Trends in Head and Neck Cancer incidence in Ho Chi Minh City, Vietnam between 1995-2015

doi:10.21203/rs.3.rs-3465041/v1

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Trends in Head and Neck Cancer incidence in Ho Chi Minh City, Vietnam between 1995-2015

https://doi.org/10.21203/rs.3.rs-3465041/v1

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Background

In Southeast Asia, the epidemiological profile of Head and Neck Cancer (HNC) remains under-researched. This study delineates the incidence and subtype-specific burdens of HNC in Ho Chi Minh City, Vietnam (1996–2015).

Methods

We conducted a population-based retrospective analysis using the Ho Chi Minh City Cancer Registry. The study estimated the 5-year point incidence for four HNC subtypes over 20 years. Age-standardised rates (ASR) were determined using national population metrics. Joinpoint regression analysis was executed to discern patterns over time.

Results

HNC incidence in Ho Chi Minh City escalated between 1996 and 2015, with nasopharyngeal and oral cancers demonstrating pronounced prevalence. Male diagnoses constituted 73%. The median age of HNC diagnosis in the Vietnamese cohort was approximately a decade earlier than global averages.

Conclusions

The marked variance in HNC trends in Ho Chi Minh City from global patterns underscores the urgency for implementing effective healthcare strategies in Vietnam.

Head and neck cancer (HNC)

Ho Chi Minh City

Vietnam

Age of Diagnosis Trends

Cancer Control Strategies

Southeast Asia Cancer Incidence

Head and neck cancers (HNC) represent more than 550,000 cases per year globally and are the sixth most common cancer type [1]. They are a heterogenous group of cancers that affect the areas of the upper aero-digestive tract. Its major subtypes include oral cancer, oropharyngeal cancer, nasopharyngeal cancer, and cancers of the laryngo-pharyngeal area. The complex aetiology of head and neck cancer comprises of both intrinsic and extrinsic factors. In addition to the two major risk factors associated with the development of head and neck cancer [2], particularly habitual tobacco and alcohol consumption, it is now broadly accepted that viral infections (e.g., Human Papillomavirus, HPV) are also critical in this cancer’s pathogenesis [3].

There is a geographic disparity in the distribution of head and neck cancers, most notably, that head and neck cancer is the most common cancer in economically disadvantaged countries [4], particularly observed in South and Southeast Asia [5]. Many of these occurrences are attributed to the use of betel quid [6]. In Western populations, the decrease in combustible tobacco use and increased HPV prevalence have allowed an epidemiologic shift that has heightened the role of high-risk HPV strains in HNC pathology [7]. This subset of the disease is seen more often in younger patients and most commonly presenting in the oral cavity, tongue, and oropharynx.

The lifetime risk of developing HNC is approximately 1 in 100 in developed countries, although these statistics are skewed towards men and people aged over 60 [8]. The cost of HNC, including diagnosis, treatment, and ongoing care, is significant. In the United States, the annual economic burden is estimated to exceed $3.2 billion [9].

Shifting focus to Southeast Asia, this region witnesses a higher prevalence of HNC due to risk factors like high tobacco usage, alcohol consumption, and betel quid chewing. The lifetime risk of developing HNC in this region is higher than the global average, although precise data is lacking [10, 11]. The economic burden is also substantial. For instance, in Thailand, the annual cost of oral cancer treatment, a subset of HNC, is estimated at over US$20 million [12, 13].

In Vietnam, the specific statistics for HNC are not clearly defined due to limited research and data availability. However, considering the prevalent risk factors similar to those in other Southeast Asian countries, it is likely that the incidence, lifetime risk, and economic burden of HNC are high. Given the financial constraints of the country's healthcare system, this creates a pressing issue.

The first step to addressing the burden of HNC in Southeast Asia is to analyse surveillance data for trends in the incidence of HNC. In the past few decades, rapid socioeconomic development has allowed improved control of communicable diseases in Southeast Asia, which resulted in the emergence of cancer as the leading cause of death in these countries. Until now, there has been no systematic documentation of the incidence of head and neck cancer in Vietnam over the past 30 years. During this period, Vietnam has experienced rapid and comprehensive sociocultural change, as a result of the economic transition. This economic transition has impacted traditional and cultural behaviours and has contributed to various public health outcomes.

