Head and Neck Cancer Incidence in the United States Following the Onset of COVID-19 Pandemic

Head and neck cancer (HNC) remains a significant health concern, with an estimated 71,000 new cases expected in the United States (US) in 2024 [1]. The COVID-19 pandemic altered healthcare delivery, causing a 10% drop in overall cancer incidence in the US in 2020 compared to 2019 [2]. While prior studies have examined pandemic-related incidence disruptions during the pandemic [3], the specific trajectory of HNC incidence following the pandemic warrants further investigation. Understanding these trends is essential for optimizing cancer screening and delivery in future public health crises. This study aims to provide insights into HNC incidence trends during and after the COVID-19 pandemic.

This National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registry, updated on April 17, 2024, was used [4]. Age-adjusted incidence data (per 100,000 people) were extracted based on ICD-O-3 codes for lip, tongue anterior, gum, floor of mouth, palate excluding soft and uvula, buccal mucosa, mouth other, major salivary glands, nasopharynx, oropharynx, hypopharynx, pharynx and oral cavity other, nasal cavity and paranasal sinuses, sinus other, and larynx cancers. No institutional review board approval or informed consent was required as the data is publicly available and de-identified. Data on “localized,” “regional,” and “distant” disease was obtained using the SEER Combined Summary Stage (2004+) variable, with staging based on organ site.

Age-adjusted incidence rates were obtained, and data were selected by sex, race, and origin, and combined summary stage. Annual percent change (APC) was calculated using the average change in lower and upper confidence intervals of incidence rates. Data analysis was conducted using R 4.4.0 with data.table, ggplot2, ggrepel packages. Plots were visualized using ggplot2.

In 2021, there were 28,154 new HNC cases, resulting in an incidence rate of 14.6 new cases per 100,000 individuals. From 2020 to 2021, incidence increased by 14.0%, corresponding to an APC of +4.5%. This follows a decline from 2019 to 2020, with an APC of −6.9% (Figure 1A). The largest increases by anatomical site from 2020 to 2021 were observed in “sinus other” (+30.7%), “floor of mouth” (+21.2%), “gum” (+20.6%), and “buccal mucosa” (+17.9%) (Figure 1B).

The APC trends were consistent across racial groups, showing a decline in 2020 followed by an increase in 2021. The largest increase occurred in Asian American and Pacific Islander (AAPI) (+16.0%), followed by Hispanics (+14.1%), non-Hispanic Whites (+11.4%), and non-Hispanic Blacks (NHB) (+10.4%). Examining the data by sex, increases were + 10.3% in females and +11.8% in males.

Of the 28,154 new cases, 9202 (32.7%) were local, 13,832 (49.1%) were regional, and 3458 (12.3%) were distant. The incidence of all three stages increased from 2020 to 2021. The largest APC rise was in localized cases (+23.0%), followed by regional (+6.9%) and distant (+4.8%).

Our analysis indicates that HNC incidence in the US increased from 2020 to 2021, reflecting a recovery from the decline observed in 2020. However, the overall incidence remains lower than pre-pandemic levels. This may reflect a combination of a downward trend of HNC incidence over the years and the persistent and lingering effects of disrupted healthcare access. These findings align with previous studies documenting a reduction in cancer diagnoses during the early pandemic due to healthcare disruptions, followed by a gradual recovery [5, 6].

Despite the increase in HNC incidence and APC among various racial groups, disparities persisted, with NHB patients having the most modest increase in HNC incidence. A systematic review highlighted significant disparities in access to care and socioeconomic status affecting NHB patients with HNC [7], which may explain the smaller change in incidence observed in our analysis. Conversely, the AAPI demographic has been associated with improved overall survival in HNC [7]. While this finding may reflect underlying biological differences, it could be influenced by increased access to care. Further research is needed to investigate these disparities.

The pandemic's impact on cancer screening raises concerns about delayed diagnoses. Our study found a significant increase in localized HNC cases from 2020 to 2021, while the increases in distant and regional cases were less pronounced. This suggests that the decline in diagnoses during the pandemic primarily affected early-stage disease, rather than leading to an increase in late-stage presentations. However, our analysis did not include tumor staging beyond SEER summary stage, preventing an evaluation of whether localized tumors were more advanced. The implications of these trends for long-term outcomes require further investigation.

This study highlights shifts in HNC incidence trends from 2020 to 2021, emphasizing the rebound in early-stage diagnoses following pandemic-related declines. Future research should focus on the long-term consequences of delayed diagnoses and the need for healthcare systems that maintain screening and diagnostic services during public health emergencies. Strategies are needed to reduce disparities in HNC and prevent delays in cancer care during future public health crises.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.