Alabama Counties with Highest Incidence of Head and Neck Cancer Identified
Lack of access to care and socioeconomic factors are linked to advanced head and neck cancer in Alabama’s Black Belt, so labeled because of its rich black soil and once thriving agricultural trade. The region is now a target of efforts to enhance early identification and treatment for head and neck cancer.
Now known for its massive poverty (nearly one in three residents live below the poverty level), lack of education (more than 40 percent of adults have not completed high school), and low number of primary care physicians and dentists (health care providers who screen for and detect head and neck cancer), the seventeen counties that make up this region are among the most affected by head and neck cancer in the state. If diagnosed early, head and neck cancer is highly treatable. But once the disease reaches advanced stages, treatment is often disabling, disfiguring and, unfortunately, unsuccessful.
The results of “Head and Neck Cancer Demographics in Alabama” will be presented by authors, William Carroll, MD, Eben Rosenthal, MD, Brooke Wilkerson, BA, Chris Baranano, MD, Scott Magnuson MD, and Glenn Peters, MD, all of the University of Alabama-Birmingham, at the 6th International Conference on Head and Neck Cancer (http://www.sic2004.org) being held August 7-11, 2004, at the Wardman Park Marriott, in Washington, D.C.
Methodology: The geographic distribution of 843 head and neck patients seen over a three year period in the authors’ clinical practice was defined using data from the University of Alabama-Birmingham (UAB) Head and Neck database. A county-by-county population map was charted; population data was obtained from the 2000 US census. Relative rates of referrals from state counties were generated. (Note: To confirm that the referral rates reflect true cancer incidences rather than individual referral patterns, the data were compared with Alabama Department of Public Health cancer incidence rates.)
Alabama Department of Public Health (ADPH) data for squamous cell carcinoma of the oral cavity, pharynx, and larynx were reviewed. Incidence rates for these cancers were generated by dividing the number of cases documented by the population of the county. These incidence rates were compared with the referral rates generated from the UAB database.
US census data from the year 2000 were used by the UAB Center for Business and Economic Research and the Cartographic Research Center to generate maps illustrating the racial distribution, per capita incomes, poverty rates, insurance status, education levels, and physician and dentist density for Alabama counties.
Results: Incidence rates for head and neck cancer in Alabama are highest in the Black Belt region of the state and the northern rural Appalachian counties. Referral rates for head and neck cancer from these regions are almost double those of other areas of the state. Patients from these counties were generally referred for treatment at a later stage of disease with massive involvement of bone and extra-oral soft tissue and grim prognosis.
The data also showed that the number of primary care physicians and dentists practicing in the Black Belt region are lower than other areas of the state.
The UAB Head and Neck Cancer database was used to examine the impact of race on the stage of presentation of head and neck cancer in Alabama residents. Forty-four percent of African Americans presented with T4 primary disease vs. 28 percent of Caucasians. The ratio for T3 and T4 combined is 77 percent for African Americans versus 54 percent for Caucasians. These ratios do not reach statistical significance with the numbers available at this time.
Conclusion: The data confirm that incidence rates of head and neck cancer in Alabama are highest in the Black Belt and rural northern Appalachian regions of the state. The cause of these high rates is unknown, but the data suggest a link to socioeconomic factors such as income level and access to primary care. As a result of these preliminary findings, efforts are underway in the Black Belt counties to identify barriers to early detection and treatment of head and neck cancer.