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. 2024 Jan 11;150(3):193–200. doi: 10.1001/jamaoto.2023.4322

Head and Neck Cancer Incidence in the United States Before and During the COVID-19 Pandemic

Jason Semprini 1,2, Nitin A Pagedar 3, Eric Adjei Boakye 4,5, Nosayaba Osazuwa-Peters 6,7,8,✉
PMCID: PMC10784997  PMID: 38206603

Key Points

Question

How did the incidence rate of localized and advanced head and neck cancer (HNC) change between 2019 and 2020, the first year of the COVID-19 pandemic?

Findings

In this cross-sectional study of patients diagnosed with HNC from 2017 to 2020 in the US, incidence rates of early-stage HNC declined by 7.9% from 2019 to 2020, without change in advanced HNC diagnoses.

Meaning

Because the incidence of only localized and regional HNC decreased during the first year of the COVID-19 pandemic, a greater number of advanced HNC diagnoses may be observed in later years.

Abstract

Importance

Research about population-level changes in the incidence and stage of head and neck cancer (HNC) associated with the COVID-19 pandemic is sparse.

Objective

To examine the change in localized vs advanced HNC incidence rates before and during the first year of the pandemic.

Design, Setting, and Participants

In this cross-sectional study of patients in the US diagnosed with HNC from 2017 to 2020, the estimated number with cancer of the oral cavity and pharynx (floor of mouth; gum and other mouth; lip; oropharynx and tonsil; and tongue) and larynx were identified from the SEER cancer registry. Subgroup analyses were stratified by race and ethnicity, age, and sex. Data were analyzed after the latest update in April 2023.

Exposure

The COVID-19 pandemic in 2020.

Main Outcomes and Measures

The primary outcomes were the annual incidence rates per 100 000 people for localized HNC (includes both localized and regional stages) and advanced HNC (distant stage) and weighted average annual percentage change from 2019 to 2020. Secondary outcomes included annual percentage change for 2017 to 2018 and 2018 to 2019, which provided context for comparison.

Results

An estimated 21 664 patients (15 341 [71%] male; 10 726 [50%] ≥65 years) were diagnosed with oral cavity and pharynx cancer in 2019 in the US, compared with 20 390 (4355 [70%] male; 10 393 [51%] ≥65 years) in 2020. Overall, the HNC incidence rate per 100 000 people declined from 11.6 cases in 2019 to 10.8 in 2020. The incidence rate of localized cancer declined to 8.8 cases (−7.9% [95% CI, −7.5 to −8.2]) from 2019 to 2020. The localized cancer incidence during the first year of the pandemic decreased the most among male patients (−9.3% [95% CI, −9.2 to −9.5]), Hispanic patients (−12.9% [95% CI, −12.9 to −13.0]), and individuals with larynx cancer (−14.3% [95% CI, −13.6 to −15.0]). No change in the overall incidence rate was found for advanced HNC.

Conclusions and Relevance

In this cross-sectional study, the incidence of localized HNC declined during the first year of the pandemic. A subsequent increase in advanced-stage diagnoses may be observed in later years.

This cross-sectional study examines the change in the incidence rates of localized and advanced head and neck cancer before and during the first year of the COVID-19 pandemic.

Introduction

There will be 67 000 patients with new head and neck cancer (HNC) diagnoses in the US in 2023, with more than 15 000 deaths.1 Several factors have been important for the developing epidemiology of HNC in the US in the last few decades, including behavioral and lifestyle changes associated with the disease.2,3 For example, the population-level decrease in cigarette smoking has coincided with the decrease in incidence of oral cavity cancer; additionally, a concomitant increase in incidence of human papillomavirus–associated oropharyngeal cancer has occurred.4,5,6

The COVID-19 pandemic affected both the diagnosis and treatment of many cancer sites, including HNC .7,8,9 Several studies have reported disparities associated with access to care during the COVID-19 pandemic, which may have affected stage at presentation and survival outcomes of patients with cancer, especially among individuals with limited access to care.10,11,12 However, although studies have described the epidemiology and outcomes of HNC associated with the COVID-19 pandemic, the generalizability of these studies to the HNC population in the US has been limited, as most have been either from a single institution, aggregated data from multiple institutions, or studies with data outside of the US.7,9,13,14,15,16,17,18,19 Thus, because of the lack of population-based data, whether or to what extent the COVID-19 pandemic affected diagnoses of HNC in the US is unclear. Also, the understanding of population-based changes in the stage of presentation of HNC during the COVID-19 pandemic is limited.

Methods

In this cross-sectional study, we aimed to fill the aforementioned gaps by describing the incidence of HNC before and during the COVID-19 pandemic, thereby highlighting changes in localized vs advanced HNC presentation in the first year of the pandemic. We also described differences in incidence on the basis of race and ethnicity, anatomic tumor subsite, and other sociodemographic characteristics. On April 19, 2023, the National Cancer Institute released the Surveillance, Epidemiology, and End Results (SEER) cancer registry data file for 2020, and those data were subsequently analyzed for this study from April 2023 to August 2023.20 Included data spanned from 2017 through 2020, derived from the SEER*Explorer interactive website. Institutional review board approval and informed consent were not required because the data were deidentified, publicly available, and did not meet the definition of human subjects research, according to 45 CFR §46.102(e)(1).

