Study finds oral tongue cancer increasing in young, white females

A UNC study released this week in the Journal of Clinical Oncology finds an increasing incidence of squamous cell carcinoma of the oral tongue in young white females in the United States over the last three decades.A team of researchers from UNC Lineberger Comprehensive Cancer Center, Gillings School of Global Public Health and School of Medicine analyzed data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database. They found that, between 1975 and 2007, the overall incidence of the disease was decreasing, for all ages, genders and races. However, the incidence of oral tongue squamous cell carcinoma rose 28 percent among individuals ages 18 to 44. Specifically, among whites ages 18 to 44, the incidence increased 67 percent. The increase was most dramatic for white females in this age group, with a 111 percent change. The incidence decreased for African-American and other racial groups.

Historically, oral tongue cancer has been associated strongly with heavy tobacco and alcohol use. Other epidemiological studies have related the decreasing incidence of oral tongue cancer in the United States to the decreased use of tobacco products. Though the UNC research team verified the known decreasing incidence of oral tongue cancer, they were surprised to observe an increasing incidence in young white individuals, specifically young white females.

“Lately we have seen more oral tongue cancer in young white women in our clinic,” said Bhisham Chera, MD, assistant professor of radiation oncology in the UNC School of Medicine and lead author of the study. “So we looked at the literature, which reported an increase in oral tongue squamous cell carcinoma in young white individuals, but we couldn’t find any information about gender-specific incidence rates. That’s when we decided we should take a look at the SEER data.”

Over the past decade, researchers have observed an association between the human papilloma virus and squamous cell carcinoma of the tonsil and tongue. Patients with human papilloma virus-associated oral squamous cell carcinoma are typically male, white, non-smokers, non-drinkers, younger in age and higher in socioeconomic status.

 

UNC researchers preliminarily have tested the cancers of the oral tongue of their young white female patients and have not found them to be associated with the virus. Other institutions also have noted the absence of the virus in young females with oral tongue cancer. UNC researchers have found anecdotally that these young white female patients are typically non-smokers and non-drinkers.”Our findings suggest that the epidemiology of this cancer in young white females may be unique and that causative factors may be things other than tobacco and alcohol abuse. Based on our observations and the published data, it appears that these cases may not be associated with the human papilloma virus. We are actively researching other causes of this cancer in this patient population,” Chera said.

Although the increasing rate of oral tongue cancer in young white females is alarming, oral tongue cancer is rare, relative to breast, lung, prostate and colorectal cancers. “Primary care physicians and dentists should be aware of this increasing incidence and screen patients appropriately,” Chera said. Oral tongue cancer typically is treated first with surgery, followed by radiation and, in some cases, chemotherapy.

Other UNC Lineberger researchers who contributed to the study include William R. Carpenter, PhD, assistant professor of health policy and management in the UNC Gillings School of Global Public Health; and Sagar Patel, BA, (radiation oncology), Mark Weissler, MD, Trevor Hackman, MD, and Carol Shores, MD, PhD (otolaryngology/head & neck surgery), and D. Neil Hayes, MD, MPH (hematology/oncology), all in the UNC School of Medicine. Former UNC Lineberger member Marion Couch, MD, PhD (otolaryngology/head & neck surgery), now on the University of Vermont faculty, also contributed.

UNC Gillings School of Global Public Health contact: Ramona DuBose, director of communications, (919) 966-7467 or ramona_dubose@unc.edu.