Descriptive and analytical epidemiology of nasopharyngeal cancer

Information concerning the descriptive and analytical epidemiology of NPC that has been reported mainly since the first international symposium on the subject in Singapore in 1964 are reviewed. NPC is rare in most countries in the world, with an age-adjusted incidence rate of less than 1 per 100,000, and the incidence rate is twice as high in males as in females. Chinese of southern origin have a uniquely high risk, the incidence rates per 100,000 being 10--20 in males and 5--10 in females. The greater the admixture of southern Chinese blood in a given ethnic group, the more likely it is that the NPC incidence rate in that group will be raised. The incidence in both sexes begins to rise after the ages of 20--24 and reaches a plateau at between 45 and 54. When the logarithm of mortality and morbidity is plotted against the logarithm of the age, the power of the age that provides the best fit to a straight line on a log-log graph is approximately two to four. These figures are lower than for other cancers. Seroepidemiological case-control studies indicate that both different birthplace and abnormal response to EBV antigen significantly enhance the risk for NPC; when these two factors are combined, the relative risk appears to rise further. The effect of other environmental chemicals, such as from cigarette smoking, shown to be significant in several retrospective studies, could explain in part epidemiological phenomena such as sex difference in incidence. The definitive reason for the uniquely high risk in southern Chinese should be further investigated by taking into account the interactions of host factors (birthplace, HLA, etc.) and environmental factors (EBV, chemical carcinogens including nitrosamines, excessive intake of salted fish, nutritional deficiencies, etc.).