Data Source

This latest SEER data set specifically included new data on the association between the COVID-19 pandemic and 2020 cancer incidence, with evidence that the beginning of the pandemic early in 2020 prompted delays in health services and, consequently, an estimated 9.26% overall decrease in cancer incidence in 2020. However, the actual contribution of HNC sites to this overall decrease reported in the SEER data modeled for COVID-19 is unclear as there were no site-specific data for HNC in the report.21 By synthesizing cancer data from multiple sources, including cancer registries, hospitals, and pathology laboratories, SEER is considered the premium population-level data set in the US. Representing data from 22 geographically defined registries, SEER is highly representative of the overall US cancer burden.22,23

Measures

The SEER*Explorer database disaggregates incidence rates by age (<50 years, 50-64 years, ≥65 years), sex, race and ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White). Race and ethnicity groups were as supplied by the database and unable to be disaggregated further. SEER*Explorer also disaggregates cancers by site and anatomic site. For this study, we restricted our analysis to cancers of the oral cavity and pharynx (floor of mouth; gum and other mouth; lip; oropharynx and tonsil; tongue; salivary gland; nasopharynx; hypopharynx; and other oral cavity and pharynx), as well as the larynx, on the basis of the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) definitions.24 For oral cavity, pharynx, and larynx cancers, SEER excludes the following histologic types: 9050-9055, 9140, and 9590-9993. Incidence was reported separately for (1) localized-stage and regional-stage cancers combined (hereafter referred to as localized) and (2) distant-stage cancers (hereafter referred to as advanced). Subgroup analyses were performed by race and ethnicity, age, sex, and available subsites: floor of mouth (C040-C049), gum and other mouth (C030-C039, C050-C059, C060-C069), lip (C000-C009), oropharynx and tonsil (C090-C099, C100-C109), tongue (C019-C029). The larynx subsite (C320-C329) was also included as a separate site subgroup but not in the total or demographic subgroup rates, as SEER*Explorer does not allow combining incidence rates of specific cancer sites (ie, oral cavity and pharynx with larynx). Unstaged incidence rates were not reported. Further stratification by multiple categories (ie, differences by race and ethnicity for each site) was not feasible as SEER suppresses disaggregated data with low patient counts.

Statistical Analysis

We retrieved the observed incidence rate data (per 100 000 people) from the SEER*Explorer software (Surveillance Research Program, National Cancer Institute).25 After reporting observed incidence rates, we estimated the annual percentage change (APC) in incidence between 2017 to 2018, 2018 to 2019, and 2019 to 2020. APC is a commonly used measure to assess trends in cancer incidence rates over time.26 In this study, the APC in incidence rates from the previous year’s incidence rate is reported. Reporting multiple years of APCs allows us to determine the extent to which the changing patterns in HNC cancer incidence were associated with pandemic or prepandemic trends. To account for uncertainty and measurement error in the SEER data, we calculated a weighted average APC using the upper and lower values of the incidence rate confidence intervals. We also report the 95% CI of the APC. See eTable 1 in Supplement 1, which includes the observed incidence rate data, the calculated APCs for each year, and the respective confidence intervals for each APC calculation. Figures were made using Stata statistical software, version 18 (StataCorp).

Results

For 2019, the SEER 22 data file includes 21 664 patients (15 341 [71%] male; 10 726 [50%] ≥65 years) with cancers of the oral cavity and pharynx. For 2020, only 20 390 patients (4355 [70%] male; 10 393 [51%] ≥65 years) were diagnosed with cancers of the oral cavity and pharynx. Table 1 reports the overall counts of oral cavity and pharynx cancers diagnosed between 2017 and 2020 and stratified by stage at presentation, race and ethnicity, age, sex, and site. Table 1 also reports that there were 5117 larynx cancers diagnosed in 2019 and 4550 larynx cancers diagnosed in 2020.

Table 1. Number and Distribution of Patients With Oral Cavity, Pharynx, and Larynx Cancer in the SEER 22 Dataa.

Variable No. (%)
2017 2018 2019 2020
Totalb 20 550 21 265 21 664 20 390
Stageb
Localized 6143 (30) 5989 (28) 6032 (28) 5528 (27)
Regional 10 545 (51) 11 124 (52) 11 744 (54) 11 129 (55)
Advanced 2346 (11) 2267 (11) 2412 (11) 2323 (11)
Unstaged 1516 (7) 1873 (9) 1475 (7) 1410 (7)
Race and ethnicityb,c
Hispanic 1972 (10) 2159 (10) 2235 (10) 2112 (10)
Non-Hispanic Black 1585 (8) 1648 (8) 1656 (8) 1595 (8)
Non-Hispanic White 15 433 (75) 15 808 (74) 16 117 (74) 14 930 (73)
Otherd 1560 (8) 1650 (8) 1656 (8) 1753 (9)
Age, yb
<50 2478 (12) 2424 (11) 2359 (11) 2152 (11)
50-64 8443 (41) 8441 (40) 8579 (40) 7845 (38)
≥65 9629 (47) 10 400 (49) 10 726 (50) 10 393 (51)
Sexb
Female 5994 (29) 6235 (29) 6323 (29) 6035 (30)
Male 14 556 (71) 15 030 (71) 15 341 (71) 14 355 (70)
Site
Floor of mouth 766 (4) 795 (4) 807 (4) 681 (3)
Gum and other mouth 2718 (13) 2768 (13) 3012 (14) 2849 (14)
Lip 921 (4) 896 (4) 824 (4) 750 (4)
Oropharynx and tonsil 4829 (23) 5391 (25) 5534 (26) 5310 (26)
Tongue 6582 (32) 6764 (32) 6862 (32) 6650 (33)
Other sitee 4734 (23) 4651 (22) 4625 (21) 4150 (20)
Larynxb 5108 5169 5117 4550
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Abbreviation: SEER, Surveillance, Epidemiology, and End Results.

