Epidemiology and Trend of Head and Neck Cancers in Iran

Photodynamic Therapy: A Novel Approach for Head and Neck Cancer Treatment with Focusing on Oral Cavity

Oral cancers, specifically oral squamous cell carcinoma (OSCC), pose a significant global health challenge, with high incidence and mortality rates. Conventional treatments such as surgery, radiotherapy, and chemotherapy have limited effectiveness and can result in adverse reactions. However, as an alternative, photodynamic therapy (PDT) has emerged as a promising option for treating oral cancers. PDT involves using photosensitizing agents in conjunction with specific light to target and destroy cancer cells selectively. The photosensitizers accumulate in the cancer cells and generate reactive oxygen species (ROS) upon exposure to the activating light, leading to cellular damage and ultimately cell death. PDT offers several advantages, including its non-invasive nature, absence of known long-term side effects when administered correctly, and cost-effectiveness. It can be employed as a primary treatment for early-stage oral cancers or in combination with other therapies for more advanced cases. Nonetheless, it is important to note that PDT is most effective for superficial or localized cancers and may not be suitable for larger or deeply infiltrating tumors. Light sensitivity and temporary side effects may occur but can be managed with appropriate care. Ongoing research endeavors aim to expand the applications of PDT and develop novel photosensitizers to further enhance its efficacy in oral cancer treatment. This review aims to evaluate the effectiveness of PDT in treating oral cancers by analyzing a combination of preclinical and clinical studies.

Correction: The Role of Social Support in Preventing Suicidal Ideations and Behaviors: A Systematic Review and Meta-Analysis

In the article titled "The Role of Social Support in Preventing Suicidal Ideations and Behaviors: A Systematic Review and Meta-Analysis,"1 published as e00609 on June 1, 2024, in the Journal of Research in Health Sciences, corrections have been made to the author list and affiliations. The second affiliation of the first author, Nahid Darvishi, was omitted. The order of the corresponding author, Mehran Farhadi, has been changed from fourth to second. Additionally, the third author has withdrawn from the article due to personal reasons, prompting adjustments in the order of co-authors and their affiliations. These corrections have been applied to both the PDF and HTML versions of the article.

Dietary Inflammatory Index and Head and Neck Cancer: A Multicenter Case-Control Study in Iran

BACKGROUND

The inflammatory potential of diet may affect carcinogenesis. This study aimed to determine the association between dietary inflammatory index (DII) and the risk of head and neck cancer (HNC), as well as the interaction between DII and cigarette smoking in HNC development within the Iranian population. Study Design: This is a case-control study.

METHODS

In this multicenter case-control study, participants' dietary intake was assessed using a validated 130-item food frequency questionnaire, from which DII was computed. The study recruited 876 new cases from referral hospitals across 10 provinces and 3409 healthy controls who were frequency-matched based on age, gender, and residential place. Logistic regression was used to obtain odds ratios (ORs) for HNC across tertiles of DII, which were adjusted for confounding variables.

RESULTS

A higher pro-inflammatory diet was associated with an increased risk of all HNC (OR T3 vs. T1 [95% CI]: 1.31 [1.06, 1.62]; P-trend=0.013). There was a significant association between lip and oral cavity cancers and DII (OR T3 vs. T1 [95% CI]: 1.56 [1.16, 1.66]; P-trend=0.004). Furthermore, an inflammatory diet was associated with an increased risk of pharynx cancer (OR T3 vs. T1 [95% CI]: 2.08 [1.14, 3.79]; P-trend=0.02). Additionally, no significant association was observed between DII and larynx cancer, while an interaction was found between DII and tobacco use on the risk of HNC (OR T3 vs. T1 [95% CI]: 2.52 [1.78, 3.57]; P-interaction=0.03).

CONCLUSION

DII was positively associated with HNC risk. There was a significant association between DII and the risk of lip, oral cavity, and pharynx cancers. Additionally, there was an interaction between tobacco use and DII in determining the risk of HNC.

Dos and don'ts in designing a computerized oral and lip squamous cell cancer registry

BACKGROUND

In the last ten years, many countries have started to develop constructive systems for registering common diseases and cancers. In this research, we intended to determine and identify the minimum data set (MDS) required for the design of the oral and lip squamous cell cancer registration system in Iran.

