of alcohol drinkers decreased from 56.1% at pre-treatment to 40.4% at 0-3 months post-treatment, but then increased and surpassed baseline levels by 24 + months post-treatment (64.4%, p = 0.0079). Concurrently, moderate drinkers (AUDIT = 1 - 3) decreased from 34.2% at pre-treatment to 25.2% at 0-3 months post-treatment, but then increased and surpassed baseline levels at 24 + months post-treatment (39.7%, p = 0.0129). Trends among heavy (AUDIT > 3), and heaviest (AUDIT > 6) drinkers were similar, but not statistically significant. At 24 + months post-therapy, we observed a statistically significant increase in female users (39.1% to 63.2%, p = 0.0213) and moderate drinkers < 55 years old (43.4% to 61.9%, p = 0.0184)., Conclusion: Alcohol consumption in survivors of HNC transiently decreases in the immediate months after treatment, but then increases and remains largely stable by 24 months. This pattern is particularly concerning and highlights the need for timely interventions., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: Head and neck cancers are aggressive epithelial tumours that are recognised as being particularly challenging to treat. Here, we report the targeted DNA profiling and the prevalence of neurotrophic-tropomyosin receptor tyrosine kinase gene (NTRK) aberrations in Chinese patients with head and neck cancers., Methods: Samples of 127 patients with head and neck cancer were retrospectively analysed. Profiling was performed by next-generation sequencing of the 1021-gene panel with tumour tissue and matched peripheral blood control samples., Results: This study was inspired by the outcome benefit of a parotid cancer patient harbouring ETV6-NTRK3 fusion, who received crizotinib treatment and achieved a 2-year progression-free survival. Genomic profiling of 127 patients with head and neck cancers indicated that TP53 is the most frequently mutated gene both in our cohort and in The Cancer Genome Atlas (TCGA) database. A higher prevalence of NTRK genetic aberrations (7.9%, 10/127), including NTRK fusion (3.1%) and mutation, was observed in our population than in TCGA. The most common fusion was the ETV6-NTRK3. Compared to the NTRK-wt group, the NTRK aberration group had more APC and PTPRD aberrations (p < 0.05). NTRK fusion was also associated with lower tumour mutation burden (TMB) (p < 0.05). TP53 and LRP1B mutations were significantly associated with higher TMB (both p < 0.01), which may be potential markers of immunotherapy., Conclusions: This is the first study to report targeted DNA profiling of Chinese patients with head and neck cancers. As NTRK genetic aberrations are more common in this Chinese population, the efficacy of NTRK inhibitors should be studied further., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: To estimate the relative prognostic ability of socioeconomic status (SES) compared to overall stage for HPV-negative head and neck squamous cell carcinoma (HNSCC) MATERIALS AND METHODS: Data were obtained from the Carolina Head and Neck Cancer Epidemiology Study (CHANCE). An empirical 4-category SES classification system was created. Cox proportional hazards models, survival gradients, Bayesian information criterion (BIC), and Harrell's C index were used to estimate the prognostic ability of SES compared to stage on overall survival (OS)., Results: The sample consisted of 1229 patients with HPV-negative HNSCC. Patients with low SES had significantly increased risk of mortality at 5 years compared to patients with high SES (HR 3.11, 95% CI 2.07-4.67; p < 0.001), and the magnitude of effect was similar to overall stage (HR 3.01, 95% CI 2.35-3.86; p < 0.001 for stage IV versus I). Compared to overall stage, the SES classification system had a larger total survival gradient (35.8% vs. 29.1%), similar model fit (BIC statistic of 7412 and 7388, respectively), and similar model discriminatory ability (Harrell's C index of 0.61 and 0.64, respectively). The association between low SES and OS persisted after adjusting for age, sex, race, alcohol, smoking, overall stage, tumor site, and treatment in a multivariable model (HR 2.96, 95% CI 1.92-4.56; p < 0.001)., Conclusion: SES may have a similar prognostic ability to overall stage for patients with HPV-negative HNSCC. Future research is warranted to validate these findings and identify evidence-based interventions for addressing barriers to care for patients with HNSCC., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To investigate the recovery trajectory and predictors of outcome for swallowing difficulties following head and neck cancer treatment in a large prospective cohort., Materials