Vietnam has very high smoking rates among its population; in 2015, the daily smoking rate among men was 38.7% (estimated from the 2015 Global Adult Tobacco Survey) [14]. Furthermore, there are a large proportion of people exposed to second-hand smoke. In 2016, 63% of the population reported living in households where tobacco is consumed [15]. Alcohol consumption for adults almost doubled from 2003–2005 to 2008–2010, increasing from 3.8 to 6.6 litres of pure alcohol. This rate is slightly above the global rate of per capita alcohol consumption per annum, which is estimated at 6.2 litres [16, 17]. Understanding the impact of HPV16 on HNC in Vietnam presents a challenge due to the scarcity of research investigating its prevalence. Despite this, one notable study by the International Agency for Cancer Research (IACR) has provided some insight, suggesting a seropositivity rate of 21% for HPV16 in Ho Chi Minh City [18].

Given the rapid economic and social changes in Vietnam and the observed increases in risk factors for HNC, it would be timely to report on the incidence of this disease. In our study, we sought to estimate the incidence of head and neck cancer in Ho Chi Minh City, a population of 9 million inhabitants and the largest city in Vietnam. Our aims were threefold; Firstly, we looked to quantitate the incidence of head and neck cancer and its four main subtypes in Ho Chi Minh City between 1996–2015. Secondly, we analysed age-standardised rates of head and neck cancer; and third, we examined defining points of incidence through joinpoint regression analysis.

Ho Chi Minh City Cancer Registry

The anonymised data for this study was extracted from the Ho Chi Minh City Cancer Registry [19–22]. The Registry was established in 1990 to document all diagnosed cancer cases in the City. Cancer patients admitted to any hospital in the city were ascertained and checked for possible duplication. The coverage period was from January 1, 1996, to December 31, 2015. This study was restricted to people who were identified as residents of Ho Chi Minh city on their patient records. We focused on Ho Chi Minh City, as (i) it is the largest centre of commerce in the country, with a population of 8.2 million (2014 statistics); (ii) the ascertainment and documentation of cancers in the City is more complete than any other provinces in the country; and (ii) the City offers an opportunistic setting for studying the burden of cancers in a transitional population. The study was approved by the Ethics Committee of the Oncology Hospital of Ho Chi Minh City.

The Ho Chi Minh City Cancer Registry adopted the International Classification of Diseases for Oncology, 3rd Edition (ICD0-3) for the classification of primary sites of morphology and guidelines from the International Agency for Research on Cancer and the International Association of Cancer Registries. Based on the ICDP-3, we identified head and neck cancer cases (including its four subtypes) from 1 January 1996 to 31 December 2015 inclusive. The identification was further ascertained by tumour site code, morphology code and behaviour type.

Calculating ASR

Age and gender population statistics were obtained from census data managed by the General Statistics Office (GSO) of Ho Chi Minh City. Population statistics were available for 1999, 2004, 2009 and 2014. Age and gender population statistics in 1999 for Vietnam were obtained from the Bureau of Statistics of Vietnam.

Using the population statistics of Ho Chi Minh City, we computed the point incidence rate of Head and Neck cancer (per 100,000 population) for each 5-year interval: 1996–2000, 2001–2005, 2006–2010, 2011–2015 inclusive. The reason for aggregating 5-year data was to improve the stability of statistical estimates. We used the direct method of standardisation to calculate the age-standardised rate (ASR), by applying the age-specific rates observed in a period to the national population in 1999. In this approach, the ASR can be thought of as a weighted average rate, with the weights being the proportion of the national population in each age group.

Logistic joinpoint regression model

Using the United States National Cancer Institute SEER*Stat software (https://seer.cancer.gov/seerstat/), we employed a logistic joinpoint regression model to identify temporal changes in the incidence of Head and Neck cancer incidence in the Vietnamese population between 1996 and 2015. Data was first formatted in SEER*Prep using the Global Incidence File Format. Age-and-gender population statistics were obtained from census data managed by the General Statistics Office (GSO) of Ho Chi Minh City. Population statistics were available for 1999, 2004, 2009, and 2014. Age-and-gender population statistics in 1999 for Vietnam were obtained from the Bureau of Statistics of Vietnam. Cases were restricted to the head and neck cancer site codes according to the International Classification of Diseases for Oncology, Third Edition (ICD-O-3).