METHODS AND MATERIAL

At first, primary information elements related to disease registries were extracted using scientific papers published in reliable databases. After reviewing the books, related main guidelines, and 42 valid articles, the initial draft of a researcher-made questionnaire was compiled. To validate the questionnaire, two focus group meetings were held with 29 expert panel members. The final version of this questionnaire was prepared by extracting different questions and categories and receiving numerous pieces of feedback from specialists. Lastly, a final survey was conducted by the experts who were present at the previous stage.

RESULTS

Out of 29 experts participating in the study, 17 (58.62%) were men and 12 (40.37%) were women. The age range of experts varies from 34 to 58 years. One hundred-fourteen items, which are divided into ten main parts, were considered the main information elements of the registry design. The main minimum data sets have pertained to the demographic and clinical information of the patient, information related to the consumed drugs, initial diagnostic evaluations of the patient, biopsy, tumor staging at the time of diagnosis, clinical characteristics of the tumor, surgery, histopathological characteristics of the tumor, pathologic stage classification, radiotherapy details, follow-up information, and disease registry capabilities. The distinctive characteristics of the oral and lip squamous cell cancer registry systems, such as the title of the disease registration programme, the population being studied, the geographic extent of the registration, its primary goals, the definition of the condition, the technique of diagnosis, and the kind of registration, are all included in a model.

CONCLUSION

The benefits of designing and implementing disease registries can include timely access to medical records, registration of information related to patient care and follow-up of patients, the existence of standard forms and the existence of standard information elements, and the existence of an integrated information system at the country level.

The incidence of oral cavity cancer in Iran: A systematic review and meta-analysis

BACKGROUND AND AIMS

Oral cancer is now a top priority for non-communicable illnesses and universal health care plans, according to the WHO. There is no general estimate of the incidence of oral cavity cancer in Iran, despite multiple investigations. The purpose of this study is to evaluate the age-standardized incidence rate (ASR) of oral cavity cancers in Iran.

METHOD

In accordance with the MOOSE (Meta-analyses of Observational Studies in Epidemiology) Checklist recommendations, this systematic review was conducted. PubMed/MEDLINE, Web of Science, ScienceDirect, Embase, Scopus, ProQuest, and Google Scholar were used as the international databases for the systematic literature search, while SID (Scientific Information Database), Magiran and element were used as the Iranian databases. The heterogeneity of the research will be evaluated by means of the inverse variance and Cochran Q tests, along with random-effect models. It was determined what caused the heterogeneity using a meta-regression model. By eliminating experiments one at a time, sensitivity analysis was used. The meta-analysis was corrected utilizing the Trim-and-fill method due to the identification of noteworthy publication bias via the Egger's test and asymmetry of the funnel plot.

RESULTS

This research incorporated a total of 22 journal articles. The pooled ASR of oral cavity cancer for males and females was estimated at 1.96 (95% CI: 1.65-2.26) (Q statistic = 1118.09, df = 25, p < .0001, I²  = 97.8%), and 1.46 (95% CI: 1.14-1.77) (Q statistic = 2576.99, df = 26, p < .0001, I²  = 99.0%), respectively. According to the funnel plots and Egger's test, there is no evidence of publication bias in studies reporting on males (bias = 1.3220, 95% CI: -3.9571, 6.6012, p = .610), but for ASR in females, Egger's test was significant (bias = -7.6366, 95% CI: 2.2141, 13.05904, p = .008). Based on Trim-and-fill methods, overall ASR corrected in females was estimated to be 1.36 (95% CI: 1.05%-1.66%).

CONCLUSION

Iran's oral cavity cancer incidence was lower than the global average, but owing to variables including an aging population, a rise in life expectancy, and exposure to risk factors like smoking, we anticipate an increasing trend.

The Occurrence of Activated Leukocyte Cell Adhesion Molecule (ALCAM) and Its Predictive Factors in Patients with Oral Squamous Cell Carcinoma

OBJECTIVES

To determine the occurrence of Activated Leukocyte Cell Adhesion Molecule (ALCAM) and its predictive factors in patients with oral squamous cell carcinoma (OSCC).

METHODS

This cross sectional study was concocted on 102 patients with OSCC referred to Imam Khomeini Hospital of Tehran during 1997-2015. The data collection tool a checklist consisted of demographic and pathologic (lymph node involvement, differentiation, tumor size and tumor location) characteristics which extracted from patients' medical records. To evaluate ALCAM, a new sample of tumor tissue was prepared from archive. Finally, the multivariable logistic regression model was used to determine the predictive factors of ALCAM by STATA14.

RESULTS

the number (%) of men and women were 70 (68.6) and 32 (31.4%), respectively. The mean age (S.D) of participants was 61.7 (15.6) years. Of the total samples, 32 (38.2), 19 (18.6), 36 (35.3) and 8 (7.8%) samples were related to the tongue, oral mucosa, skin and lips, respectively. More than half of the tumors had good differentiation and lymph node involvement and 74.5% were ≥20 mm. Also, 79.41% of the samples were positive for the overall incidence of ALCAM. The most important predictors of the overall incidence of ALCAM were tumor size (OR: 3.46, 95% CI: 1.71 - 7.01) and tumor location (OR: 3, 95% CI: 1.03 - 8.72). Similarly, for incidence of cytoplasmic ALCAM were age (OR: 2.56, 95% CI: 1.38 - 4.76) and location of the tumor (OR: 3.23, 95% CI: 1.08 - 9.64). However, the only predictor of membranous ALCAM incidence was lymph node involvement (OR: 0.36, 95% CI: 0.19 - 0.66).

CONCLUSION

The results of our study suggest preliminary evidence for the potential clinical application of ALCAM as a prognostic biomarker for OSCC which may be the basis for future clinical application, however further studies are recommended.

Geo-epidemiological reporting and spatial clustering of the 10 most prevalent cancers in Iran

Cancer is a problem of both global and local concern. We determined the geo-epidemiological and spatial distribution of the 10 most common cancers in Iran. We used the data of the Iranian Cancer Registry for the year 2014 analysing the prevalence of 112,131 registered cancer cases with the aim of detecting potential geographical underlying causes. The geographic distribution of cancers is reported as standardized incidence rates at the provincial level considering risk with respect to sex and age. A geographical information systems (GIS) approach based on Anselin Local Moran's index method was used to map clusters and spatial autocorrelation patterns. The mean age of the patients was 55.6 (±17.8) and 61.7 (±18.2) for females and males, respectively, in the database which showed 46.1% (n=51,665) of all cases to be female. Analysis of the spatial distribution of cancers showed significant differences among the different provinces. Stomach and breast cancers were the most prevalent cancers in men and females, respectively. The highest incidence rates of stomach cancer were found in Ardabil and Zanjan provinces, with 48.38 and 48.08 per 100,000 population, respectively, while Tehran and Yazd provinces had the highest incidences of breast cancer, 51.0 and 47.5 per 100,000 population, respectively. Strong clustering patterns for stomach and breast cancers were identified in the north-western provinces and in Semnan Province, respectively. These patterns indicate a diversity of geo-epidemiological contributing factors to cancer incidence in Iran.

Head and Neck Cancer Treatments from Chemotherapy to Magnetic Systems: Perspectives and Challenges

BACKGROUND

Cancer is one of the diseases causing society's fears as a stigma of death and pain. Head and Neck Squamous Cell Carcinoma (HNSCC) is a group of malignant neoplasms of different locations in this region of the human body. It is one of the leading causes of morbidity and mortality in Brazil, because these malignant neoplasias, in most cases, are diagnosed in late phases. Surgical excision, chemotherapy and radiotherapy encompass the forefront of antineoplastic therapy; however, the numerous side effects associated with these therapeutic modalities are well known. Some treatments present enough potential to help or replace conventional treatments, such as Magnetic Hyperthermia and Photodynamic Therapy. Such approaches require the development of new materials at the nanoscale, able to carry out the loading of their active components while presenting characteristics of biocompatibility mandatory for biomedical applications.

OBJECTIVE

This work aims to make a bibliographical review of HNSCC treatments. Recent techniques proven effective in other types of cancer were highlighted and raised discussion and reflections on current methods and possibilities of enhancing the treatment of HNSCC.

METHOD

The study was based on a bibliometric research between the years 2008 and 2019 using the following keywords: Cancer, Head and Neck Cancer, Chemotherapy, Radiotherapy, Photodynamic Therapy, and Hyperthermia.

RESULTS

A total of 5.151.725 articles were found, 3.712.670 about cancer, 175.470 on Head and Neck Cancer, 398.736 on Radiotherapy, 760.497 on Chemotherapy, 53.830 on Hyperthermia, and 50.522 on Photodynamic Therapy.

CONCLUSION

The analysis shows that there is still much room for expanding research, especially for alternative therapies since most of the studies still focus on conventional treatments and on the quest to overcome their side effects. The scientific community needs to keep looking for more effective therapies generating fewer side effects for the patient. Currently, the so-called alternative therapies are being used in combination with the conventional ones, but the association of these new therapies shows great potential, in other types of cancer, to improve the treatment efficacy.

Cancer Trends in Iraq 2000-2016

OBJECTIVES

Precise and quantitative assessment of the trend of cancer burden enables policymakers and health managers to prioritize diseases and allocate resources better. This infers what caused a decrease or increase in the rate of cancer occurrence, and if it denotes timing of implementation of a control measure, it presents the impact on the disease rate. This study's objective was to evaluate trends in child and adult cancer in Iraq from 2000 onwards.

METHODS

We used the registries of the Iraqi Ministry of Health that were gathered from all governorates from 2000-2016. Data were presented as incidence rates to depict the trends of different types of cancers distributed by age, gender, and governorates.

RESULTS

Breast cancer witnessed a significant increase with predominance in females. Lung cancer rate increased significantly from 4.08 to 5.60/100 000 (p = 0.038), affecting males more than females. The brain cancer trend showed a bimodal pattern (two peaks in 2004 and 2011) with no significant trend change (p = 0.788). Both genders were similarly affected. The trend of stomach and colorectal cancer showed an accelerated increase after 2007.

CONCLUSIONS

Almost all cancers (particularly lung and gastrointestinal) showed constantly raising trends, especially after 2007. Only cervical and laryngeal cancer had a decreasing trend. Most cancers were predominant in males.

The Molecular Epidemiology of Herpes Simplex Virus Type 1 and 2 (HSV-1 and HSV-2) in Head and Neck Cancer (HNC)

Background: Head and neck cancers (HNC) constitute the sixth common type of malignancies worldwide and can affect a wide range of anatomical regions. The role of the herpes simplex virus (HSV) in oral squamous cell carcinoma (OSCC) has been previously investigated. Objectives: The objective of the current study was to evaluate the molecular epidemiology of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) in patients with HNC. Methods: A total of 156 patients with HNC were chosen including 90 biopsies and 66 formalin-fixed paraffin-embedded (FFPE) samples. HNC was confirmed and affected different anatomical regions. HSV detection was performed by a polymerase chain reaction (PCR) and HSV typing was assessed by a multiplex PCR. Results: The 156 HNC specimens included 35 (22.4%) larynx, 29 (18.6%) tongue, 6 (3.8%) glands (parotid and tonsil), 12 (7.6%) nasopharynx, 9 (5.7%) pharynx, 33 (21%) vocal cord, 3 (1.9%) palatine, glottis 17 (10.8%), nasal 2 (1.3%), mandibular 4 (2.5%), lip 4 (2.5%), neck 1 (0.6%), and face 1 (0.6%). The mean ± SD of the patients’ age was 60.3 ± 12.65, where 121 (77.1%) were male. The HSV was detected in 4 (2.6%) samples and 75% of HSV positive samples were HSV-1. Conclusions: The rate of HSV infection in Iranian patients with HNC was 2.6% with the majority being HSV-1 (75%). As a preliminary study in Iranian patients with HNC, cancer location was not statistically significant. Further investigations are needed to assess the role of HSV in HNC.

Salivary Secretor Status of Blood Group Antigens in Patients with Head and Neck Cancer

BACKGROUND:

Head and neck cancers include malignancies of the scalp and neck skin, nasal cavity, paranasal sinuses, oral cavity, salivary glands, pharynx and larynx. The term ABO secretor refers to people who secrete blood group antigens in their body fluids such as saliva, sweat, tears, semen, and serum. Non-secretors refer to those who do not secrete their blood group antigens in their body fluids. The lack of blood type antigens in body discharge increases the susceptibility to certain types of diseases and infection.

AIM:

Our study aimed to investigate the relationship between the secretion of blood groups in the saliva of patients with head and neck cancers.

MATERIAL AND METHODS:

This case-control study was performed on 110 people (57 patients with head and neck cancer who were referred to Imam Khomeini Hospital, Tehran and 53 cancer-free controls). Five ml of non-stimulated saliva were collected by the spitting method. By agglutination or lack of agglutination in the test tubes, we determined the patient’s secretor or non-secretor condition.

RESULTS:

In terms of secretor status, 52.7% of all samples were secretors. In the case group, 19 out of 57 cases (33.3%) were secretors, and 38 were non-secretors (66.7%). In the control group, 39 out of 53 cases (73.6%) were secretors, and 14 cases were non-secretors (26.4%). There was a significant difference in the percentage of non-secretors between the two groups (p = 0.00).

CONCLUSION:

People with non-secretor status may be more prone to develop head and neck cancer. The presence of these antigens in saliva may have a protective effect.

Population Survey of Knowledge about Oral Cancer and Related Factors in the Capital of Iran

Knowledge about oral cancer risk factors and signs is thought to improve prevention and early diagnosis, and in turn, increases survival. In this population-based survey, knowledge about oral cancer was assessed in Iran. A total of 1800 self-administered questionnaires (collecting sociodemographic data and questions regarding oral cancer risk factors and signs) were distributed through random sampling. Final scores ranged between 0 and 15 for the risk factors and 0-11 for the signs. Scores below the median indicated a low level of knowledge, scores representing the third quartile of correct answers indicated a moderate level of knowledge, and scores representing the upper quartile indicated a high level of knowledge. Statistical tests were used for analysis of knowledge level in different sociodemographic categories. A total of 1312 participants completed the questionnaires. The average of knowledge scores for risk factors was 5.3 ± 3.0 and for signs was 4.5 ± 2.9. Overall, 75 and 56% respectively were able to identify major risk factors (smoking and alcohol); 23.5% could not define any related signs and symptoms. Dividing scores into quartiles indicated that three out of four people had "low" knowledge about risk factors and 58% had "low" knowledge about signs and symptoms. Females and highly educated people had more knowledge of oral cancer. Significant difference was found between job and level of knowledge (P = 0.001). This survey revealed that public knowledge of oral cancer was not satisfactory in Iran. Efforts should be done to inform and educate people with risk factors, initial clinical presentation, and symptoms, in order to improve prevention and promote early diagnosis.

Human Papillomavirus Investigation in Head and Neck Squamous Cell Carcinoma: Initial Report from the Low Risk HPV Types Associations

Background:

Head and neck squamous cell carcinomas (HNSCC) are a major health issue in many parts of the world. Recently, attention has focused on the human papilloma virus (HPV) as a potential causative agent for HNSCC. This study aimed to survey HPV occurrence in HNSCCs as part of a comprehensive molecular epidemiology approach.

Methods:

In this retrospective study, patients were recruited from hospitals affiliated to the Iran University of Medical Sciences, Tehran, Iran. Formalin-fixed paraffin-embedded (FFPE) blocks were subjected to DNA isolation by QIAamp® DNA FFPE Tissue Kit and nested PCR, HPV-16 specific conventional PCR, and extra INNO-LiPA HPV genotyping assays were subsequently performed. PCR products were purified with a High Pure PCR Product Purification Kit and sequenced with an ABI 3730 XL sequencer. CLC Main Workbench 5 and MEGA5 bioinformatics software was used to analyze the raw data and to create the phylogenetic tree. SPSS v.20 was applied for statistical analysis.

Results:

A total of 156 FFPE blocks were collected from 2011 to 2017. Total mean age (y) of participants was 60.5 ± 12.6; 77.6 % (121/156) being men and 22.4% (35/156) e women. Overall, 5/156 (3.2%) patients (3 females and 2 males) were found to be HPV positive using the three methods. HPV genotyping revealed HPV types 16, 2, 27, and 43 in these malignancies. Tumor location and lymph node involvement indicated significant differences between the sexes.

Conclusion:

Although high risk HPV genotypes have been associated with HNSCCs, our findings indicate a potential of low risk HPV types to also contribute to such malignancies.

Head and Neck Cancers in North-East Iran: A 25 year Survey

INTRODUCTION

Cancers are among the worst noncommunicable diseases around the world. Head and neck cancers are ranked as the fifth most common cancers worldwide. As there are different distributions of risk factors around the world, the incidence of these cancers varies from one place to another.

MATERIALS AND METHODS

We conducted a descriptive analytic cross-sectional study, based on census-based records from the private oncology clinic in Mashhad, Iran. Data from 1,075 patients with head and neck cancers were analyzed from 1986 to 2010. We categorized the duration of study into five periods: 1986-1990, 1991-1995, 1996-2000, 2001-2005, and 2006-2010. Head and neck cancers refers to cancers originating from seven sites in the head and neck including the nasal cavity, oral cavity, pharynx, larynx, salivary glands, paranasal sinuses, and thyroid.

RESULTS

Data of 1,075 patients were analyzed. 66.2% were male. Mean ± standard deviation (SD) age at the time of diagnosis was 55.37±15.55 years. The most frequent type of head and neck cancer was larynx cancer (36%), followed by pharynx (28.5%), oral (17.5%), thyroid (6.8%), sinus (6.4%), salivary gland (4.10%), and nasal cancer (0.70%). although larynx cancer was the most frequent cancer over the whole study duration, there was a significant (P=0.04) difference in the relative frequency of these cancers across the five time periods. There was a significant difference in mean age between cancer categories (P<0.001). The only cancer with a different mean age at different time periods was pharynx cancer (P=0.02). There was a significant difference between sex and cancer categories (P<0.001).

CONCLUSION

Laryngeal cancer was the most common head and neck cancer over the whole duration of this study. The differences in the patterns of other head and neck cancers could be due to geographical differences and also different risk factors and lifestyles all over the world. Further investigations in these fields are suggested in future studies.

Frequency of Head and Neck Squamous Cell Carcinomas and Related Variables in Southern Iran (Ahvaz City): 10-Year Retrospective Study

Objective:

Squamous cell carcinoma (SCC) is a life threatening lesion but there has been only limited research about its frequency in Iran. The aim of this study was to evaluate the frequency of squamous cell carcinoma of the head and neck in the records of the pathology department of Imam Khomeini hospital in Ahvaz between 2005 and 2015.

Methods:

The retrospective and cross-sectional study was conducted using 55,708 medical records of cancer throughout the body, accumulated in the pathology department of Imam Khomeini in Ahvaz in the designated period. Information about age, gender, site of involvement, histological characteristics, status of lymph node metastasis, smoking habit, family history, job and education level was extracted and data were analyzed with the Chi-square test with SPSS version 22.

Result:

Of the total of 55,708 records, 582 patients (1.04%) had head and neck squamous cell carcinomas. The male to female ratio was 2.85. The frequencies in the head, mouth and neck were 28.7%, 22% and 49.3% respectively. Significant relationships between being male and location (neck) (p = 0.002), age (60 to 80 years old) and being a farmer (p = 0.001) was observed. The most important correlated risk factors were: smoking, sunlight exposure, rural residence, job and education level.

Conclusion:

Head and neck squamous cell carcinomas were found to account for 1.04% of all cancers in Ahvaz, one of the southern provinces of Iran.

Epidemiology and Inequality in the Incidence and Mortality of Nasopharynx Cancer in Asia

OBJECTIVES

One of the most common head and neck cancers is nasopharynx cancer. Knowledge about the incidence and mortality of this disease and its distribution in terms of geographical areas is necessary for further study and better planning. Therefore, this study was conducted with the aim of determining the incidence and mortality rates of nasopharynx cancer and its relationship with the Human Development Index (HDI) in Asia in 2012.

METHODS

The aim of this ecologic study was to assess the correlation between age-specific incidence rate (ASIR) and age-specific mortality rate (ASMR) with HDI and its components, which include the following: life expectancy at birth, mean years of schooling, and gross national income per capita. Data about SIR and SMR for every Asian country for 2012 were obtained from the global cancer project. We used the correlation bivariate method for the assessment. Statistical significance was assumed if p < 0.05. All reported p values are two-sided. Statistical analyses were performed using SPSS (Version 15.0, SPSS Inc.).

RESULTS

A total of 68,272 cases (males, 71.02%; females, 28.97%; sex ratio, 2.45) and 40,530 mortalities (males, 71.63%; females, 28.36%; sex ratio, 2.52) were recorded in Asian countries in 2012. The five countries with the highest ASIR of nasopharynx cancer were Malaysia, Singapore, Indonesia, Vietnam, and Brunei, and the five countries with the highest ASMR were Indonesia, Vietnam, Singapore, Malaysia, and Brunei. The correlation between HDI and ASIR was 0.097 (p = 0.520) [0.105 in men (p = 0.488) and 0.119 in women (p = 0.901)]. The correlation between HDI and ASMR was -0.102 (p = 0.502) [-0.072 in men (p = 0.633) and -0.224 in women (p = 0.134)].

CONCLUSION

Nasopharynx cancer is native to Southeast Asia. The highest incidence and mortality rates are found in Malaysia, Singapore, Indonesia, Vietnam, and Brunei. No significant relation was found between the standardized incidence and mortality rates of nasopharynx cancer and the HDI components. Further studies are recommended in Southeast Asian countries in order to find the etiology of cancer, as well as its diagnosis and treatment.