a

Data were derived from SEER*Explorer, reporting the total number of patients with oral cavity and pharynx cancer in the SEER 22 data file.

b

Larynx cancer is not included in overall rate or subgroups because of limitations of the database.

c

Race and ethnicity groups were as provided by the SEER database and could not be stratified further.

d

Other indicates Non-Hispanic American Indian or Alaska Native and Non-Hispanic Asian or Pacific Islander, as defined by SEER.

e

Other sites include salivary gland, nasopharynx, hypopharynx, and other oral cavity and pharynx.

The overall HNC incidence rate declined from 11.6 (95% CI, 11.5-11.8) new patients per 100 000 people in 2019 to 10.8 (95% CI, 10.6-10.9) new patients per 100 000 people in 2020, a 7.7% (95% CI, −7.8 to −7.6) decrease (eTable 1 in Supplement 1). The localized HNC incidence rate declined from 9.5 (95% CI, 9.3-9.8) new patients per 100 000 people in 2019 to 8.8 (95% CI, 8.6-9.0) new patients per 100 000 people in 2020, a 7.9% (95% CI, −7.5 to −8.2) decrease (Table 2). However, no significant change in incidence for advanced-stage HNC was found (in 2019 and 2020, 1.3 and 1.2 new patients per 100 000 people, respectively; APC, 0.0%). Before the pandemic, the APCs for both localized and advanced cancers were minimal between 2017 and 2019 (Figure 1) (localized APC in 2019, 2.7% [95% CI, 2.2-3.2]); advanced APC in 2019, 0.0%).

Table 2. Observed and Annual Percentage Change Incidence Rate in 2020 by Stage.

Variable Localized HNCa Advanced HNCa
2020 Incidence APC, % (95% CI) 2020 Incidence APC, % (95% CI)
Totalb 8.8 −7.9 (−7.5 to −8.2) 1.2 0.0c
Race and ethnicityb
Hispanic 5.1 −12.9 (−12.9 to −13.0) 0.9 −10.1 (−9.1 to −11.1)
Non-Hispanic Black 6.2 −1.6 (−1.5 to −1.7) 1.3 −13.0 (−11.8 to −14.3)
Non-Hispanic White 17.6 −8.4 (−8.2 to −8.6) 1.2 −3.6 (0.0 to −7.1)
Age, yb
<50 1.8 −12.1 (−9.1 to −15.0) 0.2 0.0c
50-64 21.2 −9.2 (−9.1 to −9.3) 2.9 −3.4 (−3.1 to −3.6)
≥65 33.9 −5.4 (−5.4 to −5.5) 4.8 −8.5 (−8.0 to −8.9)
Sexb
Female 5.0 −3.9 (−3.7 to −4.0) 0.6 −13.4 (−12.5 to −14.3)
Male 13.1 −9.3 (−9.2 to −9.5) 1.9 −2.6 (0.0 to −5.3)
Site
Floor of mouth 0.3 0.0c 0.0c 0.0c
Gum and other mouth 1.1 −8.0 (−7.7 to −8.3) 0.3 0.0c
Lipd 0.3 −25.0 (0.0 to −50.0) NA NA
Oropharynx and tonsil 2.3 −4.0 (−3.8 to −4.2) 0.3 0.0c
Tongue 3.0 −4.7 (−3.3 to −6.1) 0.3 0.0c
Larynxb 1.8 −14.3 (−13.6 to −15.0) 0.3 0.0c
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Abbreviation: APC, annual percentage change; HNC, head and neck cancer; NA, not applicable.

a

Incidence per 100 000 people for cancers of the oral cavity and pharynx and corresponding APC from 2019 to 2020 are displayed, stratified by localized (includes localized and regional stage) vs advanced (includes distant stage).

b

Larynx cancer is not included in overall rate or subgroups because of limitations of the database.

c

Confidence intervals were not significant, ie (0.0%-0.0%).

d

Advanced-stage diagnoses were suppressed.

Figure 1. Head and Neck Cancer (HNC) Incidence.

Figure 1.

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For 2018 to 2020, this line graph plots the annual percentage change (APC) in incidence of HNC (per 100 000 people) from the prior year. Incidence of early-stage HNC significantly declined in 2020, the first year of the COVID-19 pandemic. The 2018 APC represents the percentage change from 2017 to 2018; the 2019 APC, the percentage change from 2018 to 2019; and the 2020 APC, the percentage change from 2019 to 2020. Early-stage HNC includes localized-stage and regional-stage cancers. Advanced-stage HNC indicates distant-stage cancers. The bars indicate 95% CIs.