Using the Joinpoint Regression Program within SEER*Stat, we conducted a time-trend analysis to identify the years when significant changes occurred in the incidence rates. We used the Bayesian Information Criterion (BIC) to select the best-fitting joinpoint model, which detects the number and location of joinpoints (i.e., years where the rate of incidence changes) over the study period. We allowed for a maximum of 2 points in the model. We also calculated the annual percentage change (APC) and the average annual percentage change (AAPC) with 95% confidence intervals (CIs) to quantify the magnitude and direction of trends. All statistical analyses were performed using SEER*Stat version 8.3.8 and R version 4.0.2. A p-value less than 0.05 was considered statistically significant.

Recorded HNC cases in Ho Chi Minh City 1996–2015

Between January 1, 1996, and December 31, 2015, 8,974 new cases of Head and Neck cancer had been registered in the Registry (Fig. 1 and Supplementary Table 1). Based on the clinical grade (n = 6,523 male, n = 2,451 female), the majority of cases were at Grade II for males and Grade I for females. Overall, 29% of head and neck cancer cases were classified as Grade II, which was the most prevalent grading. The majority of cases were diagnosed through histology of primary cancer (88.66%), with 64.5% and 24.16% of cases detected using this method for males and females, respectively.

By subtype, Nasopharynx cancer was the most common cancer in males (23.08%), whereas in females, cancer of the oral cavity was the prevalent cancer at 12.31% (Supplementary Table 2). 14.53% of nasopharynx cases were diagnosed at grade IV, whereas the majority of cases were diagnosed as grade I for larynx and pharynx cancers and cancers of the oral cavity. For oropharynx cases, the majority were graded at grade II. For all cancer subtypes, the basis of diagnosis was overwhelmingly by histology of primary cancer 18.56%, 28.83%, 30.63% and 10.63% for larynx/pharynx, nasopharynx, oral cavity, and oropharynx cases, respectively.

Incidence rates of HNC in Ho Chi Minh City 1996–2015

Overall, all four head and neck cancer subtypes saw increases in incidence over the 20 years examined (Fig. 2). Nasopharyngeal and oral cavity cases were the most prominent cancer subtypes diagnosed in Ho Chi Min City between 1996 and 2015. Laryngeal and pharyngeal cancers were also increasing, realising its highest level of incidence in 2014. Oropharyngeal cancers had the lowest incidence but increased steadily over the 20 years.

The median age of diagnosis for all head and neck cancers was 56 for males and 57 for females, respectively (Table 1). Males were diagnosed at a lower median age than females for laryngeal/ pharyngeal cancers (61 years of age) and oral cavity cancers (56 years of age), six and 11 years prior to females, respectively (67 years of age for both cancer types in females). In contrast, women were diagnosed slightly younger than males with nasopharyngeal and oropharyngeal cancers; 55 years and 47 years respectively for females and 56 years and 50 years respectively for males (one year earlier in oropharyngeal cancers and 3 years prior for nasopharyngeal cancers).

Table 1

**Median age of diagnosis for males and females residing in Ho Chi Minh City Vietnam by subtype (years of age).** Males were diagnosed earlier than females for laryngeal/pharyngeal and oral cavity cancers, whereas females were diagnosed earlier than males for oropharyngeal cancers and nasopharyngeal cancers.
	Laryngeal/ pharyngeal	Oral cavity	Oropharyngeal	Nasopharyngeal	Head and Neck (all)
Male	61	56	56	50	56
Female	67	67	55	47	57

Overall, head and neck cancers increased between 1996 and 2015 for both males and females in Ho Chi Minh City. Five-year examination of incidence by age group saw both males and females between 40 and 69 years of age increasing, with the 50–59 age group highly representative in both sexes (Fig. 3, A and B). There was a change in distribution of incidence in both males and females between the periods of 1996 and 2000, to 2011 and 2015. In the 1996 period, 25.59% of cases of head and neck cancer were in males aged between 60–69. In the 5-year period to 2015 to 35.39% of cases were made of up males aged 50–59. Likewise, in females with head and neck cancers, 25.2% of cases diagnosed between 1996 and 2000 were in females aged 70–79. In 2011 to 2015, 25.53% of cases were seen in females aged 50–59 (Supplementary Table 3A).

Nasopharynx cases remained consistently prevalent in males and females aged between 40–59 (Supplementary Fig. 1, A and B). Nasopharyngeal cancers peaked in the 5-year period between 2006 and 2010 in both males and females in the 40–49 age group, representing 31% of nasopharyngeal cases in males and 33% in females for that time period (Supplementary Table 3B).

