Trends in the incidence, mortality, and survival rates of oral and pharyngeal cancer in a high-risk area in Michigan, USA.

OBJECTIVE: The aim of this analysis was to analyze the incidence, mortality and survival rates for the city of Detroit and Wayne County, Michigan. In Detroit, about four out of the five residents are African-Americans.

METHODS: Rates and standard errors on oral cancer incidence, survival, and mortality by county of residence, race, gender, stage of diagnosis were provided by the Michigan Cancer Surveillance Program, which is maintained by the Michigan Department of Community Health. Rates were expressed per 100,000 individuals and age adjusted to reflect the distribution of the USA population in 2000. Analysis for trends was conducted by the authors using the National Cancer Institutes' joinpoint regression program (version 3.0).

RESULTS: In 1993-2002, the incidence rate of oral cancer in Michigan (one of the 50 states in the USA) was 11.3 per 100,000, and in the city of Detroit, it was 16.6. In African-American males in Michigan the incidence rate was 24.3 per 100,000, one of the highest among all American males. The city of Detroit, with 9% of the total state population, had 13.1% of all new cases. Between 1993 and 2002, there was a drop in incidence rates in Michigan and Detroit. However, there was an increase in mortality rates in Michigan and Detroit between 2000 and 2002. In Detroit, the incidence and mortality rates of 'white' and African-American males were not different and the highest incidence rates were found in adults between the ages of 50 and 74 years. In the state, the peak incidence rates were found in adults 75 years or older. In 2000-2002, residents of Detroit had the lowest percentage (28.3%) of cases detected at early cancerous stage (in situ or localized) compared with rates in Michigan. African-Americans in Michigan had a 5-year survival rate of 34.9% compared with the state average of 54.6%.

CONCLUSIONS: African-American males in Detroit accounted for a larger proportion of the oral cancer cases relative to their population size. There was surprising similarity between the incidence and mortality rates of African and 'white' Americans in Detroit. While the incidence rates have declined in Michigan and Detroit, mortality rates have increased between 2000 and 2002. This finding is contrary to national trends. In order to target programs to prevent oral cancer, oral cancer statistics for in small areas or high-risk populations should be evaluated separately.