Stratified by race and ethnicity, the largest decline in incidence of localized HNC at the beginning of the pandemic in 2020 was among Hispanic adults (incidence rate, 5.1 new patients per 100 000 people [95% CI, 4.7-5.4]; APC, −12.9% [95% CI, −12.9 to −13.0]) (Figure 2). The decline in incidence of localized HNC was the smallest among non-Hispanic Black adults (incidence rate, 6.2 new patients per 100 000 people [95% CI, 5.7-6.7]; APC, −1.6% [95% CI, −1.7 to −1.5]). Non-Hispanic Black and Hispanic adults reported a respective 13.0% and 10.1% decline in advanced-stage diagnoses, whereas the decline for non-Hispanic White adults was only 3.6% (Figure 3). The pre-2020 trends did not appear to differ by race and ethnicity, with localized disease APCs ranging from 0.0% to 4.7%, and advanced-stage APCs ranging from −7.4% to 12.7%.

Figure 2. Localized Head and Neck Cancer (HNC) Incidence by Demographic.

Figure 2.

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For 2018 to 2020, this line graph plots the annual percentage change (APC) in incidence of localized HNC (per 100 000 people) from the prior year, stratified by sex, race and ethnicity, and age. The 2018 APC represents the percentage change from 2017 to 2018; the 2019 APC, the percentage change from 2018 to 2019; and the 2020 APC, the percentage change from 2019 to 2020. Race and ethnicity groups were as reported in the SEER data.

Figure 3. Advanced-Stage Head and Neck Cancer (HNC) Incidence by Demographic.

Figure 3.

Open in a new tab

For 2018 to 2020, this line graph plots the annual percentage change (APC) in incidence of advanced-stage HNC (per 100 000 people) from the prior year, stratified by sex, race and ethnicity, and age. The 2018 APC represents the percentage change from 2017 to 2018; the 2019 APC, the percentage change from 2018 to 2019; and the 2020 APC, the percentage change from 2019 to 2020.

Heterogeneity in changing HNC incidence by age was also observed. Compared with 2019, incidence in 2020 for younger adults (<50 years) had the largest observed decline in localized oral cancer (APC, −12.1% [95% CI, −9.1 to −15.0]) but no significant change (APC, 0.0%) in advanced-stage incidence (Figure 3). Older adults, who reported the highest incidence—an estimated 33.9 new patients per 100 000 people—for localized diagnoses in 2020, showed declines in both localized and advanced rates (localized APC, −5.4% [95% CI, −5.4 to −5.5]; advanced APC, −8.5% [95% CI, −8.0 to −8.9]).

Incidence rate changes also appeared to differ by sex. In 2020, the incidence rate for male patients with localized HNC declined to 13.1 per 100 000 people (APC, −9.3% [95% CI, −9.2 to −9.5]) and to 1.9 new patients per 100 000 people for advanced-stage HNC (APC, −2.6% [95% CI, 0.0 to −5.3]). Female patients, however, reported an APC of only −3.9% (95% CI, −3.7 to −4.0) for localized HNC in 2020, but an APC of −13.4% (95% CI, −12.5 to −14.3) for advanced-stage incidence. Yet, Figure 2 shows female patients experienced a 36.7% increase in advanced-stage HNC diagnoses in 2019, compared with 2018 (2018 incidence rate, 0.6 new patients per 100 000 people; 2019 incident rate, 0.7 new patients per 100 000 people). Despite this observed increase, caution should be used when interpreting dramatic changes in APC for low-incidence cancers over a short time frame.

Finally, incidence rate changes also varied by anatomic tumor site. First, for advanced-stage HNC, no significant changes from 2019 to 2020 were reported for any anatomic tumor subsite (APC range, 0.0%-0.3%). However, considerable variation in APC of localized disease was found, ranging from 0.0% for floor of the mouth to −25.0% (95% CI, 0.0 to −50.0) for lip sites (Table 2). Based on the lower-bound confidence intervals, the largest change by anatomic subsite was in larynx cancers with a 14.3% decrease (95% CI, −15.0 to −13.6) in incidence of localized HNC in 2020 compared with 2019.

Discussion

The COVID-19 pandemic had far-reaching effects on health care systems worldwide, including substantial disruptions to cancer screening, diagnosis, and management in the US.27,28,29,30,31 This repercussion has included health care systems with equal access to care, such as the Veterans Affairs health care system.32 Although several studies have investigated the pandemic’s potential effect on population-level cancer screening and diagnosis,33,34,35 data describing population-level changes in incidence of cancer due to the pandemic have been scarce because of the typical 2-year to 4-year lag in population-based surveillance data.36 This lag in access to cancer registry data has delayed dissemination of evidence assessing how cancer cases and mortality trends changed since 2020. Additionally, nationally representative cross-sectional surveys, such as the Behavioral Risk Factor Surveillance Systems or National Health Interview Survey, have been used in studies to highlight the influence of the pandemic on cancer. However, these studies have heavily focused on cancers with approved, evidence-based screening protocols, such as breast, cervical, colorectal, and lung cancers.33,35,37 Thus, very little generalizable data have been reported on the less common cancers, or cancers without an approved screening protocol, such as HNC.