and Methods: Data from 5404 participants of the Head and Neck 5000 study were collected from 2011 to 2014. Patient-reported swallowing was measured using the EORTC HN35, recorded at baseline (pre-treatment) and 4 and 12 months post-baseline. Mixed-effects linear multivariable regression was used to investigate time trends, compare cancer sites, and identify associations between clinical, socio-demographic and lifestyle variables., Results: 2458 participants with non-recurrent oral (29%) oropharyngeal (46%) and laryngeal (25%) cancer were included in the analysis. There was a clinically significant deterioration in scores between baseline and four months for swallowing (11.7 points; 95% CI 10.7-12.8) and trouble with social eating (17.9 points; 95% CI 16.7-19.2), but minimal difference between baseline and 12 months. Predictors of better swallowing and social eating were participants with larynx cancer, early-stage disease, treatment type, age, gender, co-morbidity, socio-economic status, smoking behaviour and cohabitation., Conclusion: Swallowing problems persist up to a year after head and neck cancer treatment. These findings identify disease and demographic characteristics for particularly vulnerable groups, supporting the need for holistic interventions to help improve swallowing outcomes. People diagnosed with head and neck cancer at risk of severe eating and drinking problems following treatment can be identified earlier in the pathway, receive more accurate information about early and late post-treatment side-effects, which can inform shared decision-making discussions., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: Over the last few decades, there have been changes in the diagnostic capabilities and treatment of head and neck squamous cell carcinoma (HNSCC) patients. However, the impact of these changes on the ultimate survival of patients remains unclear. The objective of this study was to analyze the changes in disease-specific survival of patients with HNSCC treated consecutively over a period of 30 years in a tertiary center., Material and Methods: We carried out a retrospective analysis of 5,206 carcinomas located in the oral cavity, nasopharynx, oropharynx, hypopharynx, larynx or with metastatic squamous cell carcinoma without a known primary tumor treated in our center during the period 1985-2016. The overall and disease-specific survival was analyzed according to the year of diagnosis of the tumor., Results: There was a significant trend towards an increase in disease-specific survival over the study period, with an average survival gain of 0.28% per year, which means an increase in 5-year disease-specific survival values from about 63.5% during the initial years of the study to 72% during the final years. Patients who had a greater increase in survival were those with primary tumors located in the rhino-oro-hypopharynx, with advanced tumors (stages III-IV) and treated with radiotherapy or chemoradiotherapy. This increase in disease-specific survival did not translate into overall survival., Conclusion: Over the last 30 years we have observed a significant increase in the disease-specific survival of the patients with HNSCC, with an average increase of 0.28% per year in the 5-year specific-disease survival., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

To investigate factors that affect and also decrease the duration for recurrences and secondary tumors in cSCC. A retrospective study was conducted for all patients who were treated for a cSCC of the head and neck between 2009 and 2016. Anamnestic as well as epidemiological and histological data were noted and correlated with the occurrence of recurrences and secondary cancers. The duration between surgery and these events was used to determine if histological factors accelerate their occurrence. The highest risk for recurrences was seen in patients with previous skin cancers (RR 3.23). Histological ulceration (p = 0.003) and grading (p = 0.031) of the tumor were found as significant factors accelerating the time to relapse. Surrounding chronic precancerotic lesions (p < 0.001) and poor tumor grading (p = 0.035) were found as significant factors accelerating the time until a secondary cSCC was observed. Known risk factors increase not only the risk for a cSCC but also for recurrences. Specific histologic findings can help to adjust follow-up intervals to identify recurrences and secondary tumors at an early stage as these were shown to decrease the duration for a further event., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

