CU Medicine’s joint global research reveals regional disparities in head and neck cancer risk with Hong Kong’s overall incidence above global average and growing incidence risks among women worldwide
A global epidemiological study co-led by The Faculty of Medicine of The Chinese University of Hong Kong (CU Medicine), in collaboration with universities in the Chinese Mainland and overseas, has revealed significant regional, age, and gender disparities in head and neck cancer (HNC) incidence. Global incidence in men remained generally higher than in women, despite an increase in incidence in the female population. Public policy interventions such as tobacco control policies, strengthening of human papillomavirus (HPV) prevention and population health habits may contribute to a decline in HNC incidence. With the support of the findings in fostering HNC prevention and treatment worldwide, researchers call for more localised and multi-disciplinary approaches to HNC prevention, treatment and early intervention, with more targeted measures to tackle the surging incidence risks in women, so as to alleviate this global disease burden.
CU Medicine conducted the study collaboratively with the Department of Global Health, School of Public Health at Peking University, the School of Public Health of Fudan University, The Seventh Affiliated Hospital of Sun Yat-sen University, and the School of Public Health and Preventive Medicine at Monash University. The study results have been published in the renowned international medical journal MedComm.
Featured are CU Medicine research team members including (from left) Dr Jason Huang Junjie, the first author and Assistant Professor; Dr Claire Zhong Chenwen, the co-corresponding author and Research Assistant Professor; and Professor Martin Wong Chi-sang, the senior corresponding author and Professor, all from The Jockey Club School of Public Health and Primary Care; as well as Professor Jason Chan Ying-kuen, the co-corresponding author, and Chairman and Clinical Professor of the Department of Otorhinolaryngology, Head and Neck Surgery; as well as Dr Chen Zigui, the co-author of the study and Associate Professor of the Department of Microbiology.
Study fills gap in global epidemiological research of world’s sixth most common cancer
HNC primarily encompasses malignant tumours of the oral cavity, pharynx, nasopharynx, oropharynx, hypopharynx and salivary glands. Key risk factors include smoking, alcohol consumption, betel-nut chewing, occupational exposure, Epstein-Barr virus (EBV), poor oral hygiene and the increasing prevalence of HPV. In 2022, HNC accounted for approximately 5% of new cancer cases worldwide, making it the sixth most common cancer globally that year. Hong Kong’s incidence rate was above the global average, with about 11 new cases per 100,000 population[1], and particularly significant among men.
There has been a lack of comprehensive, up-to-date, global analysis regarding the epidemiological landscape of HNC, as previous research was solely national or regional in scope. The study integrates data from GLOBOCAN under the Global Cancer Observatory (GCO), the Cancer Incidence in Five Continents Plus (CI5 Plus) database, and the Global Burden of Disease (GBD) data. It investigates the incidence, risk factors and epidemiological trends of HNC across different ages, genders and countries, thereby filling the vacuum in the global epidemiological research of HNC.
Huge disparities in disease incidence are related to various risk factors
Research data indicate that in 2022, the estimated age-standardised incidence rate (ASR) of HNC globally was 9.8 cases per 100,000 population, with approximately 947,211 new cases reported worldwide. The incidence rate in men (ASR: 15.3) consistently remained about three times that in women (ASR: 4.6). The 50-74 age group was the high-incidence population for HNC (ASR: 36.1), with incidence about eight times that of the 15-49 age group (ASR: 4.6).
By region and nation, Melanesia and Bangladesh had the highest incidence (please refer to Tables 1 and 2). At the country level, the incidence of HNC is closely associated with various lifestyle and metabolic risks[2], given the positive correlation between HNC incidence and prevalence of multiple lifestyle and health factors, including smoking, alcohol consumption, unhealthy diet, diabetes and dyslipidemia. Regardless of gender or age group, smoking is a risk factor that is highly correlated with HNC incidence.