To our knowledge, this cross-sectional study is among the first to report population-level assessment of the COVID-19 pandemic’s potential effect on HNC incidence using the latest aggregate SEER data. We showed that cancer incidence for HNC decreased in 2020 relative to 2019. Most importantly, this decline in incidence was found only for cancers diagnosed earlier, that is localized and/or regional disease, with no overall change in incidence for advanced disease. Given the stable trends in both localized and advanced HNC in the study years before the pandemic (2017-2019), these findings suggest that the COVID-19 pandemic’s disruptions to health care may have delayed detection of localized HNC. We should, therefore, expect a subsequent rise in advanced-stage HNC in the coming years.

Delayed detection of localized HNC because of the COVID-19 pandemic’s disruption to health care is profound for population-based cancer surveillance. Even before accounting for pandemic-related changes, a long-standing concern in HNC surveillance has been early detection of disease,38 with less than one-third of patients presenting at the earliest stages of disease development.36,39 In fact, increasing the earliest detection of patients with HNC is one of the goals of the Healthy People 2030 initiative.40 Early detection was also the primary goal of AHEAD (Advancing Head & Neck Cancer Early Detection Research), a funding initiative by the National Institutes of Health (NIH)/National Institute of Dental and Craniofacial Research (NIDCR).41 Early detection of HNC improves treatment options, chances of preserving function without compromising esthetics, overall quality of life, and survival.36,42,43 Although the clinical manifestations of symptoms related to different anatomic subsites differ, early detection is generally infrequent for HNC for a variety of reasons, mostly due to the advanced manifestation of clinical symptoms.39,42,44 This could also be why we do not observe a complementary decline in advanced-stage HNC from 2019 to 2020; pandemic or not, a symptomatic patient with advanced HNC will be more likely to be diagnosed. This is complicated by the fact that, unlike some other cancers with approved screening and early detection protocols, the US Preventive Services Task Force currently has not held sufficient evidence to recommend population-based HNC screening of patients who are asymptomatic.45 Hence, the current screenings are opportunistic and dependent on individuals visiting their primary care clinicians or dentists, and oral cancer screenings are currently recommended in regular preventive checkups.45 Unfortunately, the COVID-19 pandemic altered preventive health care, which, by extension, may have also affected early detection of HNC through opportunistic, routine primary care and dental visits or screenings.46,47,48,49 Additionally, as more preventive care visits were completed via telemedicine during the COVID-19 pandemic, opportunities for early detection of HNC by physical examination were reduced.41,50,51,52,53,54

In addition to fewer physical examinations of patients who are minimally symptomatic, some symptomatic patients’ presentations to primary or specialist care may have been delayed. The capacities of these offices may have decreased, and patients may have been reluctant to come to a health care facility out of fear of contracting COVID-19. Although examining the changes in HNC incidence during the COVID-19 pandemic is crucial, understanding differences by race and ethnicity, age, sex, and tumor site provides further insights into the pandemic’s potential effect on cancer care. We found differences in the incidence of localized HNC based on ethnicity, with the highest decrease in incidence seen among Hispanic individuals. Such information could help clinicians and policymakers prioritize interventions and resources to mitigate any potential long-term effects of the pandemic on HNC outcomes, especially among subgroups that are historically underserved.55 In particular, given the well-established disparities in HNC outcomes among racial and ethnic minority groups,56,57 evaluating differential changes in HNC incidence due to the COVID-19 pandemic might inform whether the pandemic may have exacerbated already existing health inequities in HNC care. Although the current study has described changes in HNC incidence by localized and advanced disease, as more data emerge, future work advancing equity in HNC care should examine any sociodemographic factors associated with postpandemic HNC outcomes.

Strengths and Limitations

This cross-sectional study is a novel descriptive analysis of population-based incidence of HNC during the COVID-19 pandemic. Future research expanding on this report will provide further evidence and more robust analyses of postpandemic incidence and mortality trends in HNC, with particular reference to population subgroups that are historically underserved regarding access to cancer care.

First, although we focused on analyzing observed incidence trends to assess how HNC may have changed during 2020, we are unable to infer causality of the COVID-19 pandemic on HNC incidence or delayed diagnoses. Second, while we described incidence rates by localized and advanced HNC, our descriptive analysis using SEER*Explorer limits our ability to further analyze factors associated with stage of disease presentation or clinical and nonclinical determinants of stage of presentation in the COVID-19 era. Third, we report data at the most granular level available by SEER*Explorer,25 and any further disaggregation would result in suppressed data, limiting the usefulness of such an approach for comparing trends by multiple categories of race and ethnicity, sex, age, and tumor site. Future research analyzing cancer case data remains warranted. Finally, the most recent data release (SEER’s November 2022 submission of the 2020 data file) may not be a complete picture of the cancer incidence from 2020, given the delayed reporting for SEER databases.

