Oral cancer incidence statistics

Oral cancer is the 15th most common cancer in the UK (2009), accounting for around 2% of all new cases. It is the 12th most common cancer among men in the UK, accounting for over 2% of all new cases of cancer in males. It is the 16th most common cancer among women, responsible for more than 1% of all new cases of cancer in females. In 2009, there were 6,236 new cases of oral cancer in the UK (Table 1.1): 4,097 (66%) in men and 2,139 (34%) in women, giving a male:female ratio of 19:10.1-4

The crude incidence rate shows that there are more than 13 new oral cancer cases for every 100,000 males in the UK and around 7 for every 100,000 females (Table 1.1).

Table 1.1: Oral Cancer (C00-C06, C09, C10 and C12-C14), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2009

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The European age-standardised incidence rates (AS rates) are significantly higher in Scotland compared with Wales, Scotland and Northern Ireland for males, and compared with England only for females. 1-4 The rates do not differ significantly between England, Wales and Northern Ireland for either sex (Table 1.1).  

The geographical variation in oral incidence across the UK largely reflects the prevalence of the two most well established risk factors for the major types of oral cancers - excessive alcohol consumption and smoking. A north-south divide in oral cancer incidence (particularly for males) has existed across the UK since at least the 1990s.5 More recent data shows that the highest incidence rates of oral cavity cancer (ICD-10 C02-C04, C06) are still in Scotland, Northern Ireland and the north of England for males.6 A clear divide across the UK is much less pronounced for females, though the highest rates are also in Scotland and Northern Ireland.

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Oral cancer incidence is strongly related to age, though the patterns by age are quite different for men and women (Figure 1.1).1-4 For men, age-specific incidence rates increase sharply from around age 45 and peak at ages 60-69, before falling in the over 70s. Age-specific oral incidence rates increase much more gradually for women, from around age 45, but peaking in the over-80s. 

In the UK between 2007 and 2009, an average 44% of oral cancer cases were diagnosed in people aged 65 and over; more than 25% were diagnosed in the under 55s. Incidence rates are higher for males than females and this gap is widest between the ages of 55 and 59, when the male:female ratio of age-specific incidence rates (to account for the different proportions of males to females in each age group) is 29:10 (almost three times higher in men).  The male:female rate ratio decreases to less than 16:10 at age 80+ (Figure 1.1).

Figure 1.1: Oral Cancer (C00-C06, C09, C10 and C12-C14), Average Number of New Cases per Year and Age-Specific Incidence Rates, UK, 2007-2009

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The oral cancer incidence trend is shown in Figure 1.2 for Great Britain.1-3

Oral cancer incidence rates have overall increased in Britain since the mid-1970s, with most of this increase occurring since the late 1980s for both sexes (Figure 1.2). European AS incidence rates have increased by 25% and 28% for men and women, respectively, in the last decade (between 1998-2000 and 2007-2009).

Figure 1.2: Oral Cancer (C00-C06, C09, C10 and C12-C14), European Age-Standardised Incidence Rates, Great Britain, 1975-2009

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The oral cancer incidence trend is shown in Figure 1.3 for the UK.1-4

Figure 1.3: Oral Cancer (C00-C06, C09, C10, C12-C14), European Age-Standardised Incidence Rates, UK, 1993-2009

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Oral cancer incidence rates in Britain have overall increased for the 0-49, 50-59, 60-69 and 70-79 age groups since the mid-1970s (Figure 1.4).1-3 The largest increases have been in people aged 50-59 and 60-69, with European AS incidence rates increasing by around a third (33% and 34%, respectively) between 1998-2000 and 2007-2009.1-3

Rising trends of oral cancer in young and middle-aged men, particularly of cancer of the tongue, have been reported in some European countries and the USA.7-9

Figure 1.4: Oral Cancer (C00-C06, C09, C10, C12-C14), European Age-Standardised Incidence Rates, Persons, By Age, Great Britain, 1975-2009

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Lifetime risk is an estimation of the risk that a newborn child has of being diagnosed with cancer at some point during their life. It is a summary of risk in the population but genetic and lifestyle factors affect the risk of cancer and so the risk for every individual is different.

