UNC study finds oral tongue cancer increasing in young, white females

A team of researchers from UNC Lineberger Comprehensive Cancer Center analyzed data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database and found that, between 1975 and 2007, the overall incidence for all ages, genders, and races of the disease was decreasing.

However, the incidence of oral tongue squamous cell carcinoma rose 28 percent among individuals ages 18 to 44. Specifically, among white individuals ages 18 to 44 the incidence increased 67 percent. The increasing incidence was most dramatic for white females ages 18 to 44. They had a percentage change of 111 percent. Interestingly, the incidence decreased for African American and other racial groups.

Historically, oral tongue cancer has been strongly associated 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 been seeing more oral tongue cancer in young white women in our clinic. So we looked at the literature, which reported an increase in oral tongue squamous cell carcinoma in young white individuals but couldn't find any information about gender-specific incidence rates, so we decided we should take a look at the SEER data,” said Bhisham Chera, MD, lead author on the study and assistant professor in the Department of Radiation Oncology.

Over the past decade an association between the human papilloma virus with squamous cell carcinoma of the tonsil and tongue has been observed. Patients with human papilloma virus associated oral squamous cell carcinoma are typically male, white, non-smokers, non-drinkers, younger in age and have higher socioeconomic status. The researchers at UNC have preliminarily 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 have also noted the absence of the virus in young females with oral tongue cancer. The UNC researchers have also anecdotally observed 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 the 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.” he added.

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

Other UNC Lineberger researchers who contributed to the study include Sagar Patel, BA, of the Department of Radiation Oncology, William R. Carpenter, PhD, MHA, professor of health policy and management in the UNC Gillings School of Global Public Health, Marion Couch, MD, PhD, formerly a professor of otolaryngology/head & neck surgery at UNC (now at the University of Vermont), Mark Weissler, MD, distinguished professor of otolaryngology/head & neck surgery, Trevor Hackman, MD, assistant professor of otolaryngology/head & neck surgery, D. Neil Hayes, MD, MPH, associate professor in the division of hematology/oncology, and Carol Shores, MD, PhD, associate professor of otolaryngology/head & neck surgery.