Oropharyngeal cancers affected males more than females in Ho Chi Minh City (n = 2,071 for males; n = 913 for females), with males in the 50–59 age group affected substantially more than other age groups (Supplementary Fig. 1, C and D). In the period between 1996 and 2000, 27.2% of males with oropharyngeal cancers were diagnosed between 60–69 years old (Supplementary Table 3C). In 2011 to 2015, 41% were diagnosed in the 50–59 age range. In contrast, for females diagnosed with oropharyngeal cancers in 1996 to 2000, 18.97% of cases were diagnosed in the 40–49 age range. In 2011 to 2015, 29.41% of cases were diagnosed in the 60–69 age range.

Pharyngeal and laryngeal cancer incidence increased considerably in males and decreased in females between 1996 and 2015 (Supplementary Fig. 1, E and F). Between 2001 and 2015, a steep increase was observed for males aged between 50–59. In the 2001 period, this age group represented 20% of pharyngeal/ laryngeal cases. By the 2011 to 2015 period, this age group represented 38% of these cases. In contrast, there were only 153 cases of laryngeal/pharyngeal cancers in females over the 20-year period examined (n = 1,756 in males), which saw a slight decrease in cases between 1996 and 2015 (Supplementary Table 3D).

Similar to pharyngeal/ laryngeal cancers, incidence in the cancers of the oral cavity increased considerably in males and decreased in females between 1996 and 2015 (Supplementary Fig. 1G and H). Between 1996 and 2000, 23.9% of cases for males were diagnosed in the 70–79 age range (Supplementary Table 3E). This age range lowered between 2011 and 2015, with the majority cases (34.08%) cases seen in the 50–59 age range. Similarly, in females, 37.12% of cases were diagnosed for patients between 70–79 in 1996 to 2000, however by 2011 to 2015, 27.61% of cases were seen in the 50–59 age r

The 5-year age-standardised incidence rate (ASR) for HNC

Overall, the age standardised rates for the head and neck subtypes remained somewhat consistent over the 20 years examined, except for nasopharynx, which decreased from 3.2 per 100,000 population to 2.7 per 100,000 (see Supplementary Tables 4). When comparing our findings on ASR and crude rates for head and neck patients in Ho Chi Minh City to GLOBOCAN statistics, head and neck cancer rates remain consistent for all subtypes, except again for Nasopharyngeal cancer, where the overall crude rate and ASR between 1996 and 2015 was 2.3 and 2.7 respectively. The crude rate and ASR for the world in 2020 was 1.7 and 1.5 respectively (per 100,000 population). This correlates with Nasopharynx cases accounting for 33% of overall head and neck cancer cases in Ho Chi Minh city over the 20 years between 1996 and 2015.

If we now examine the HNC subtypes in more depth, the 5-year ASR for oral cancer was 3.5 cases per 100,000 population during the 1996 to 2000 period. This rate decreased slightly to 3.2 cases in 2011 to 2015. In males over the same time, ASR increased from 4.3 cases per 100,000 population to 5.5 per 100,000 population, while in females the ASR progressively decreased from 2.9 to 1.6 (Supplementary Table 5, A). For cancers of the oropharynx, overall, the ASR increased from the period 1996–2000 to 2011–2015 from 1 case per 100,000 population to 1.3 cases per 100,000 population (Supplementary Table 5, B). In males, this increased over the same period from 1.7 cases per 100,000 population to 2.2 cases per 100,000 population. In females, a smaller increase was seen of 0.5 cases per 100,000 population to 0.6 per 100,000 population over the same time.

In Nasopharynx cases, the ASR decreased slightly from 3.2 cases per 100,000 population to 2.6 cases of the 20-year period (Supplementary Table 5, C). Males were overrepresented between 1996 and 2000, with an ASR of 5.1 cases per 100,000 population. Incidentally, the ASR decreased in the period 2011 to 2015 with an ASR of 4.4. This rate was still more frequent than females, which also saw a slight decrease in ASR from 1.8 to 1.3 in the same time period. Lastly, laryngeal, and pharyngeal cases slightly increased between 1996 and 2015 from 2.3 to 2.4 cases per 100,000 population (Supplementary Table 5, D). In males, the ASR increased from 5.0 cases per 100,000 population in 1996–2000 to 5.5 in 2011–2015. For females, ASR decreased from 0.4 cases per 100,000 population to 0.2.

