Abstract
Background/Aims Head and neck cancers account for approximately 3% of all cancers in the United States. The majority of these cancer types are squamous cell carcinoma (SCC), but also include salivary malignancies and others. These cancers are nearly twice as common among men as they are among women. Head and neck cancers are also diagnosed more often among people over age 50 years. Over-all disease specific survival rates are around 50%. There have been previous studies that demonstrate racial and gender disparities in the patterns of treatment and survival, but these studies are performed in academic tertiary centers with populations comprised mainly of referral patients with limited follow up. No studies have been performed within vertically integrated health systems.
Methods The Henry Ford Health System’s Virtual Data Warehouse was queried to obtain data on head and neck cancer patients diagnosed between 1990 and 2013. Search criteria included all tumors of the upper aerodigestive tract including SCC, salivary gland malignancies and also endocrine tumors. Mortality data was obtained from SEER and Michigan State mortality data. Follow up was 20 years. Both HMO and non-HMO patients were included within the study. Statistical analysis was performed using chi-squared test.
Results 1364 thyroid cancers, 225 salivary gland cancers and 1376 aerodigestive SCCs were found. Statistically significant survival differences were found with regard to race and gender in several tumor types. For thyroid malignancies, females and Non-African Americans had a statistically significant improved survival (P = 0.0073 and P <.0001). For salivary gland malignancies, females and African Americans had a statistically significant improved survival (P = 0.0384 and P = 0.0013). For aerodigestive SCCs African Americans had a worse survival but there were no statistical differences by gender (P <.0001 and P = 0.6984).
Conclusions Disparities in head and neck cancer outcomes exist relative to race and gender within an integrated health system. It is unclear why African Americans with salivary malignancies have a survival advantage but worse survival in other tumor types. Further study and analysis is required to control for other factors such as socioeconomic status, education, smoking/alcohol use, comorbidities and treatment modality to answer these questions.
