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