Joinpoint regression analysis

Joinpoint regression analysis did not identify breakpoints in any of the head and neck cancer subtypes throughout 1996 to 2015 (Supplementary Fig. 2, A-D). In cancers of the oral cavity, age-adjusted rates increased over the 20 years, whereas females decreased in the same period (Supplementary Fig. 2, A). Oropharyngeal and pharyngeal/ laryngeal age-adjusted rates increased in both males and females (Supplementary Fig. 2, B; Supplementary Fig. 2, D), whereas nasopharyngeal age-adjusted rates decreased slightly for both males and females (Supplementary Fig. 2, C).

This study represents a comprehensive 20-year analysis of Head and Neck Cancer (HNC) cases in Ho Chi Minh City, Vietnam. Over this period, 8,974 Vietnamese individuals were diagnosed with HNC with a disproportionate gender distribution. Specifically, males constituted 73% of these cases, significantly outnumbering female cases which made up the remaining 27%. The study examined four HNC subtypes, namely cancer of the oral cavity (34% of cases), nasopharyngeal cancers (33%), oropharyngeal (12%) and laryngeal/pharyngeal cancers (21%), demonstrating that HNC subtype prevalence in Vietnam is not dissimilar to that observed globally [23]. Intriguingly, a significant age gap was identified in Vietnam, with diagnosis typically occurring around 10 years earlier than global averages. There was also a decrease in the mean age of diagnosis over the 20-year period investigated, a stark contrast to increasing diagnosis age trends observed in Western countries [24].

Our findings are consistent with observations in other Asian countries and globally. Similar to Taiwan and the Philippines, oral cancer is a significant health burden in Vietnam, with more than 5,000 new cases every year in Taiwan [25] and a crude rate of 2 per 100,000 in the Philippines [26]. Nasopharyngeal cancer, the leading HNC subtype in China and Hong Kong, also accounted for a considerable proportion of Vietnamese cases [27, 28]. However, unlike Western countries, where oropharyngeal cases have sharply risen due to increasing human papillomavirus (HPV) infections [29], this subtype only accounted for a smaller fraction of HNC cases in Vietnam. Despite this, there has been a steady increase in the case numbers of oropharyngeal cancers in Vietnam over the 20-year period (Fig. 2), and this may be due to HPV type-16, the most prevalence strain of the HPV virus globally [30, 31]. However, we do not have accurate rates for HPV-16 infections for this region, particularly for males, with previous research looking at HPV infection rates among Vietnamese woman [32, 33]. It was recently reported that HPV in Vietnamese males was common with high-risk HPV genotypes, although this study looked at penile cell samples [34].

Our study has also revealed notable disparities in the median age of diagnosis for various HNC subtypes in Ho Chi Minh City. Notably, for laryngeal and oral cancers, the median age of diagnosis was higher in females (67 years for both subtypes) than in males (61 and 56 years, respectively, as indicated in Table 1. Conversely, for oropharyngeal and nasopharyngeal cancers, males presented at a median age of 56 and 50 years, respectively, which was slightly older than their female counterparts diagnosed at 55 and 47 years. Taken together, the median age of diagnosis for males was 56, a year younger than the median for females at 57.

In a global context, the median age of diagnosis for non-virally associated Head and Neck Squamous Cell Carcinoma (HNSCC) is typically 66 years [35]. Viral-associated HNCs, such as HPV-associated oropharyngeal cancer and Epstein-Barr virus-associated nasopharyngeal cancer, exhibit a lower median age of diagnosis, around 53 and 50 years, respectively [36]. Data specific to median age of diagnosis in Asia remains limited, but strikingly, there exists a 10-year disparity between the global median age of diagnosis and that observed for both sexes in Ho Chi Minh City.

In contrast, Western countries have seen an upward trend in the mean age of HNC diagnosis over the past several decades [37]. The U.S., for example, documented an increase mean age at diagnosis for all HNC subtypes from 1975 to 2016, with the sole exception of oropharyngeal cancer [38]. This subtype saw a decrease in mean age of diagnosis, paralleled by a surge in proportional prevalence, potentially attributable to a rise in HPV-related oropharyngeal cancers.

In a closer examination of Ho Chi Minh City from 1996 to 2015, the mean age of diagnosis receded over this 20-year span for all HNC subtypes, barring oropharyngeal and nasopharyngeal cancers (refer to Supplementary Table 6, A-C). Oral cancers documented the most significant decline, with the mean age of diagnosis falling from 63 years in 1996–2000 to 57 years in 2011–2015. The average age of diagnosis for nasopharyngeal patients remained relatively static, at 49 in 1996, rising slightly to 50 in 2011 and 2015, an observation consistent with statistics from other Asian countries [39].

