Secular trends of nasopharyngeal carcinoma incidence in Singapore, Hong Kong and Los Angeles Chinese populations, 1973–1997

  • Juhua Luo
  • Kee Seng Chia
  • Sin Eng Chia
  • Marie Reilly
  • Chuen Seng Tan
  • Weimin Ye


Nasopharyngeal carcinoma (NPC) is a rare cancer in most parts of world, but rather common in Southern China and Southeast Asia. This study used IARC published datasets to explore the secular trends of incidence rates of NPC among different Chinese populations in Singapore, Hong Kong and Los Angeles, over the time period 1973–1997. We observed great disparity in the risks and time trends of NPC in those selected Chinese populations. The highest risk was in Hong Kong where the incidence rates have declined rapidly throughout the whole study period in both males and females. For Singapore Chinese, the incidence rates also dropped recently in both genders, but the low incidence rates in Los Angeles Chinese have remained essentially unchanged over time. We further assessed the contribution of period and cohort effects to the observed trends in Hong Kong and Singapore populations through age-period-cohort modeling and found that an age-cohort model provided the best fit to the data in both populations, although for Singapore females a simple age-drift model fit the data well. There was a statistically significant decrease in the drop in incidence of NPC for cohorts born around 1940 in Hong Kong and 1958 in Singapore. This indicates that environmental and lifestyle changes play an important role in the declining incidence of NPC over time.