Conclusions

Assessing the association between the first year of the COVID-19 pandemic and the stage of diagnosis in patients with HNC is a critical step in evaluating the potential effect of the COVID-19 pandemic on cancer care outcomes. The potential for delayed diagnosis and its subsequent association with treatment outcomes and mortality rates necessitates a detailed analysis of HNC incidence rates by stage. We found that the observed incidence of HNC decreased from 2019 to 2020. Although this decrease was mostly from localized diagnoses, heterogeneity was observed across race, ethnicity, sociodemographic factors, and anatomic tumor site. This information could guide the development of targeted interventions to reduce the COVID-19 pandemic’s morbidity and mortality rates in this patient population, as well as motivate future research analyzing the novel population cancer registry data. This current analysis provides baseline data for how the COVID-19 pandemic potentially affected HNC incidence and highlights areas in which interventions and research may be needed to improve future outcomes for patients with HNC.

Supplement 1.

eTable 1. Observed Incidence Rate, Annual Percentage Change by Year, and Confidence Intervals

jamaotolaryngolheadnecksurg-e234322-s001.xlsx (27.5KB, xlsx)
Supplement 2.

Data Sharing Statement

jamaotolaryngolheadnecksurg-e234322-s002.pdf (17.2KB, pdf)

References

  • 1.Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi: 10.3322/caac.21763 [DOI] [PubMed] [Google Scholar]
  • 2.Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008;83(4):489-501. doi: 10.4065/83.4.489 [DOI] [PubMed] [Google Scholar]
  • 3.Kim L, King T, Agulnik M. Head and neck cancer: changing epidemiology and public health implications. Oncology (Williston Park). 2010;24(10):915-924. [PubMed] [Google Scholar]
  • 4.Joseph AW, D’Souza G. Epidemiology of human papillomavirus-related head and neck cancer. Otolaryngol Clin North Am. 2012;45(4):739-764. doi: 10.1016/j.otc.2012.04.003 [DOI] [PubMed] [Google Scholar]
  • 5.Sturgis EM, Cinciripini PM. Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus-associated cancers. Cancer. 2007;110(7):1429-1435. doi: 10.1002/cncr.22963 [DOI] [PubMed] [Google Scholar]
  • 6.Marur S, Forastiere AA. Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2016;91(3):386-396. doi: 10.1016/j.mayocp.2015.12.017 [DOI] [PubMed] [Google Scholar]
  • 7.Solis RN, Mehrzad M, Faiq S, et al. The impact of COVID-19 on head and neck cancer treatment: before and during the pandemic. OTO Open. 2021;5(4):2473974X211068075. doi: 10.1177/2473974X211068075 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Dolan S. What is the impact of COVID-19 on head and neck squamous cell carcinoma patients? Evid Based Dent. 2020;21(2):52-53. doi: 10.1038/s41432-020-0091-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Crossley JR, Nelson LL, VanDolah H, Davidson BJ, Maxwell JH. The impact of COVID-19 on presentation and diagnosis of head and neck squamous cell carcinoma. Laryngoscope Investig Otolaryngol. 2022;7(5):1436-1440. doi: 10.1002/lio2.893 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Pujolar G, Oliver-Anglès A, Vargas I, Vázquez ML. Changes in access to health services during the COVID-19 pandemic: a scoping review. Int J Environ Res Public Health. 2022;19(3):1749. doi: 10.3390/ijerph19031749 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Graboyes E, Cramer J, Balakrishnan K, et al. COVID-19 pandemic and health care disparities in head and neck cancer: scanning the horizon. Head Neck. 2020;42(7):1555-1559. doi: 10.1002/hed.26345 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Fu J, Reid SA, French B, et al. ; COVID-19 and Cancer Consortium (CCC19) . Racial disparities in COVID-19 outcomes among Black and White patients with cancer. JAMA Netw Open. 2022;5(3):e224304-e224304. doi: 10.1001/jamanetworkopen.2022.4304 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Hanna GJ, Rettig EM, Park JC, et al. Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19. Oral Oncol. 2021;112:105087. doi: 10.1016/j.oraloncology.2020.105087 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Lo Giudice G, Colella G, Boschetti CE, Colella C, Tartaro G, Cirillo N. Increased delay in diagnosis, but not treatment, among patients with oral cancer during the COVID-19 pandemic. JAMA Otolaryngol Head Neck Surg. 2023;149(1):91-92. doi: 10.1001/jamaoto.2022.3652 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Nath S, Ferreira J, McVicar A, Oshilaja T, Swann B. Rise in oral cancer risk factors associated with the COVID-19 pandemic mandates a more diligent approach to oral cancer screening and treatment. J Am Dent Assoc. 2022;153(6):495-499. doi: 10.1016/j.adaj.2022.01.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.COVIDSurg Collaborative . Head and neck cancer surgery during the COVID-19 pandemic: an international, multicenter, observational cohort study. Cancer. 2021;127(14):2476-2488. doi: 10.1002/cncr.33320 [DOI] [PubMed] [Google Scholar]