A finding from our research was the higher ASR of overall HNC in men compared to women. This gender discrepancy aligns with prior studies examining HNC trends [40], and points towards a higher prevalence of risk factors such as smoking and alcohol consumption among men. These behaviours, particularly tobacco and alcohol use, have been recognised as significant risk factors for HNC [41].

In the context of Vietnam, understanding the trends in alcohol consumption and smoking is essential. Over the years, Vietnam has experienced an upward trend in both smoking and alcohol consumption, particularly among men [42]. Evidently, these lifestyle factors could contribute to the observed higher ASR of HNC in men. Efforts to reduce the prevalence of these risk factors could potentially lead to a decrease in the incidence of HNC and need to be an integral part of any comprehensive cancer control strategy [43]. This highlights the urgency for public health measures in this region to mitigate these risk factors, and, thus, potentially reduce the incidence of HNC among men.

Differences between our study and existing data, particularly regarding the prevalence of HPV-related oropharyngeal cancer, could potentially be attributed to a lack of data on HPV infection rates, especially HPV16, in Vietnam. Our data illustrates a consistent increase in oropharyngeal cases across the observed years, a trend possibly linked to HPV16. This warrants a more in-depth exploration, as do the regional factors that may be influencing the observed earlier age of diagnosis and decreasing age trends.

Whilst the escalating incidence of oropharyngeal cancer could signal the significant role of HPV, attention needs to be drawn to the potential benefits of an expanded HPV vaccination programme in Vietnam. The demonstrated efficacy of the HPV vaccine in preventing HPV-related cancers is internationally recognised [44]. By 2019, it had been incorporated into the national immunization programs of 100 countries, endorsed by the World Health Organization [45]. Vietnam, where the prevalence of HPV infection varies widely and vaccine coverage remains low, would particularly benefit from this approach.

Simultaneously, the data highlights the imperative for robust HNC detection, given the earlier age of diagnosis and decreasing age trends observed. Delays in cancer diagnosis contribute to heightened risk of premature death and lower survival rates; in late-stage HNC, the overall 5-year survival rate is less than 40% [35]. Hence, screening strategies for early identification of HNC cases in Vietnam warrant consideration.

These conclusions, while significant, should be framed within the strengths and limitations of our study. The data were drawn from a well-established registry, ensuring a comprehensive capture of total HNC incidence in Ho Chi Minh City. Nevertheless, our inability to track individual patients for survival analysis and the potential non-generalisability of our findings to rural or non-urban settings, where HNC incidence may be lower, must be acknowledged.

In conclusion, our registry-based study exposes an increasing trend over the past 20 years for all HNC subtypes in Ho Chi Minh City. These findings present a foundation for the development of future cancer control strategies. Given the rapidly expanding population and economy of Vietnam, the implementation of appropriate healthcare policy and measures, including HPV vaccination and cancer screening, is poised to impact future HNC diagnoses and treatments in this region.

Ethical approval and consent to participate

The research was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent for participation in the study procedures. The study was approved by the Ethics Committee of the Oncology Hospital of Ho Chi Minh City.

Consent for publication

Not applicable.

Data availability statement

All data generated or analysed during this study are included in this published article and its supplementary information files.

Conflict of interest

The authors declare no competing interests

Funding

This project was funded by a Translational Cancer Research Network PhD Scholarship Top-Up Award, supported by the Cancer Institute NSW Australia.

Authors’ contributions

FD and NT developed the original idea and drafted the initial manuscript. FD, DP, NDH, TVN, DS and NHT performed data analysis and provided input into the manuscript. All authors provided intellectual input and reviewed the final submission.

Acknowledgements

FD is supported by a UTS scholarship.

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No competing interests reported.

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Trends in Head and Neck Cancer incidence in Ho Chi Minh City, Vietnam between 1995-2015

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Abstract

Figures

Introduction

Methods

Ho Chi Minh City Cancer Registry

Calculating ASR

Logistic joinpoint regression model

Results

Recorded HNC cases in Ho Chi Minh City 1996–2015

Incidence rates of HNC in Ho Chi Minh City 1996–2015

The 5-year age-standardised incidence rate (ASR) for HNC

Joinpoint regression analysis

Discussion

Declarations

References

Additional Declarations

Supplementary Files

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