In head and neck cancer (HNC), some subsites are associated with human papillomavirus (HPV) infection, whereas others are unrelated. Although studies have demonstrated the heterogeneity of HPV prevalence worldwide, its impacts on incidence trends in HNC are unknown. This systematic review examined the incidence trends for HPV-related HNC subsites, exploring patterns by geographic region, age group, sex, and race/ethnicity. We searched for publications on PubMed, Embase, and Scopus. Eligible articles included population-based studies that analyzed incidence trends for subsites classified as a proxy for HPV infection in HNC (hereafter referred to as HPV-related subsites). We retrieved 3,948 non-duplicate records, of which 31 were eligible articles, representing 18 countries and spanning almost fifty years. Overall, the incidence of HPV-related HNC subsites rose, while most of the HPV-unrelated subsites declined or remained stable. For HPV-related HNC subsites, incidence trends increased regardless of age group, highlighting a distinct global pattern between sexes. Also, similar peaks in increased risk were observed in recent cohorts from both Australia and the United States. There is a dramatic shift in the global trends of HNCs, characterized by the emerging burden in HNC for HPV-related subsites., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: While it is known that certain ethnic and immigrant groups are at increased risk of developing head and neck cancer, the individual effects of immigration status and ethnicity on head and neck cancer outcomes is less clear. We sought examine the independent effects of immigration and Chinese and South Asian ethnicity on overall survival in a head and neck cancer patient population., Methods: This was a population-based retrospective matched cohort study using linked Ontario administrative databases between 1994 and 2017. Incident cancer cases were captured in long-standing residents of Chinese and South Asian ethnicity, Chinese and South Asian immigrants, as well as a reference population. Subjects were followed until death. A hard-matching approach was used to adjust for key differences and ensure both groups were balanced with respect to age, sex and cancer site. Cox proportional hazard models were used to estimate the impact of Chinese and South Asian ethnicity on overall survival while further adjusting for baseline covariates., Results: Among 1639 immigrants with head and neck cancer, matched to 3278 controls, the overall 5-year survival rate was 66% and 59%, respectively. After adjusting for between group-differences, all-cause mortality was lower for immigrants (HR 0.76[95%CI 0.69-0.83]) and individuals of Chinese ethnicity (HR 0.78[95%CI 0.68-0.90]), relative to the general population., Conclusions: In Ontario, immigrants experience lower mortality rates following a head and neck cancer diagnosis. Individuals of Chinese ethnicity with head and neck cancer experience a survival advantage, relative to South Asian individuals and the general population., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Head and neck squamous cell carcinoma (HNSCC) pose a great danger to society and now we have shreds of evidence for Human Papillomavirus (HPV) being one of the major causative agents for it. Though the prevalence of HPV varies throughout the world, it is gradually on the rise. The present systematic review aims to retrospect all the available studies on the prevalence of HPV in HNSCC in India and its clinicopathological aspect to study how it is different from HPV negative HNSCC., Methods: An objective electronic database search was conducted in PUBMED Central, MeSH, NLM Catalog, Bookshelf, and PUBMED published in 25 years period from 1994 till 2019. A total of 33 articles were shortlisted for the present review., Results: Studies conducted across India show the prevalence of HPV in Head and Neck Cancers ranging from 0-86.6%. Some studies reported that HPV positive HNSCC is more common in younger age, presents with advanced stage disease, and more commonly presents with nodal metastasis. As opposed to western literature HPV positive HNSCC in India is associated with a well-differentiated tumor grade. There is no difference in treatment outcome and survival among HPV positive and negative HNSCC., Conclusion: Exact prevalence of HPV in HNSCC is still doubtful but now we have some insight into it. The prevalence of HPV in Indian HNSCC patients has risen gradually but treatment outcome and survival may be poorer compared to other countries. However definite conclusions cannot be drawn without proper prospective study., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)