  • 17.Stevens MN, Patro A, Rahman B, et al. Impact of COVID-19 on presentation, staging, and treatment of head and neck mucosal squamous cell carcinoma. Am J Otolaryngol. 2022;43(1):103263. doi: 10.1016/j.amjoto.2021.103263 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Balk M, Rupp R, Craveiro AV, et al. The COVID-19 pandemic and its consequences for the diagnosis and therapy of head and neck malignancies. Eur Rev Med Pharmacol Sci. 2022;26(1):284-290. doi: 10.26355/eurrev_202201_27779 [DOI] [PubMed] [Google Scholar]
  • 19.Kiong KL, Diaz EM, Gross ND, Diaz EM Jr, Hanna EY. The impact of COVID-19 on head and neck cancer diagnosis and disease extent. Head Neck. 2021;43(6):1890-1897. doi: 10.1002/hed.26665 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.National Cancer Institute . SEER incidence data, 1975-2020. Surveillance, Epidemiology, and End Results Program. November 2021. Accessed April 24, 2023. https://seer.cancer.gov/data/index.html
  • 21.National Cancer Institute . Impact of COVID on 2020 SEER cancer incidence data. Surveillance, Epidemiology, and End Results. 2023. Accessed November 30, 2023. https://seer.cancer.gov/data/covid-impact.html
  • 22.Kuo TM, Mobley LR. How generalizable are the SEER registries to the cancer populations of the USA? Cancer Causes Control. 2016;27(9):1117-1126. doi: 10.1007/s10552-016-0790-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Duggan MA, Anderson WF, Altekruse S, Penberthy L, Sherman ME. The Surveillance, Epidemiology, and End Results (SEER) Program and pathology: toward strengthening the critical relationship. Am J Surg Pathol. 2016;40(12):e94-e102. doi: 10.1097/PAS.0000000000000749 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.World Health Organization . International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3). Updated 2019. Accessed November 28, 2023. https://www.who.int/standards/classifications/other-classifications/international-classification-of-diseases-for-oncology
  • 25.National Cancer Institute . SEER*Explorer. Surveillance, Epidemiology, and End Results program. April 19, 2023. Accessed April 20, 2023. https://seer.cancer.gov/statistics-network/explorer/
  • 26.Clegg LX, Hankey BF, Tiwari R, Feuer EJ, Edwards BK. Estimating average annual per cent change in trend analysis. Stat Med. 2009;28(29):3670-3682. doi: 10.1002/sim.3733 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Kumar J, Kumar P. COVID-19 pandemic and health-care disruptions: count the most vulnerable. Lancet Glob Health. 2021;9(6):e722-e723. doi: 10.1016/S2214-109X(21)00098-X [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Moynihan R, Sanders S, Michaleff ZA, et al. Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open. 2021;11(3):e045343. doi: 10.1136/bmjopen-2020-045343 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Sharpless NE. COVID-19 and cancer. Science. 2020;368(6497):1290. doi: 10.1126/science.abd3377 [DOI] [PubMed] [Google Scholar]
  • 30.Patt D, Gordan L, Diaz M, et al. Impact of COVID-19 on cancer care: how the pandemic is delaying cancer diagnosis and treatment for American seniors. JCO Clin Cancer Inform. 2020;4(4):1059-1071. doi: 10.1200/CCI.20.00134 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Jabbal IS, Sabbagh S, Dominguez B, et al. Impact of COVID-19 on cancer-related care in the United States: an overview. Curr Oncol. 2023;30(1):681-687. doi: 10.3390/curroncol30010053 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Englum BR, Prasad NK, Lake RE, et al. Impact of the COVID-19 pandemic on diagnosis of new cancers: a national multicenter study of the Veterans Affairs healthcare system. Cancer. 2022;128(5):1048-1056. doi: 10.1002/cncr.34011 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Fedewa SA, Star J, Bandi P, et al. Changes in cancer screening in the US during the COVID-19 pandemic. JAMA Netw Open. 2022;5(6):e2215490. doi: 10.1001/jamanetworkopen.2022.15490 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Star J, Bandi P, Siegel RL, et al. Cancer screening in the United States during the second year of the COVID-19 pandemic. J Clin Oncol. 2023;41(27):4352-4359. doi: 10.1200/JCO.22.02170 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Shao Y, Callison K, Anderson A, LaVeist TA, Walker B. Comparison of Screening Mammogram Rates Before vs During the COVID-19 Pandemic Among Medicaid Beneficiaries in Louisiana. JAMA Netw Open. 2023;6(1):e2251687. doi: 10.1001/jamanetworkopen.2022.51687 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33. doi: 10.3322/caac.21708 [DOI] [PubMed] [Google Scholar]
  • 37.Doan C, Li S, Goodwin JS. Breast and lung cancer screening among Medicare enrollees during the COVID-19 pandemic. JAMA Netw Open. 2023;6(2):e2255589-e2255589. doi: 10.1001/jamanetworkopen.2022.55589 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Goy J, Hall SF, Feldman-Stewart D, Groome PA. Diagnostic delay and disease stage in head and neck cancer: a systematic review. Laryngoscope. 2009;119(5):889-898. doi: 10.1002/lary.20185 [DOI] [PubMed] [Google Scholar]
  • 39.Osazuwa-Peters N, Christopher KM, Hussaini AS, Behera A, Walker RJ, Varvares MA. Predictors of stage at presentation and outcomes of head and neck cancers in a university hospital setting. Head Neck. 2016;38(suppl 1):E1826-E1832. doi: 10.1002/hed.24327 [DOI] [PubMed] [Google Scholar]
