Elsevier

European Journal of Cancer

Volume 48, Issue 15, October 2012, Pages 2369-2374
European Journal of Cancer

Trends in sinonasal cancer in The Netherlands: More squamous cell cancer, less adenocarcinoma: A population-based study 1973–2009

https://doi.org/10.1016/j.ejca.2012.05.003Get rights and content

Abstract

Background

Cancer of the nasal cavity or the paranasal sinuses (sinonasal cancer) is rare. Sinonasal cancer has been associated with various occupational risk factors such as exposure to dust of hard wood and leather. Also, a relationship with smoking habits has been suggested. We studied the long term trends in incidence to evaluate a putative effect of past preventive measures or changes in risk factors.

Design

A retrospective population-based descriptive study.

Objective

To interpret the long term trends in incidence of sinonasal cancer in The Netherlands.

Methods

Data of all 3329 patients >15 years registered during 1989–2009 by the Netherlands Cancer Registry (NCR) were analysed, by data of 447 patients registered by the Eindhoven Cancer Registry (ECR) during 1973–2009 were analysed separately. Information on patients and tumour characteristics was obtained from both registries. The incidence was calculated per 1,000,000 person years and standardised using the European Standard Population.

Results

Squamous cell carcinoma (SCC) was the most prominent histological type (48%), followed by adenocarcinoma (15%) and melanoma (8%). SCC was more frequently located in the nasal cavity or sinus maxillaris, but adenocarcinoma was more located in the ethmoid sinus. The male incidence increased during1973–1995 with a peak of 15/1,000,000/year, decreasing since then to 11/1,000,000/year due to a declining incidence of both SCC and adenocarcinoma. In females the incidence remained stable around 5/1,000,000/year up to 2006 and increased to 7.5/1,000,000 in 2009 as a result of more SCC. The male/female ratio for SCC decreased from 2.7 to 2.0, and for adenocarcinoma from 3.4 to 2.8 since 1989.

Conclusions

The higher incidence in males and the different trends in incidence in males and females may reflect differences in previous exposure to risk factors. Adenocarcinoma, related to occupational exposures, tend to decline. The trends in both male and female sinonasal SCC are comparable with the trends in lung cancer.

Introduction

Sinonasal cancer (cancer primarily located in the nasal cavity or the paranasal sinuses) is a rare cancer type in most areas of the world. In The Netherlands about 100 new cases in males and 60 in females are registered yearly, accounting for only 0.2% of all new cancers (www.ikc-net.nl). An association between sinonasal cancers and occupational exposure to wood dust has been described in several studies published in the late 1960s and early 1970s.1, 2 Especially adenocarcinoma of the nasal cavity or sinuses is strongly related with exposure to dust from hard wood (e.g. oak or beech) or leather dust.3, 4 This relationship has been established in numerous case–control studies and cohort studies summarised in the 1995 monograph of the International Agency for Research on Cancer (IARC).5 This report stated that there is sufficient evidence in humans for the carcinogenicity of wood dust (group 1).5 The Dutch Health Council confirmed this conclusion in 2000 and recommended exposure limits.6 Since the late 1980s, the wood processing industry and the building industry in The Netherlands has implemented several measures to prevent or diminish occupational exposure to wood dust (R.A. Manssen, Eurobois Europe Inc., personal communication). However, a cross-sectional survey on the exposure to wood dust among workers in the building and construction industry showed ongoing exceedance of the exposure limits.7 Also, during the 1980s and 1990s the leather processing industry moved out of The Netherlands to low-income countries. The role of other aetiologic factors (such as exposure to paints, lacquers, nickel or formaldehyde, or smoking habits) on the development of sinonasal cancer could not be ruled out.8, 9, 10, 11, 12 Changes in the incidence and distribution of the different histological types of sinonasal cancer can be an indication for changes in environmental or occupational exposures. Therefore, we studied the long term trends in the incidence of sinonasal cancer in SE Netherlands since 1973, and the trends of the several histological types of sinonasal cancer in The Netherlands since 1989.

