Burden of Lip, Oral Cavity, and Pharyngeal Cancers in China: Estimated in 2022 and Projections to 2050

Abstract

Introduction and Aims

Lip, oral cavity, and pharyngeal (LOCP) cancers comprise a heterogeneous group of malignancies with a substantial and evolving disease burden in China. This study aimed to systematically evaluate the burden of LOCP cancers in China and to project future trends.

Methods

Estimates from the GLOBOCAN database were used to quantify the incidence, mortality, and prevalence of LOCP cancers in China in 2022. Future trends were projected through 2050. Subsite-specific analyses were conducted to assess epidemiologic variations and temporal dynamics across different anatomic locations.

Results

In 2022, an estimated 116,142 new LOCP cancer cases occurred in China, with a pronounced male predominance. Nasopharyngeal cancer and lip and oral cavity cancer were the major contributors, accounting for 43.9% and 32.0% of cases, respectively, whereas oropharyngeal cancer remained relatively uncommon. Projections indicate a sustained increase in both incidence and mortality across all LOCP cancers through 2050. Notably, lip and oral cavity cancer is expected to show the most pronounced growth, with a potential shift towards becoming a leading contributor, particularly among females.

Conclusions

LOCP cancers impose a substantial and growing burden in China, characterised by marked subsite heterogeneity and evolving epidemiologic trends. These findings highlight the necessity for subsite-specific prevention, early detection, and targeted intervention strategies, as well as the importance of strengthening precision-oriented cancer control frameworks to mitigate future disease burden.

Clinical Relevance

These findings provide critical evidence to inform national cancer control strategies and advance the paradigm shift towards precision public health and proactive, anticipatory cancer prevention strategies. The observed subsite heterogeneity, coupled with projected increases in lip and oral cavity cancer incidence, underscores the urgent need for more precise, anatomically targeted prevention and early detection frameworks.

Introduction

Lip, oral cavity, and pharyngeal (LOCP) cancers constitute a major subset of malignancies and represent a significant and growing global health burden.¹ According to the GLOBOCAN database developed by the International Agency for Research on Cancer (IARC), these cancers account for a substantial proportion of cancer incidence and mortality worldwide, with pronounced geographic, etiological, and demographic heterogeneity.² Their pathogenesis is closely linked to established risk factors such as tobacco use,³ alcohol consumption,⁴ and region-specific exposures (eg, betel nut)⁵ and is further shaped by complex interactions within the local immune microenvironment. Despite advances in early detection and therapeutic strategies, survival outcomes for many subtypes remain suboptimal, particularly in low- and middle-resource settings, underscoring the urgent need for refined epidemiologic assessment and targeted prevention strategies.⁶

China bears a considerable share of the global burden of LOCP cancers, driven by its large population size, rapid demographic aging, and sustained exposure to major behavioural and environmental risk factors.⁷ The epidemiologic landscape in China is characterised by marked heterogeneity across anatomic subsites, including the persistently high incidence of nasopharyngeal carcinoma in certain regions.⁸ These patterns reflect complex interactions between environmental exposures, lifestyle factors, and biological susceptibility.^9,10 However, comprehensive, nationally representative, subsite-specific analyses remain scarce. This lack of integrated evidence hampers precise risk stratification and limits the development of targeted intervention strategies.

The burden of these cancers is expected to increase substantially in the coming decades,¹¹ primarily due to population growth and accelerated aging. Accurate projections of future incidence and mortality are therefore essential for anticipating health care demands and optimising resource allocation. In China, this need is particularly critical in the context of national health strategies, such as the Healthy China 2030 initiative, which emphasises cancer prevention, early diagnosis, and precision management. A robust understanding of current and future disease burden at the subsite level is indispensable for informing policy decisions, guiding screening and prevention programs, and supporting the implementation of precision medicine approaches in oncology.

In this study, we provide a comprehensive assessment of the burden of LOCP cancers in China using the most recent national estimates for 2022, and we project incidence and mortality trends through 2050. By integrating subsite-specific epidemiologic data with demographic projections, this work aims to delineate the evolving landscape of these cancers and to identify key drivers of future burden. The findings are expected to offer critical evidence for optimising cancer control strategies, advancing precision prevention and intervention, and supporting national health care planning in the context of an aging population and ongoing epidemiologic transition.

Methods

Data on cancer incidence, mortality, and prevalence were obtained from the GLOBOCAN 2022 database, developed by the IARC and accessible through the Global Cancer Observatory (Cancer Today) platform (https://gco.iarc.who.int/today/en). This database provides contemporary estimates for 185 countries and territories, covering approximately 98% of the global population.¹² National-level estimates are derived from the best available population-based cancer registry data and modelled using standardised methods that account for variations in data quality, coverage, and completeness.

