Rates of occurrence in the United States

Close to 58,500 Americans will be diagnosed with oral or oropharyngeal cancer this year. It will cause over 12,250 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 58,500 newly diagnosed individuals, only slightly more than half will be alive in 5 years. (Approximately 57%) This is a number that has not significantly improved in decades. (The survival number at five years from diagnosis was, for many decades, about 50%, so 57% is an improvement over the last ten years. However, this is due to the increase of HPV16-caused cancers, which are more vulnerable to existing treatment modalities, conferring a significant survival advantage. So a change in the etiology, not improved early discovery or treatments; which are relatively unchanged from a decade ago, are not the primary cause for improvement.) The death rate for oral cancer is higher than that of cancers that we hear about routinely, such as cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, cancer of the testes, and many others. If you expand the definition of oral and oropharyngeal cancers to include cancer of the larynx, the numbers of diagnosed cases grow to approximately 58,500 individuals and 13,500 deaths per year in the U.S. alone. Worldwide, the problem is much greater, with over 450,000 new cases being found each year. Note that the world incidence numbers from the WHO, while the best available, are estimates that users should consider with caveats. Data collection and reporting in some countries is problematic despite the professional efforts of the WHO to be accurate.

Statistics on worldwide occurrence

Oral cancers are part of a group of cancers commonly referred to as head and neck cancers, and of all head and neck cancers, they comprise about 85% of that category. Brain cancer, auditory and ocular cancers, and thyroid cancer (an endocrine system cancer) are cancer categories of their own and are not included in the head and neck cancer group as identified by the National Cancer Institute (NCI).

Historically the death rate associated with this cancer is particularly high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development. Today (2022), that statement is still true, as there is no comprehensive program in the US to screen for the disease opportunistically, and without that, late-stage discovery is more common. Another obstacle to early discovery (and resulting in better outcomes) is the advent of a virus, HPV16, contributing more to the incidence rate of oral cancers, particularly in the posterior part of the mouth (the oropharynx, the tonsils, the base of the tongue areas) which many times does not produce visible lesions or discolorations that have historically been the early warning signs of the disease process in the anterior (front) of the mouth. There are, however, clues to its existence that can be discovered in an oral history verbal question and answer exam.

Often, oral cancer is only discovered when it has metastasized to another location, most likely the lymph nodes of the neck. The prognosis at this stage of discovery is significantly worse than when it is caught in a localized intraoral area. Besides the metastasis, the primary tumor has had time to invade deep into local structures at these later stages.

Oral cancer is hazardous because, in its early stages, it may not be noticed by the patient, as it can frequently prosper without producing pain or symptoms they might readily recognize, and because it has a high risk of producing second primary tumors. This means that patients who survive a first encounter with the disease, have up to 20 times higher risk of developing second cancer. This heightened risk factor can last 5 to 10 years after the first occurrence. There are several types of oral cancers, but around 90% are squamous cell carcinomas. The other far less common oral cancers are ACC and MEC cancers, which by comparison are relatively rare but highly deadly as the depth of knowledge about them is far less than SCC. It is estimated that approximately $4.5 billion is spent in the United States each year on the treatment of head and neck cancers. (2020 numbers)

More information on rare oral cancers.

Age, gender, race, and ethnicity

Elderly coupleThe demographics of those who develop this cancer have been consistent for some time. While historically, most people were over 40 at the time of discovery, it is now occurring more frequently in those under this age. The exact causes of those affected at a younger age are becoming more apparent in peer-reviewed research, revealing a viral etiology (cause), the human papillomavirus version 16. There are also links