Nasopharyngeal carcinoma Secular trends Age-period-cohort model 


  1. 1.
    Kumar S, Mahanta J. Aetiology of nasopharyngeal carcinoma. A review. Indian J Cancer 1998;35(2):47–56.PubMedGoogle Scholar
  2. 2.
    Yu MC, Yuan JM. Epidemiology of nasopharyngeal carcinoma. Semin Cancer Biol 2002;12(6):421–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Cancer incidence in five continents, vol. 7. IARC Sci Publ, 1997(143): p. i–xxxiv, 1–1240.Google Scholar
  4. 4.
    Proceedings of the IARC working group on the evaluation of carcinogenic risks to humans. Epstein-Barr virus and Kaposis sarcoma herpesvirus/human herpesvirus 8. Lyon, France, 17–24 June 1997. IARC Monogr Eval Carcinog Risks Hum, 1997;70:1–492.Google Scholar
  5. 5.
    Raab-Traub N. Epstein-Barr virus in the pathogenesis of NPC. Semin Cancer Biol 2002;12(6):431–41.PubMedCrossRefGoogle Scholar
  6. 6.
    Jia WH et al. Familial risk and clustering of nasopharyngeal carcinoma in Guangdong, China. Cancer 2004;101(2):363–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Zeng YX, Jia WH. Familial nasopharyngeal carcinoma. Semin Cancer Biol 2002;12(6):443–50.PubMedCrossRefGoogle Scholar
  8. 8.
    Yu MC, Henderson BE. Intake of Cantonese-style salted fish as a cause of nasopharyngeal carcinoma. IARC Sci Publ 1987;84:547–9.PubMedGoogle Scholar
  9. 9.
    Lee AW et al. Changing epidemiology of nasopharyngeal carcinoma in Hong Kong over a 20-year period (1980–99): an encouraging reduction in both incidence and mortality. Int J Cancer 2003;103(5):680–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Hsu C et al. Difference in the incidence trend of nasopharyngeal and oropharyngeal carcinomas in Taiwan: implication from age-period-cohort analysis. Cancer Epidemiol Biomarkers Prev 2006;15(5):856–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Sun LM et al. Trends in the incidence rates of nasopharyngeal carcinoma among Chinese Americans living in Los Angeles County and the San Francisco metropolitan area, 1992–2002. Am J Epidemiol 2005;162(12):1174–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Jia WH et al. Trends in incidence and mortality of nasopharyngeal carcinoma over a 20–25 year period (1978/1983–2002) in Sihui and Cangwu counties in southern China. BMC Cancer 2006;6:178.PubMedCrossRefGoogle Scholar
  13. 13.
    Cancer incidence in five continents, vol. 4. IARC Sci Publ 1982;42:1–807.Google Scholar
  14. 14.
    Cancer incidence in five continents, vol. 5. IARC Sci Publ 1987;88:1–970.Google Scholar
  15. 15.
    Cancer Incidence in Five Continents. Age-standardized incidence rates, four-digit rubrics, and age-standardized and cumulative incidence rates, three-digit rubrics. IARC Sci Publ 1992;120:871–1011.Google Scholar
  16. 16.
    Cancer incidence in five continents, vol. 8. IARC Sci Publ 2002;155:1–781.Google Scholar
  17. 17.
    Clayton D, Schifflers E. Models for temporal variation in cancer rates. II: Age-period-cohort models. Stat Med 1987;6(4):469–81.PubMedCrossRefGoogle Scholar
  18. 18.
    Clayton D, Schifflers E. Models for temporal variation in cancer rates. I: Age-period and age-cohort models. Stat Med 1987;6(4):449–67.PubMedCrossRefGoogle Scholar
  19. 19.
    Holford TR. The estimation of age, period and cohort effects for vital rates. Biometrics 1983;39(2):311–24.PubMedCrossRefGoogle Scholar
  20. 20.
    Holford TR. Analysing the temporal effects of age, period and cohort. Stat Methods Med Res 1992;1(3):317–37.PubMedGoogle Scholar
  21. 21.
    Pawitan Y. In all likelihood. Statistical modeling and inference using likelihood (Section 3.5). Oxford: Oxford Science Publicaitons; 2001.Google Scholar
  22. 22.
    Zucchini W. An introduction to model selection. J Math Psychol 2000;44(1):41–61.PubMedCrossRefGoogle Scholar
  23. 23.
    Robertson C, Gandini S, Boyle P. Age-period-cohort models: a comparative study of available methodologies. J Clin Epidemiol 1999;52(6):569–83.PubMedCrossRefGoogle Scholar
  24. 24.
    Robertson C, Boyle P. Age-period-cohort analysis of chronic disease rates. I: Modelling approach. Stat Med 1998;17(12):1305–23.PubMedCrossRefGoogle Scholar
  25. 25.
    Tarone RE, Chu KC. Evaluation of birth cohort patterns in population disease rates. Am J Epidemiol 1996;143(1):85–91.PubMedGoogle Scholar
  26. 26.
    Jemal A, Chu KC, Tarone RE. Recent trends in lung cancer mortality in the United States. J Natl Cancer Inst 2001;93(4):277–83.PubMedCrossRefGoogle Scholar
  27. 27.
    Kupper LL et al. Statistical age-period-cohort analysis: a review and critique. J Chronic Dis 1985;38(10):811–30.PubMedCrossRefGoogle Scholar
  28. 28.
    Shanmugaratnam K, Lee HP, Day NE. Cancer incidence in Singapore 1968–1977. IARC Sci Publ 1983;(47):1–171.Google Scholar
  29. 29.
    Buell P. The effect of migration on the risk of nasopharyngeal cancer among Chinese. Cancer Res 1974;34(5):1189–91.PubMedGoogle Scholar
  30. 30.
    Yu MC et al. Nasopharyngeal carcinoma in Chinese—salted fish or inhaled smoke? Prev Med 1981;10(1):15–24.PubMedCrossRefGoogle Scholar
  31. 31.
    Fraumeni JF Jr, Mason TJ. Cancer mortality among Chinese Americans, 1950–69. J Natl Cancer Inst 1974;52(3):659–65.PubMedGoogle Scholar
  32. 32.
    Burt RD, Vaughan TL, McKnight B. Descriptive epidemiology and survival analysis of nasopharyngeal carcinoma in the United States. Int J Cancer 1992;52(4):549–56.PubMedCrossRefGoogle Scholar
  33. 33.
    Lee JT, Ko CY. Has survival improved for nasopharyngeal carcinoma in the United States? Otolaryngol Head Neck Surg 2005;132(2):303–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Simons MJ et al. Immunogenetic aspects of nasopharyngeal carcinoma. IV. Increased risk in Chinese of nasopharyngeal carcinoma associated with a Chinese-related HLA profile (A2, Singapore 2). J Natl Cancer Inst 1976;57(5):977–80.PubMedGoogle Scholar
  35. 35.
    Goldsmith DB, West TM, Morton R. HLA associations with nasopharyngeal carcinoma in Southern Chinese: a meta-analysis. Clin Otolaryngol Allied Sci 2002;27(1):61–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Hu SP et al. Further evidence for an HLA-related recessive mutation in nasopharyngeal carcinoma among the Chinese. Br J Cancer 2005;92(5):967–70.PubMedCrossRefGoogle Scholar
  37. 37.
    Lu CC et al. Genetic susceptibility to nasopharyngeal carcinoma within the HLA-A locus in Taiwanese. Int J Cancer 2003;103(6):745–51.PubMedCrossRefGoogle Scholar
  38. 38.
    Lu SJ et al. Linkage of a nasopharyngeal carcinoma susceptibility locus to the HLA region. Nature 1990;346(6283):470–1.PubMedCrossRefGoogle Scholar
  39. 39.
    Tse LA et al. Incidence rate trends of histological subtypes of nasopharyngeal carcinoma in Hong Kong. Br J Cancer 2006;95(9):1269–73.PubMedCrossRefGoogle Scholar
  40. 40.
    Vaughan TL et al. Nasopharyngeal cancer in a low-risk population: defining risk factors by histological type. Cancer Epidemiol Biomarkers Prev 1996;5(8):587–93.PubMedGoogle Scholar
  41. 41.
    Au JS et al. Time trends of lung cancer incidence by histologic types and smoking prevalence in Hong Kong 1983–2000. Lung Cancer 2004;45(2):143–52.PubMedCrossRefGoogle Scholar
  42. 42.
    Ho J. Recent advances in human tumor virology and immunology. In: W N et al., editors. Genetic and environmental factors in nasopharyngela carcinoma. Tokyo: University of Tokyo Press; 1971. p. 275–295.Google Scholar
  43. 43.
    Yu MC et al. Cantonese-style salted fish as a cause of nasopharyngeal carcinoma: report of a case-control study in Hong Kong. Cancer Res 1986;46(2):956–61.PubMedGoogle Scholar
  44. 44.
    Yu MC, Huang TB, Henderson BE. Diet and nasopharyngeal carcinoma: a case-control study in Guangzhou, China. Int J Cancer 1989;43(6):1077–82.PubMedCrossRefGoogle Scholar
  45. 45.
    Zheng YM et al. Environmental and dietary risk factors for nasopharyngeal carcinoma: a case-control study in Zangwu County, Guangxi, China. Br J Cancer 1994;69(3):508–14.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Juhua Luo
    • 1
  • Kee Seng Chia
    • 2
    • 3
  • Sin Eng Chia
    • 2
  • Marie Reilly
    • 1
  • Chuen Seng Tan
    • 1
    • 2
  • Weimin Ye
    • 1
  1. 1.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  2. 2.Center for Molecular Epidemiology, Faculty of MedicineNational University of SingaporeSingaporeSingapore
  3. 3.Department of Community, Occupational and Family Medicine, Faculty of MedicineNational Univeristy of SingaporeSingaporeSingapore

Personalised recommendations