Incidence estimates for China were calculated as weighted averages from 919 subnational registries (spanning 2015-2017) and applied to the 2022 population. Mortality was estimated from incidence using mortality-to-incidence ratios derived from survival estimates. Prevalence estimates for 2022 were computed using sex-, site-, and age-specific incidence-to-prevalence ratios, based on data from Nordic countries for 2006-2015 for a 1-, 3-, and 5-year prevalence. Prevalence is presented both as absolute numbers and as proportions per 100,000 persons.

$$Prevalenc{e}_{country}=Incidenc{e}_{Country}·\left(\frac{Prevalenc{e}_{Nordic}}{Incidenc{e}_{Nordic}}\right)·\left(\frac{HD{I}_{Country}}{HD{I}_{Nordic}}\right)$$

Age-standardised incidence and mortality rates (ASRs) per 100,000 person-years for each cancer site were calculated using the 1966 Segi-Doll World Standard Population.

The Cancer Tomorrow platform (https://gco.iarc.who.int/tomorrow/en) offers a suite of data visualisation tools for predicting future cancer incidence and mortality. For a given country or region, projections from 2022 to 2050 are based on current GLOBOCAN 2022 estimates for 36 specific cancer types and all cancers combined, across 185 countries and territories, stratified by sex and age group. The key assumptions underlying these projections are that national rates (as estimated in 2022) remain unchanged during the 2022-2050 prediction period and that national population projections for these years are accurate. The expected number of new cancer cases or deaths for a country or region in a given future year (eg, 2025, …, 2050) is computed by multiplying the age-specific incidence or mortality rates estimated for 2022 by the corresponding expected population for that year. For the present study, data for LOCP cancers were obtained directly from the IARC Cancer Today and Cancer Tomorrow databases. All anatomic site classifications are predefined by the database interface.^13,14

Results

In 2022, an estimated 116,142 new cases of LOCP cancers were diagnosed in China, with 82,289 (70.9%) occurring in males and 33,853 (29.1%) in females. The nasopharynx (51,010 cases) and the lip and oral cavity (37,208 cases) were the most common subsites, accounting for 43.9% and 32.0% of all LOCP cancers in China, respectively (Figure 1A). Other subsites included the salivary glands (10,434 cases; 9.0%), hypopharynx (9549 cases; 8.2%), and oropharynx (7941 cases; 6.8%). Unlike the global LOCP burden,² nasopharyngeal and lip and oral cavity cancers are the predominant LOCP cancer types in China, with a notably lower incidence of oropharynx cancer.

Fig. 1.

Number of new lip, oral cavity, and pharyngeal cancers and deaths in China in 2022. A, Both males and females. B, Males. C, Females.

In the same year, China recorded approximately 63,585 deaths from LOCP cancers, of which 47,105 (74.1%) were male and 16,480 (25.9%) were female. The leading causes of death were again cancers of the nasopharynx (28,408 deaths) and the lip and oral cavity (20,831 deaths), representing 44.7% and 32.8% of all LOCP cancer deaths, respectively (Figure 1A). The remaining deaths were attributed to cancers of the hypopharynx (5775; 9.1%), oropharynx (4924; 7.7%), and salivary glands (3647; 5.7%). Consistent with incidence, mortality for nasopharyngeal and lip and oral cavity cancers was highest. However, unlike the incidence pattern, mortality from hypopharyngeal and oropharyngeal cancers exceeded that of salivary gland cancer. The incidence and mortality for LOCP cancer subtypes, stratified by sex, are presented in Figures 1B and 1C, respectively.

In China (2022), nasopharyngeal cancer had the highest ASR at 2.4 per 100,000, followed by lip and oral cavity cancer at 1.5, while oropharyngeal cancer had the lowest ASR at 0.33. The ASRs for salivary gland and hypopharyngeal cancers were 0.48 and 0.39, respectively (Supplementary Table S1). In males, the highest ASRs were observed for nasopharyngeal (3.4) and lip and oral cavity (2.0) cancers, with the lowest ASR for salivary gland cancer (0.54). In females, nasopharyngeal (1.3) and lip and oral cavity (1.0) cancers also showed the highest ASRs, whereas hypopharyngeal cancer had the lowest ASR (0.04). Compared with global statistics for LOCP cancers, ASRs in China were lower for cancers of the lip and oral cavity, salivary glands, oropharynx, and hypopharynx but higher for nasopharyngeal cancer. This trend was consistent for both males and females when compared separately (Supplementary Table S1).