  • 40.US Department of Health and Human Services . Office of Disease Prevention and Health Promotion. Increase the proportion of oral and pharyngeal cancers detected at the earliest stage—OH-07. Healthy People 2030. 2020. Accessed November 27, 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions/increase-proportion-oral-and-pharyngeal-cancers-detected-earliest-stage-oh-07
  • 41.National Institute of Dental and Craniofacial Research . AHEAD (Advancement of Head and Neck Cancer Early Detection Research). Updated February 2022. Accessed November 27, 2023. https://www.nidcr.nih.gov/grants-funding/funding-priorities/future-research-initiatives/ahead-advancement-head-neck-cancer-early-detection-research
  • 42.Thompson-Harvey A, Yetukuri M, Hansen AR, et al. Rising incidence of late-stage head and neck cancer in the United States. Cancer. 2020;126(5):1090-1101. doi: 10.1002/cncr.32583 [DOI] [PubMed] [Google Scholar]
  • 43.Molina MA, Cheung MC, Perez EA, et al. African American and poor patients have a dramatically worse prognosis for head and neck cancer: an examination of 20,915 patients. Cancer. 2008;113(10):2797-2806. doi: 10.1002/cncr.23889 [DOI] [PubMed] [Google Scholar]
  • 44.Panth N, Simpson MC, Sethi RKV, Varvares MA, Osazuwa-Peters N. Insurance status, stage of presentation, and survival among female patients with head and neck cancer. Laryngoscope. 2020;130(2):385-391. doi: 10.1002/lary.27929 [DOI] [PubMed] [Google Scholar]
  • 45.Moyer VA; U.S. Preventive Services Task Force . Screening for oral cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(1):55-60. doi: 10.7326/M13-2568 [DOI] [PubMed] [Google Scholar]
  • 46.Anderson KE, McGinty EE, Presskreischer R, Barry CL. Reports of forgone medical care among US adults during the initial phase of the COVID-19 pandemic. JAMA Netw Open. 2021;4(1):e2034882. doi: 10.1001/jamanetworkopen.2020.34882 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Park S, Stimpson JP. Trends in self-reported forgone medical care among Medicare beneficiaries during the COVID-19 pandemic. JAMA Health Forum. 2021;2(12):e214299. doi: 10.1001/jamahealthforum.2021.4299 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Whaley CM, Pera MF, Cantor J, et al. Changes in health services use among commercially insured US populations during the COVID-19 pandemic. JAMA Netw Open. 2020;3(11):e2024984. doi: 10.1001/jamanetworkopen.2020.24984 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Kranz AM, Chen A, Gahlon G, Stein BD. 2020 Trends in dental office visits during the COVID-19 pandemic. J Am Dent Assoc. 2021;152(7):535-541.e1. doi: 10.1016/j.adaj.2021.02.016 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Lingen MW, Kalmar JR, Karrison T, Speight PM. Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol. 2008;44(1):10-22. doi: 10.1016/j.oraloncology.2007.06.011 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Roser SM, Nelson SR, Chandra SR, Magliocca KR. Head and neck cancer. In: Patton LL, Glick M, eds. The ADA Practical Guide to Patients with Medical Conditions. 2nd ed. American Dental Association; 2015:273-298. [Google Scholar]
  • 52.Hashim D, Genden E, Posner M, Hashibe M, Boffetta P. Head and neck cancer prevention: from primary prevention to impact of clinicians on reducing burden. Ann Oncol. 2019;30(5):744-756. doi: 10.1093/annonc/mdz084 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Al-Maweri SA, Halboub E, Warnakulasuriya S. Impact of COVID-19 on the early detection of oral cancer: a special emphasis on high risk populations. Oral Oncol. 2020;106:104760. doi: 10.1016/j.oraloncology.2020.104760 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Villa A, Sankar V, Shiboski C.. Tele(oral)medicine: a new approach during the COVID-19 crisis. Oral Dis. 2021;27 Suppl 3(Suppl 3):744-745. doi: 10.1111/odi.13364 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55.Taylor DB, Osazuwa-Peters OL, Okafor SI, et al. Differential outcomes among survivors of head and neck cancer belonging to racial and ethnic minority groups. JAMA Otolaryngol Head Neck Surg. 2022;148(2):119-127. doi: 10.1001/jamaoto.2021.3425 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56.Gaubatz ME, Bukatko AR, Simpson MC, et al. Racial and socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States. Oral Oncol. 2019;89:95-101. doi: 10.1016/j.oraloncology.2018.12.023 [DOI] [PubMed] [Google Scholar]
  • 57.Osazuwa-Peters N, Massa ST, Christopher KM, Walker RJ, Varvares MA. Race and sex disparities in long-term survival of oral and oropharyngeal cancer in the United States. J Cancer Res Clin Oncol. 2016;142(2):521-528. doi: 10.1007/s00432-015-2061-8 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement 1.

eTable 1. Observed Incidence Rate, Annual Percentage Change by Year, and Confidence Intervals

jamaotolaryngolheadnecksurg-e234322-s001.xlsx (27.5KB, xlsx)
Supplement 2.

Data Sharing Statement

jamaotolaryngolheadnecksurg-e234322-s002.pdf (17.2KB, pdf)

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