Head and Neck Cancer Incidence Disparities Found to be Driven by Risk Factors, Not Race

Camille Ragin, PhD, MPH
Camille Ragin, PhD, MPH

PHILADELPHIA (January 20, 2022)—Researchers at Fox Chase Cancer Center have found that disparities in the incidence of head and neck cancer (HNC) are driven by behavioral and environmental risk factors rather than race. They demonstrated this in the first-ever study to compare HNC incidence in Black patients in the United States, the Caribbean, and Africa.

HNC is comprised of subsites such as the oral cavity and larynx. Different subsites are associated with different primary risk factors, with tobacco and alcohol abuse and human papilloma virus (HPV) infection being the two most prevalent. Existing research shows that in the United States, Blacks have a higher incidence of HNC overall and in tobacco- and alcohol-related subsites than whites, suggesting that race may be a factor in the incidence of HNC.

However, in a recently published study led by Camille Ragin, PhD, MPH, a professor in the Cancer Prevention and Control research program at Fox Chase, researchers found that the HNC subsites and their associated risk factors showed significant variation by geography and region.

“It tells us that a lot of the disparities in incidence that we see for head and neck cancer are being driven primarily by behavior and these risk factors, not necessarily because of Black race,” said Ragin.

The study was conducted by the HNC working group of the African Caribbean Cancer Consortium (AC3), a global effort to assess cancer burden in the African diaspora, which Ragin founded in 2006. Researchers compiled cancer registry data from the Caribbean, Africa, and the United States, collecting and analyzing nearly 15,000 cases of HNC that occurred between 2013 and 2015.

The first author of the study was Aviane Auguste, PhD, an early stage investigator at the University Hospital of Guadeloupe. Auguste is a mentee of the AC3 Mentor-Mentee Matching Program, which was founded as part of an NCI-P20 grant awarded to Fox Chase. The program is a partnership between Fox Chase and the University of the West Indies.

The researchers found that the incidence trends in HNC subsites in the United States did not hold true across Black populations in other regions. Certain risk factors for HNC, such as HPV infection and tobacco and alcohol abuse, may be specific to certain geographic regions since incidence rates of HNC in HPV-related subsites were higher in some Caribbean and African countries, while incidence rates of HNC in alcohol- and tobacco-related subsites were higher in others.

These findings can be used by public health administrators to inform their behavioral intervention efforts, such as where smoking cessation programs would be more effective versus HPV vaccination. “It helps us to figure out how to prioritize the interventions that need to happen in order to address the burden of disease in these different countries and different regions,” Ragin said.

The paper, “Heterogeneity in Head and Neck Cancer Incidence Among Black Populations from Africa, the Caribbean and the USA: Analysis of Cancer Registry Data by the AC3,” was published in Cancer Epidemiology.

Fox Chase Cancer Center (Fox Chase), which includes the Institute for Cancer Research and the American Oncologic Hospital and is a part of Temple Health, is one of the leading comprehensive cancer centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase is also one of just 10 members of the Alliance of Dedicated Cancer Centers. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence six consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. It is the policy of Fox Chase Cancer Center that there shall be no exclusion from, or participation in, and no one denied the benefits of, the delivery of quality medical care on the basis of race, ethnicity, religion, sexual orientation, gender, gender identity/expression, disability, age, ancestry, color, national origin, physical ability, level of education, or source of payment.

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