Regarding the mortality ASR for LOCP cancers in China (2022), nasopharyngeal cancer also ranked highest (1.2), followed by lip and oral cavity cancer (0.78). Salivary gland cancer had the lowest ASR (0.14), while hypopharyngeal and oropharyngeal cancers had ASRs of 0.23 and 0.19, respectively (Supplementary Table S2). In males, nasopharyngeal (1.8) and lip and oral cavity (1.1) cancers exhibited the highest mortality ASRs, and salivary gland cancer had the lowest mortality ASR (0.18). In females, nasopharyngeal (0.56) and lip and oral cavity (0.45) cancers again showed the highest mortality ASRs, whereas hypopharyngeal cancer had the lowest mortality ASR (0.02). Relative to global LOCP cancer statistics, China’s mortality ASR for nasopharyngeal cancer was higher, while mortality ASRs for all other LOCP subsites were lower, a pattern observed in both sexes (Supplementary Table S2).

To better illustrate the burden of LOCP cancers in China, Figure 2 presents the proportion of global new cases occurring in China in 2022. China accounted for the highest proportion of global new cases for nasopharyngeal cancer (42.4%) and salivary gland cancer (18.9%) overall, as well as for both sexes individually. For lip and oral cavity cancer and hypopharyngeal cancer, China ranked second globally, accounting for 9.5% and 11.1% of new cases, respectively. Notably, among females, China ranked third for new hypopharyngeal cancer cases. China ranked third for new oropharyngeal cancer cases, representing 7.5% of the global total.

Fig. 2.

Proportion of new lip, oral cavity, and pharyngeal cancer cases in China relative to the global total in 2022.

Figure 3 shows the proportion of global LOCP cancer deaths occurring in China in 2022. China had the highest share of global deaths from nasopharyngeal cancer (38.7%) for both sexes combined and separately. For all other LOCP subsites, China ranked second in global deaths: lip and oral cavity (11.1%), salivary glands (15.2%), oropharynx (9.4%), and hypopharynx (14.1%). Female hypopharyngeal cancer deaths in China ranked third globally.

Fig. 3.

Proportion of lip, oral cavity, and pharyngeal cancer deaths in China relative to the global total in 2022.

We further compiled 1-, 3-, and 5-year prevalence estimates for LOCP cancers (Figure 4). Nasopharyngeal cancer exhibited the highest prevalence, with rates of 2.7, 7.4, and 11.2 per 100,000 persons at 1, 3, and 5 years, respectively. These were followed by lip and oral cavity cancer, with corresponding prevalence rates of 1.9, 5.0, and 7.6 per 100,000. Oropharyngeal cancer had the lowest 1-year prevalence (0.41 per 100,000), whereas hypopharyngeal cancer showed the lowest 3- and 5-year prevalence rates (0.95 and 1.3 per 100,000, respectively; Supplementary Table S3).

Fig. 4.

The 1-, 3-, and 5-year prevalence of lip, oral cavity, and pharyngeal cancers in China.

Projections from 2022 to 2050 indicate an increasing trend in both new cases (Figure 5A) and deaths (Figure 5B) for all LOCP cancers (see Supplementary Tables S4 and S7 for data from 2025 to 2045). Lip and oral cavity cancer is projected to experience the greatest increase in both new cases (55.8%) and deaths (89.0%), with its incidence potentially approaching that of nasopharyngeal cancer by 2050. In contrast, nasopharyngeal cancer is expected to see the smallest increase in new cases (14.9%) and deaths (42.8%), yet it will likely remain the leading contributor to the LOCP cancer burden in China. Salivary gland cancer is projected to see increases of 32.0% in new cases and 77.7% in deaths; oropharyngeal cancer, 42.9% and 66.8%; and hypopharyngeal cancer, 38.7% and 48.3%, respectively.

Fig. 5.

Estimated number of new cases and deaths of lip, oral cavity, and pharyngeal cancers in China from 2022 to 2050, with projected percentage increase. A, Estimated new cases. B, Estimated deaths.

Projected increases in new cases and deaths are also observed for both males (Figure 6A, C) and females (Figure 6B, D) with LOCP cancers (see Supplementary Tables S5, S6 and S8, S9 for 2025-2045 data). For nasopharyngeal cancer, new cases in both sexes are projected to peak around 2040, followed by a slight decline. Notably, among females, new cases of lip and oral cavity cancer are projected to surpass those of nasopharyngeal cancer by 2030, becoming the most common LOCP cancer in this subgroup. A similar trend is projected for female lip and oral cavity cancer deaths, which are also expected to exceed those from nasopharyngeal cancer by 2030.

Fig. 6.