Table 1: Top three regions with the highest ASR of HNC incidence
Top three regions with the highest incidence | ASR of incidence (per 100,000) |
Melanesia | 19 |
South-Central Asia | 16 |
Eastern Europe | 13 |
Table 2: Top three countries with the highest ASR of HNC incidence
Top three countries with the highest incidence | ASR of incidence (per 100,000) |
Bangladesh | 24 |
Papua New Guinea | 22 |
Romania | 20 |
Global incidence trends vary and women face higher risks
The global incidence trend of HNC was mixed, with 14 countries showing a significant upward trend and 13 indicating a significant downward trend among the 45 countries covered by the research. Spain, Italy, India, the United Kingdom and China exhibited the most pronounced upward trends, while Turkey, Israel, Malta, Switzerland and Denmark showed the most significant declines. Countries with a higher Human Development Index (HDI) demonstrated a relatively clear downward trend, possibly due to greater public awareness of quality of life and health education, as well as stricter tobacco control policies. Regions with the highest smoking rates, such as Oceania and Europe, showed a significant increase in incidence trends.
Gender analysis reveals that the upward trend in incidence was more prevalent among women than men. 14 countries recorded increasing incidence among women and only 5 saw a decrease; meanwhile, there are 12 countries each reporting an increase and a decrease in incidence among men. The regions with the highest increase among women were Spain, the United Kingdom and India, while Kuwait, Israel and Argentina showed the most significant declines in women. European studies suggest that this trend could be related to increased HPV infection among women and a rise in female smokers. Age-stratified trends also vary, with a significant increase in incidence among younger populations in India, Colombia and the United Kingdom, while Qatar and Denmark showed the most significant declines in younger age groups.
Dr Jason Huang Junjie, the first author of the study and Assistant Professor from The Jockey Club School of Public Health and Primary Care at CU Medicine, stated: “Our results reveal substantial geographical differences in the incidence of head and neck cancer, reflecting country-level variation in risk-factor prevalence. In Melanesia, the high health burden could persist unless there are changes in betel-nut consumption, while in South-Central Asia and Eastern Europe, strengthening HPV control is essential. These findings highlight the importance of region-specific prevention strategies.”
Dr Claire Zhong Chenwen, the co-corresponding author of the study and Research Assistant Professorfrom The Jockey Club School of Public Health and Primary Care at CU Medicine, stated: “The study shows that head and neck cancer is linked to lifestyle factors and unhealthy conditions, including smoking, alcohol use, unhealthy diet, diabetes, and lipid disorders. These insights underscore the need for early intervention and stronger health education to reduce modifiable risks and support high-risk populations across different settings.”
Dr Chen Zigui, the co-author of the study and Associate Professor from the Department of Microbiology at CU Medicine, stated: “The viral aetiology of certain head and neck cancers – particularly Epstein-Barr virus for nasopharyngeal carcinoma and HPV for oropharyngeal cancers – demands greater attention to infection prevention and surveillance. Understanding the molecular epidemiology of these viruses across different populations is essential for the development of targeted interventions.”
Professor Jason Chan Ying-kuen, the co-corresponding author of the study and Chairman and Clinical Professor of the Department of Otorhinolaryngology, Head and Neck Surgery at CU Medicine, commented: “The anatomical complexity of head and neck cancers demands a multidisciplinary approach to treatment and prevention. Our data showing elevated incidence in specific regions call for enhanced early detection programmes and clinical awareness, particularly for HPV-associated oropharyngeal cancers, which present distinct diagnostic and therapeutic challenges.”
Professor Martin Wong Chi-sang, the senior corresponding author of the study and Professor in The Jockey Club School of Public Health and Primary Care at CU Medicine, added: “The incidence trends of HNC were less favourable in some countries, particularly among female populations, possibly due to rising smoking rates and HPV exposure. These patterns necessitate targeted interventions for women, as well as further research into the drivers of these rising trends.”
[1] An age-standardised incidence rate of 11.5, according to The Hong Kong Cancer Registry in 2022.
[2] Metabolic risks refer to a clustering of cardiovascular risk factors at the physiological metabolic level, including hypertension, dyslipidemia, diabetes, and obesity in the current study.