In 2010, in the UK, the lifetime risk of developing oral cancer is 1 in 84 for men and 1 in 160 for women.10

The lifetime risk for oral cancer has been calculated by the Statistical Information Team using the ‘Adjusted for Multiple Primaries’ (AMP) method; this accounts for the possibility that someone can have more than one diagnosis of oral cancer over the course of their lifetime.21

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This group of cancers consists of many sites within the head and neck area (Table 1.2).1-4 The most common are in the tongue and mouth, collectively accounting for 60% of cases in 2009. Cancer of the lip accounts for more than 5% of cases. There is some evidence that this site is associated with ultraviolet radiation from sunshine or sunbeds.11

Other head and neck sites often reported with these oral cancers include cancers of the parotid gland (ICD-10 C07), other and unspecified salivary glands (C08), nasopharynx (C11), nasal cavity and middle ear (C30), sinuses (C31) and larynx (C32).  

Table 1.2: Number of New Cases of Oral Cancer (C00-C06, C09-C10 and C12-C14), By Subsite, UK, 2009

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Although cancer registration has a long history in many countries of the world, particularly in the more affluent regions such as the UK, nearly 80% of the world’s populations live in regions that are not covered by such systems.12 Nonetheless, with a view to characterising the global burden of the disease, the International Agency for Research on Cancer routinely uses the available data to estimate worldwide cancer incidence.13

An estimated 400,000 new cases of cancer of the lip and oral cavity (ICD-10 C00-C08) and pharynx excluding the nasopharynx (C09-C10,C12-14) were diagnosed across the world in 2008 (3% of the total).13

For lip and oral cavity cancer only, the incidence rates are lowest in Eastern Asia and highest in South-Central Asia, with a four- to six-fold variation in male and female World AS incidence rates between the regions of the world (Figure 1.5).13 Much of the geographical variation in incidence across the world can be attributed to differences in tobacco smoking and alcohol consumption. Areca nut or betel quid chewing is also an important risk factor for some south Asian and Chinese populations.14 In high-risk countries such as Sri Lanka, India, Pakistan and Bangladesh, cancer of the lip and oral cavity is either the most common or second most common cancer in men, accounting for up to 15% of all new cases of cancer in males.13

Figure 1.5: Cancer of the Lip and Oral Cavity (C00-C08), World Age-Standardised Incidence Rates, World Regions, 2008 Estimates

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Within the 27 countries of the European Union, the highest European AS incidence rates for 2008 are estimated to be in Hungary for men (22 cases per 100,000) and The Netherlands, Denmark and Hungary for women (around 5 cases per 100,000), while the lowest rates are in Cyprus and Greece for men (around 3 cases per 100,000) and Romania for women (1 per 100,000, Figure 1.6).15

Lip and oral cavity cancer incidence rates for the UK are estimated to be the 24th (males) and 13th (females) highest in Europe (EU-27).15

Figure 1.6: Cancer of the Lip and Oral Cavity (C00-C08), European Age-Standardised Incidence Rates, EU-27 Countries, 2008 Estimates

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Given the most well established risk factors for the major types of oral cancer are excessive alcohol consumption and smoking, it is not surprising that oral cancer incidence is strongly associated with deprivation. The most recent England-wide data for 2000-2004 shows European AS incidence rates for head and neck cancer (ICD-10 C00-C14, C30-C32) are around 130% higher (more than double) for men living in more deprived areas compared with the least deprived, and more than 74% higher for women.16

Similar results have also been published for Northern Ireland and Wales.17,18 A study in Scotland for 2005-2009 shows a slightly larger deprivation gap, with European AS incidence rates being three times higher in the most deprived population.19

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Prevalence refers to the number of people who have previously received a diagnosis of cancer and who are still alive at a given time point. Some patients will have been cured of their disease and others will not. The latest estimates for the UK show that around 38,700 people were still alive at the end of 2006, up to ten years after being diagnosed with head and neck cancer (Table 1.3), this group includes the lip, oral cavity, pharynx, nasal cavity, middle ear, sinuses and larynx, ICD-10 codes C00-C14, C30-C32.20 Worldwide, it is estimated that almost 900,000 cancer patients of the lip, oral cavity and pharynx excluding the nasopharynx (C00-C08, C09-C10,C12-14) were still alive in 2008, up to five years after their diagnosis.13

Table 1.2: Head and Neck Cancer (C00-C14, C30-32), One, Five and Ten Year Cancer Prevalence, UK, 31st December 2006

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section reviewed 16/03/12
section updated 16/03/12