Estimated number of new cases and deaths from lip, oral cavity, and pharyngeal cancers in China from 2022 to 2050, stratified by sex. A, New cases in males. B, New cases in females. C, Deaths in males. D, Deaths in females.

Discussion

The present study provides a comprehensive evaluation of the burden and future trends of LOCP cancers in China, highlighting substantial heterogeneity across anatomic subsites in terms of epidemiologic patterns, mortality profiles, and projected trajectories. Rather than representing a uniform disease entity, these cancers exhibit distinct biological behaviours and risk factor associations, which translate into divergent patterns of incidence, survival, and temporal evolution. Importantly, our findings reveal a shift from a traditionally nasopharynx-dominated disease spectrum towards a more complex and dynamic landscape, in which different subsites contribute unequally to current burden and future growth. This heterogeneity underscores the necessity of moving beyond aggregated analyses towards subsite-specific interpretations, which are critical for understanding disease mechanisms, refining risk stratification, and guiding targeted prevention and control strategies.

Nasopharyngeal cancer represents the predominant contributor to the burden of LOCP cancers in China, accounting for the highest incidence, mortality, and prevalence across all subsites. Both incidence and mortality rates in China exceed global averages, and China contributes the largest proportion of global cases and deaths, underscoring its central role in the global disease burden. This pattern is consistent with the well-recognised endemic distribution of nasopharyngeal carcinoma in southern China (eg, Guangdong, Guangxi, and Hainan) and reflects its unique etiological profile, including Epstein-Barr virus (EBV) infection, genetic susceptibility, and environmental exposures.^15,16 At the genetic level, host human leukocyte antigen (HLA) polymorphisms have been consistently associated with nasopharyngeal cancer risk. Recent studies have identified significant interactions between high‑risk EBV subtypes and 2 HLA single-nucleotide polymorphisms (SNPs) (rs2860580 and rs2894207), with relative excess risks due to interaction of 4.08 and 3.37, respectively.¹⁷ Moreover, large‑scale genomic sequencing of EBV isolates has identified 2 nonsynonymous EBV variants within the BALF2 gene (SNP 162476_C and SNP 163364_T) that are strongly associated with nasopharyngeal cancer risk. These variants exhibit a cumulative effect, accounting for up to 83% of the overall nasopharyngeal carcinoma risk in southern China, with phylogenetic evidence suggesting an Asian origin followed by clonal expansion in endemic regions.¹⁸ Familial aggregation further supports the role of genetic susceptibility. A large family‑based study in Guangdong province reported that first‑degree relatives of nasopharyngeal cancer probands had an elevated risk of nasopharyngeal cancer, with the overall standardised incidence ratios for first‑degree relatives being 2.09.¹⁹ In addition, occupational exposure to dust, chemical vapours, exhaust/fumes, and acids or alkalis has also been associated with an increased risk of nasopharyngeal cancer, suggesting that environmental factors may act in concert with genetic and viral determinants.²⁰ Despite relatively slower projected growth compared with other subsites, nasopharyngeal cancer is expected to remain the leading contributor to overall burden through 2050. The decreasing trends in incidence and mortality observed in the future may be attributable to improvements in treatment modalities and reductions in exposure to relevant risk factors.²¹ Furthermore, EBV biomarkers have been employed in population screening, prognostic evaluation, and prediction of treatment response to guide disease management.²² These findings highlight the importance of sustained investment in biomarker-based screening strategies, early detection programs, and risk stratification approaches,²³ particularly in high-incidence regions, to further reduce disease burden and improve survival outcomes.

Lip and oral cavity cancer constitutes the second largest contributor to LOCP cancer burden in China but demonstrates the most rapid increase in both incidence and mortality projections. The substantial projected growth, particularly the marked increase in mortality, suggests a growing public health challenge that may be driven by persistent exposure to modifiable risk factors such as tobacco use and alcohol consumption. Furthermore, betel nut chewing remains a significant risk factor for oral cancer in China, particularly in the southern provinces.^5,24 Although current age-standardised rates remain lower than global averages, the rapid upward trajectory indicates a potential epidemiologic shift. The rising trend in the burden of oral cancer in China, as reported in multiple studies,25, 26, 27 warrants close attention. Importantly, projections indicate that lip and oral cavity cancer may surpass nasopharyngeal cancer as the leading subsite in certain populations, particularly among females. Lip and oral cavity cancer is often preceded by a spectrum of oral potentially malignant disorders (OPMDs),²⁸ such as oral leucoplakia and oral submucous fibrosis, which represent critical stages in disease progression. The dynamic evolution from OPMDs to invasive carcinoma is characterised by progressive genomic alteration,^29,30 epithelial dysplasia,^31,32 and remodelling of the local immune microenvironment.^33,34 This multistep progression offers a unique window for early detection and intervention, a point that warrants emphasis in current clinical practice. The increasing burden of lip and oral cavity cancer observed in this study underscores the urgent need to strengthen integrated prevention strategies, including the surveillance and management of OPMDs, particularly through early recognition and risk stratification. The implementation of risk-based screening, standardised pathologic assessment, and therapeutic strategies aimed at modulating the immune and inflammatory microenvironment holds significant promise for interrupting malignant transformation and reducing future disease burden.

Salivary gland cancer accounts for a relatively smaller proportion of the overall burden but exhibits notable epidemiologic characteristics, including moderate incidence and comparatively lower mortality rates. This pattern likely reflects the biological heterogeneity of salivary gland cancers, many of which have more favourable prognoses compared with other malignancies.³⁵ However, China contributes a disproportionately high share of global salivary gland cancer cases and deaths, indicating its nonnegligible contribution to the global burden. The projected increases in both incidence and mortality further emphasise the need for improved diagnostic accuracy and subtype-specific management strategies. Given the diversity of histopathologic subtypes and variable clinical behaviour, future research should focus on refining molecular classification and optimising personalised therapeutic approaches.^35,36

Hypopharyngeal cancer, although less common in terms of incidence, demonstrates a disproportionately high mortality burden, with death rates exceeding those of salivary gland cancer. This discrepancy reflects the aggressive nature of hypopharyngeal cancers, which are often diagnosed at advanced stages due to nonspecific early symptoms and anatomic complexity.³⁷ The relatively low prevalence further supports the poor survival associated with this subsite. Although age-standardised rates in China are lower than global averages, the substantial projected increases in both incidence and mortality indicate that hypopharyngeal cancer will remain a clinically significant challenge. However, emerging evidence suggests that immunotherapy may represent a breakthrough therapeutic approach in the future.^38,39

Oropharyngeal cancer remains the least common subsite of LOCP cancers in China in terms of both incidence and mortality. This pattern contrasts with trends observed in many Western populations, where the burden of human papillomavirus–associated oropharyngeal cancer has been rising.^2,40,41 The relatively low burden in China may be attributed to differences in risk factor profiles. Nevertheless, the projected increases in both incidence and mortality suggest an emerging trend that warrants close attention.⁴² These anticipated increases may be associated with evolving lifestyle patterns and shifting epidemiologic factors. The promotion and support of HPV vaccination in China not only have contributed to cervical cancer control^43,44 but also may aid, to some extent, in the management of oropharyngeal cancer.

Several limitations should be considered when interpreting these findings. First, the estimates were derived from modelled data in the GLOBOCAN database, which relies on the availability and quality of population-based cancer registry data and may be subject to uncertainty, particularly in regions with limited data coverage. Second, the projection analysis assumes that age-specific incidence and mortality rates remain constant over time and therefore does not account for potential changes in risk factor prevalence, screening practices, or treatment advances. Third, due to the unavailability of detailed data for each individual International Classification of Diseases, 10th Revision code, individual analyses or the combination of specific codes were not feasible. Finally, this study did not incorporate individual-level risk factors or biological heterogeneity, limiting the ability to explore mechanistic drivers of disease burden.

Conclusions

In summary, LOCP cancers impose a substantial and increasing burden in China, with pronounced heterogeneity across subsites. Nasopharyngeal cancer remains the dominant contributor, while lip and oral cavity cancer is expected to drive the most rapid future growth. These findings provide important evidence to inform national cancer control policies and support the transition towards more precise and effective management of head and neck cancers in China.

Author contributions

C.D. contributed to data curation, formal analysis, investigation, writing – original draft. L.G. contributed to data curation, formal analysis, investigation, writing – original draft. Y.C. contributed to data curation, formal analysis, investigation. G.L. contributed to formal analysis, investigation. C.P. contributed to data curation, investigation. J.Z. contributed to formal analysis, investigation. T.L. contributed to conceptualisation, formal analysis, investigation, writing – review and editing. X.C. contributed to conceptualisation, funding acquisition, investigation, writing – review and editing. All authors read and approved the final manuscript.

Funding

This work was supported by Beijing Science & Technology Development of Traditional Chinese Medicine (BJZYQN-2025-11), China Postdoctoral Science Foundation (2025M781685 and GZB20240038), China Oral Health Foundation (COHF-KQZS2026023), Talent Development Plan for the Future in Medical-Engineering Integration BRA-CDCHE and ZTA (MBRC0012025013), and National Natural Science Foundation of China (81000440).

Conflict of interest

None disclosed.