Section snippets

Patients and methods

For the study of trends in incidence we used data from the nation-wide Netherlands Cancer Registry (NCR). The NCR consists of 8 regional cancer registries and is in operation since 1989. The NCR covers the total population of The Netherlands (16.5 million persons). Each regional cancer registry receives lists of all newly diagnosed cancers on a regular basis from the pathology departments (all participating in the nation-wide pathology network PALGA). In addition, the medical records in

Results

The median age of male sinonasal cancer patients was 68 years and for female patients 67 years; the median age of SCC patients was 68 years and for adenocarcinoma patients 65 years. The age-specific incidence for the NCR patients is shown in Fig. 1. The incidence in males rises sharply after the age of 45 years (with a peak incidence of 1730 per million at 80 years), whereas the incidence in women raises steadily with age (with the highest incidence of 680 per million at 85 years).

Discussion

This study is the first describing the trends in incidence of sinonasal cancer in The Netherlands over a long period based on data derived from both a longstanding regional cancer registry and a nation-wide population based cancer registry. We found indications for a decreasing number of occupational related sinonasal adenocarcinoma. Also, we found indications that an association of smoking habits with SCC may exist.

Conflict of interest statement

All authors declare that there are no potential or actual conflicts of interest.

Acknowledgement

We thank the Netherlands Cancer Registry for providing the data for this study.

References (22)

  • E.D. Acheson et al.

    Nasal cancer in woodworkers in the furniture industry

    Br Med J

    (1968)
  • E.D. Acheson et al.

    Adenocarcinoma of the nasal cavity and sinuses in England and Wales

    Br J Ind Med

    (1972)
  • R.B. Hayes et al.

    Wood-related occupations, wood dust exposure, and sinonasal cancer

    Am J Epidemiol

    (1986)
  • A. D’Errico et al.

    A case–control study on occupational risk factors for sino-nasal cancer

    Occup Environ Med

    (2009)
  • International Agency for the Research on Cancer IARC

    IARC monographs on the evaluation of carcinogenic risks to humans

    (1995)
  • Health Council of the Netherlands: Hardwood and softwood dust; evaluation of the carcinogenicity and genotoxicity. The...
  • T. Spee et al.

    Exposure to wood dust among carpenters in the construction industry in The Netherlands

    Ann Occup Hyg

    (2007)
  • S. Hernberg et al.

    Nasal and sinonasal cancer. Connection with occupational exposures in Denmark, Finland and Sweden

    Scand J Work Environ Health

    (1983)
  • R.B. Hayes et al.

    Cancer of the nasal cavity and paranasal sinuses, and formaldehyde exposure

    Int J Cancer

    (1986)
  • A. ‘t Mannetje et al.

    Sinonasal cancer, occupation, and tobacco smoking in European women and men

    Am J Ind Med

    (1999)
  • F.W. Sunderman

    Review: nasal toxicity, carcinogenity, and olfactory uptake of metals

    Ann Clin Lab Sci

    (2001)
  • Cited by (52)

    • A population-based comparison of European and North American sinonasal cancer survival

      2018, Auris Nasus Larynx
      Citation Excerpt :

      Examination of gender demographics across continents revealed a predominance of male cases within every region. One factor explaining these findings is in regards to occupational related exposure, particularly wood dust [12,17]. Wood dust exposure is common amongst those working in forestry, furniture making, and the pulp and paper industries — occupations which have been historically male dominated [4,12].

    • Spanish consensus for the management of sinonasal tumors

      2017, Acta Otorrinolaringologica Espanola
    • Population-Based Results in the Management of Sinonasal and Ventral Skull Base Malignancies

      2017, Otolaryngologic Clinics of North America
      Citation Excerpt :

      For those with distant disease, a similar trend is seen, although adding RT to surgery is better than surgery alone. A query of the Netherlands Cancer Registry, encompassing the entire national population of 16.5 million between 1989 and 2009, found 3329 patients with sinonasal malignancies showing similar histologic trends with SCC as the most common histologic type (48%), followed by SNAC (15%), and melanoma (8%).13 Consistent with other studies, SCC more commonly involves the nasal cavity and maxillary sinus, whereas SNAC more commonly involves the ethmoid sinus.

    • Development of minimally invasive surgery for sinonasal malignancy

      2016, Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
    View all citing articles on Scopus
    View full text