title: Lower mortality from nasopharyngeal cancer in The Netherlands since 1970 with differential incidence trends in histopathology.
abstract: OBJECTIVE
  Nasopharyngeal carcinoma (NPC) is rare in western countries albeit affected by common and unrelated phenomena: smoking less in men, more in women and immigration from China and North Africa. We studied trends in NPC incidence, tumour morphology, survival and mortality in order to assess progress against this cancer.
  
  
  METHODS
  A trend analysis was performed with nationwide incidence and survival data (from The Netherlands Cancer registry in 1989-2009), followed by analysis of mortality (data from Statistics Netherlands) covering the period 1970-2009, and calculating estimated percentages of change (EAPC) in both. According to the WHO classification we distinguished keratinizing SCC (WHO-I), differentiated (WHO-IIA) and undifferentiated (WHO-IIB) non-keratinizing carcinoma.
  
  
  RESULTS
  NPC incidence significantly decreased since 1989, especially in males (EAPC 1989-2009: -1.3; 95% CI: -2.5, -0.2) and in patients with keratinizing SCC (WHO-I) (EAPC: -3.6; 95% CI: -5.3, -1.8). By contrast, the incidence of differentiated non-keratinizing tumours (WHO-IIA) significantly increased in the same period (EAPC: 9.6; 95% CI: 5.6, 13.5). One- and three-year relative survival, as an indicator of disease-specific survival increased slightly from 79% to 81% and from 57% to 65% since 1989. NPC mortality significantly decreased since 1970 (EAPC: -1.2; 95% CI: -1.8, -0.5) and more pronounced since 1989 (EAPC: -3.0; 95% CI: -4.3, -1.6).
  
  
  CONCLUSIONS
  During the past two decades, the incidence of NPC in The Netherlands decreased mainly by less keratinizing, supposedly smoking-related NPC (WHO-I). However, the incidence of non-keratinizing NPC (WHO-IIA, B) increased, most likely due to EBV infection and thus related to higher immigration levels of people from high-incidence areas.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. m.arnold.1@erasmusmc.nl
authors.forename: Melina
authors.initials: M
authors.lastname: Arnold
authors.forename: Maarten A
authors.initials: MA
authors.lastname: Wildeman
authors.forename: Otto
authors.initials: O
authors.lastname: Visser
authors.forename: Henrike E
authors.initials: HE
authors.lastname: Karim-Kos
authors.forename: Jaap M
authors.initials: JM
authors.lastname: Middeldorp
authors.forename: Renske
authors.initials: R
authors.lastname: Fles
authors.forename: I
authors.initials: I
authors.lastname: Bing Tan
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Coebergh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology; D002648:Child; D018572:Disease-Free Survival; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007633:Keratins; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D015996:Survival Rate; D055815:Young Adult
chemical_list: D007633:Keratins