title: Trends in the epidemiology of head and neck cancer in London.
abstract: BACKGROUND
  Head and neck cancers [HNCs] are biologically heterogeneous tumours. The objectives of this study were to describe trends in incidence of HNCs amongst London residents by sex, age, anatomical site, deprivation and ethnicity.
  
  
  METHODS
  Annual age-standardised incidence rates [ASRs] were calculated on HNC registration data, overall and for specific cancer sites, by sex and morphology (1985-2010) and area-based socio-economic deprivation score (2006-2010). Age-standardised incidence rate ratios [IRRs] for the main ethnic groups were calculated by cancer site, using White males and females as the reference groups (1998-2009).
  
  
  RESULTS
  The ASR of HNC in males increased by 40% from 17.3 [95% CI: 15.8-18.6] to 24.2 [95% CI: 22.5-25.8] per 100 000 and in females by 87% from 7.0 [95% CI: 6.2-7.8] to 13.1 [95% CI: 11.9-14.2] per 100 000. Seventy-three per cent of cases spanned four cancer sites: larynx, thyroid, oral and oropharynx. Larynx was most common (23%), and had the highest male: female ratio (6 : 1); ASRs decreased significantly over time, most notably in males [P < 0.001]. Oral cavity was the second most common (21%), with a male: female ratio of 2 : 1, and increasing ASRs in both sexes [P < 0.001]. The majority of cases were male (64%) and from deprived areas (59%). Deprivation was associated with a significantly higher incidence for larynx (males), oropharynx (males and females) and oral cavity (females) [P < 0.05]. The age-specific rate for middle-aged adults (45-64 years) was high for oropharyngeal cancer. The incidence of thyroid cancers increased significantly in both sexes [P < 0.001], and this was the only site more common in females. One in five cases with known ethnicity was from a non-White group (20%). Compared with their White counterparts, Bangladeshi females had a higher incidence of oral, laryngeal and thyroid cancers; Chinese males and females had a higher incidence of nasopharyngeal cancer; and Pakistani and Indian females and Indian males also had higher incidence of oral cancer.
  
  
  CONCLUSIONS
  HNCs are increasing in London males and females with significant variation by cancer site over time; oral and oropharyngeal cancers show the most significant rise, with implications for public health action and service provision.
authors.affiliation: National Cancer Intelligence Network, Public Health England, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Tataru
authors.affiliation: National Cancer Intelligence Network, Public Health England, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Mak
authors.affiliation: Guy's and St Thomas' Hospital, Head & Neck Cancer Centre, Guy's Hospital, London, Uk.
authors.forename: R
authors.initials: R
authors.lastname: Simo
authors.affiliation: National Cancer Intelligence Network, Public Health England, London, UK.|Cancer Epidemiology, Population and Global Health, London, UK.
authors.forename: E A
authors.initials: EA
authors.lastname: Davies
authors.affiliation: National Cancer Intelligence Network, Public Health England, London, UK.|Population and Patient Health, King's College London Dental Institute at Guy's, King's & St Thomas's Hospitals, London, UK.
authors.forename: J E
authors.identifier: http://orcid.org/0000-0001-5068-8008
authors.initials: JE
authors.lastname: Gallagher
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002277:Carcinoma / Q000453:epidemiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008131:London; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult