Head and neck cancer insights into aetiology and

Head and neck cancer: insights into aetiology and prognosis from a clinical cohort Andy Ness

Acknowledgements § Study participants § Christine Allmark, Sheila Fisher, Will Hollingworth, Katrina Hurley, Sam Leary, Chris Nutting, Chris Penfold, Tim Peters, Miranda Pring, Sue Ring, Simon Rogers, Steve Thomas, Stu Toms, Andrea Waylen, § Research, laboratory and clinical staff § UK National Institute for Health Research programme grant for applied research scheme (RP-PG-0707 -10034)

Structure of talk § § Background Head and neck 5000 methods Head and neck 5000 recruitment Head and neck 5000 preliminary analysis

Background

Incidence of head and neck cancers 1990 - 2006 www. ociu. nhs. uk/sph-documents/Head_and_Neck_Profiles. pdf

Head and neck cancer survival in SW England Year of diagnosis 1996 -1997 1999 -2000 2002 2003 % dead at 5 years 95% CI 54. 9 47. 8 43. 4 42. 2 50. 3, 59. 5 43. 7, 51. 9 39. 4, 47. 6 37. 9, 46. 6 p for trend < 0. 001 Drugan C et al Br J Oral Maxillofac Surg 2013; 51: 19 -24.

Head and neck 5000 methods

Eligibility criteria § § New diagnosis of head and neck cancer Seen or discussed at MDT meeting or clinic Includes those in other studies Age > 16 years

Clinical cohort head and neck cancer • Notes • H&L + sexual history • Qo. L • Blood & saliva samples • Tissue sample Baseline 4 months • Notes • H&L • Qo. L • Late toxicity 12 months ≥ 3 years Mortality data • Notes • H&L • Qo. L • • Notes H&L Qo. L Late toxicity

Ness AR et al Clinical Otolaryngology 2015 http: //www. headandneck 5000. org. uk

Head and neck 5000 recruitment

Study sites § § § 5511 recruited Opened April 2011 Closed December 2014 78 sites (76 recruited) Across the UK Map data: Google, Geo. Basis-DE/BKG

Recruitment and questionnaire response rates

Study sample Eligible 11158 Consented 5511 Eligible and continued consent 5356 Valid stage 5079 Complete data 3336

Age and gender Range: 18 to 96 years Median: 61 years Female 27% 15

Cancer diagnosis Thyroid Salivary Glands Nasal cavity Sinuses Nasopharynx Hypopharynx Oropharynx Larynx Oral Cavity

Head and neck 5000 preliminary analyses

Incidence of head and neck cancers 1990 - 2006 www. ociu. nhs. uk/sph-documents/Head_and_Neck_Profiles. pdf

Characteristics by tumour site Category (%) Larynx (n=618) Female 15 Age <60 28 Never smoked 10 ≤Moderate alcohol 50 No oral sex 50

Cigarette smoking prevalence in Great Britain http: //scienceblog. cancerresearchuk. org/2015/11/13/mouth-cancer-rates-are-increasing-but-why/

Characteristics by tumour site Category (%) Larynx (n=618) Oropharynx (n=1, 147) Female 15 22 Age <60 28 55 Never smoked 10 28 ≤Moderate alcohol 50 51 No oral sex 50 19

UK trends in sexual behaviour / http: //scienceblog. cancerresearchuk. org/2015/11/13/mouth-cancer-rates-are-increasing-but-why

Proportion of HPV positive oropharyngeal cancer in the UK 2002 -2011 80 70 Positive test (%) 60 50 40 30 20 PCR p 16 ISH HPV positive 10 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Year of diagnosis Schache A et al, Cancer Research 2016 (epub ahead of print)

Estimated incidence of oropharyngeal cancer by HPV status in the UK 2002 -2011 Age standardized rate (per 100, 000) 4. 0 HPV-positive Male HPV-positive Female HPV-negative Male HPV-negative Female 3. 5 3. 0 2. 5 2. 0 1. 5 1. 0 0. 5 0. 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Year of diagnosis Schache et al, Cancer Research 2016 (epub ahead of print)

Characteristics by tumour site Category (%) Larynx (n=618) Oropharynx (n=1, 147) Oral (n=787) Female 15 22 38 Age <60 28 55 40 Never smoked 10 28 26 ≤Moderate alcohol 50 51 51 No oral sex 50 19 54

Mortality attributed to alcohol liver disease Thomson SJ et al, Alcohol and Alcoholism 2008; 43: 416 -22.

Trends in alcohol consumption http: //scienceblog. cancerresearchuk. org/2015/11/13/mouth-cancer-rates-are-increasing-but-why/

Percentage Drank Alcohol At Least Once in Last Week, Adults Aged 16 and Over, Great Britain Prepared by Cancer Research UK Original data source: Office for National Statistics. Drinking Habits Amongst Adults, 2012. Available from http: //www. ons. gov. uk/ons/rel/ghs/opinions-and-lifestyle-survey/index. html

Preliminary survival analysis § § 2, 651 participants 336 deaths Oral cavity, oropharynx, larynx Exclude if no baseline lifestyle questionnaire, age, gender, stage, treatment intent

Preliminary analysis models § Model 1 – unadjusted § Model 2 – age, gender, site, stage, treatment intent § Model 3 – model 2, co-morbidity

Co morbidity and mortality None Mild Moderate Severe P for trend N Model 1 OR Model 2 OR (95% CI) 1240 885 422 104 1. 0 2. 1 2. 4 6. 9 1. 0 1. 9 2. 0 4. 7 <0. 001 (1. 4, 2. 6) (1. 4, 2. 9) (2. 9, 7. 7)

Smoking and mortality Category (N) Model 1 OR Model 2 OR Model 3 OR (95% CI) Never (613) Ex (1526) Current (512) 1. 0 1. 7 2. 5 1. 0 1. 7 2. 8 1. 0 1. 6 2. 5 P for trend <0. 001 Are you a current/ former / never user of tobacco? (1. 1, 2. 3) (1. 7, 3. 7)

Thankyou!