Incidence of cancers of the oral cavity and pharynx among American Indians and Alaska Natives, 1999-2004

BACKGROUND. Previous studies identified disparities in incidence rates of cancers of the oral cavity and pharynx between American Indians/Alaska Natives (AI/AN) and non-Hispanic whites (NHW) and differences between various AI/AN populations. Reporting among AI/AN has been hampered by: 1) heterogeneity among various anatomic sites of oral cavity mid pharyngeal cancers obscuring unique patterns of individual anatomic sites; 2) race misclassification and underreporting of AI/AN; and 3) sparseness of data needed to identify regional variations. METHODS. To improve race classification of AI/AN, data from US central cancer registries were linked with Indian Health Service (IHS) records. AI/AN incidence data from 1999 to 2004 were stratified by sex, age, stage at diagnosis, and anatomic subsite for 6 IHS geographic regions and compared with NHW populations. RESULTS. For all oral cavity and pharynx cancers combined, among residents of Contract Health Service Delivery Area counties, AI/AN overall had significantly lower incidence rates than NHW (8.5 vs 11.0). However, AI/AN rates were significantly higher in the Northern Plains (13.9 vs 10.5) and Alaska (16,3 vs 10.6), significantly lower in the Pacific Coast (7.7 vs 11.6) and Southwest (3.3 vs 10.4), and similar in the Southern Plains (11.4). Overall AI/AN males had higher incidence rates than AI/AN women. Nasopharyngeal cancer was more frequent (1.1 AI/AN vs 0.4 NHW), and tongue cancer less frequent (1.6 AI/AN vs 2.9 NHW) in AI/AN than NHW populations; however, rates varied by region. Stage distribution was modestly less favorable for AI/AN compared with NHW populations. CONCLUSIONS. Variation by region, anatomic site, and sex indicates a need for research into etiologic factors and attention to regional risk factor profiles when planning cancer control programs.