Epidemiology and Histopathology of Nasopharyngeal Neoplasms in Iran

Document Type : Original


1 National Research Institute of Tuberculosis and Lung Diseases, Massih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, US.

3 Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 Cancer Office, Deputy of Health, Ministry of Health, Tehran, Iran.


Introduction: This study aimed to study the trend, histologic pattern, geographical distribution, and characteristics of nasopharyngeal carcinoma (NPC) and nasopharyngeal neoplasms (NPN) from 2003 to 2017 in Iran.
Material and Methods: The Ministry of Health and Medical Education collected NPN cases from each province's corresponding university and stored them at Iran's National Cancer Registry (INCR) database. The Joinpoint program calculated the average annual percent change (AAPC) and its 95% confidence interval (CI). The jump model minimized the interfering effect of INCR transformation.
Results: A total of 3653 NPN cases were reported between 2003-2010 and 2014-2017 with a mean age of 49.04 ± 18.31 years and a male to female ratio of 2.15. The age-standardized incidence rate (ASIR) per 100,000 person-years in 2017 was 0.30 and 0.68 for females and males, respectively. Although the ASIR/100,000 of NPN raised from 0.35 to 0.49 during 2003-2017, the trend was constant with a AAPC of -2% (95% CI: -4.8% to 0.9%). The age-specific incidence rate was highest in the older than 70 years-old population (1.56/100,000). NPC formed 77.1% of NPNs and showed a constant pattern (AAPC CI: -5.7% to 0.2%), in contrast to the significant increase of non-keratinizing squamous cell carcinoma (AAPC CI: 2.3% to 24.5%).
Conclusions: Nasopharynx cancer is rare in Iran, and NPC incidence remained constant during 2003-2017, unlike their rising trend previously reported. However, non-keratinizing squamous cell carcinoma exhibited a significant increase, and future studies are needed to examine the role of the Epstein-Barr virus on this growth rate.


  1. Williams MD, Tischler AS. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Paragangliomas. Head Neck Pathol.2017;11(1):
  2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3): 209–49.
  3. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010; 127(12):2893–917.
  4. Okekpa SI, Mydin RBSMN, Ganeson S, A/L Gopalan S, Musa MY. The association between tea consumption and nasopharyngeal carcinoma: A systematic review and meta-analysis. Asian Pacific J Cancer Prev. 2020 Aug;21(8):2183–7.
  5. Okekpa SI, Mydin RBSMN, Mangantig E, Azmi NSA, Zahari SNS, Kaur G, et al. Nasopharyngeal carcinoma (NPC) risk factors: A systematic review and meta-analysis of the association with lifestyle, diets, socioeconomic and sociodemographic in asian region. Asian Pacific J Cancer Prev. 2019 Nov; 20(11): 3505–14.
  6. Janvilisri T. Omics-based identification of biomarkers for nasopharyngeal carcinoma. Dis Markers. 2015;2015.
  7. Wei K rong, Xu Y, Liu J, Zhang WJ, Liang ZH. Histopathological classification of nasopharyngeal carcinoma. Asian Pacific J Cancer Prev. 2011; 12(5): 1141–7.
  8. Sharif SET, Zawawi N, Yajid AI, Shukri NM, Mohamad I. Pathology classification of nasopharyngeal carcinoma. In: An Evidence-Based Approach to the Management of Nasopharyngeal Cancer. Elsevier; 2020. p. 73–92.
  9. Lee AWM, Ng WT, Chan YH, Sze H, Chan C, Lam TH. The battle against nasopharyngeal cancer. Radiother Oncol. 2012;104(3):272–8.
  10. Ghoncheh M, Mahdavifar N, Darvishi E, Salehiniya H. Epidemiology, incidence and mortality of breast cancer in Asia. Asian Pacific J Cancer Prev. 2016;17(6):47–52.
  11. Hui EP, Chan AT. Epidemiology, etiology, and diagnosis of nasopharyngeal carcinoma. BrocksteinB E, BrizelD M, FriedM P, RossM E(Eds), UpToDate Waltham, MA UpToDate, Inc Retrieved from http//www uptodate com. 2016; 1–11.
  12. Tsui EYK, Chan JHM, Ramsey RG, Leung TW, Cheung YK, Luk SH, et al. Late temporal lobe necrosis in patients with nasopharyngeal carcinoma: Evaluation with combined multi-section diffusion weighted and perfusion weighted MR imaging. Eur J Radiol. 2001;39(3):133–8.
  13. Hu C-Y, Wang W-M, Chu X-H, Ren Z-H, Lyu J. Global, regional, and national burden of nasopharyngeal carcinoma from 1990 to 2017-Results from the Global Burden of Disease Study 2017. Head Neck [Internet]. 2020 Nov 1 ;42(11): 3243–52. Available from: https://doi.org/10. 1002/ hed.26378
  14. Petersson F. Nasopharyngeal carcinoma: a review. In: Seminars in diagnostic pathology. Elsevier; 2015. p. 54–73.
  15. Johnson RL. Robbins Basic Pathology. Vol. 127, Archives of Pathology & Laboratory Medicine. Elsevier Health Sciences; 2003. 1532–1532 p.
  16. Zhou X, Cui J, Macias V, Ye H, Wang J, Rao PN. The progress on genetic analysis of nasopharyngeal carcinoma. Comp Funct Genomics. 2007;2007.
  17. Safavi A, Raad N, Raad N, Ghorbani J. Epidemiology of nasopharyngeal cancers in Iran: A 6-year report. Asian Pacific J Cancer Prev. 2015; 16(10):4447–50.
  18. Safavi-Naini A, Raad N, Ghorbani J, Chaibakhsh S, Ramezani-Daryasar R. Incidence trends and geographical distribution of nasopharyngeal carcinoma in Iran. Iran J Cancer Prev.2015;8(1):24-8.
  19. Iran’s National Population-Based Cancer Registry Guidline [Internet]. 2015 [cited 2021 Oct 16]. Available from: http://crc.sbmu.ac.ir/ uploads/ .pdf
  20. Mohammadi G, Akbari ME, Mehrabi Y, Motlagh AG. Quality assessment of the national cancer registry in iran: Completeness and validity. Int J Cancer Manag. 2016;9(6).
  21. Chen HS, Zeichner S, Anderson RN, Espey DK, Kim HJ, Feuer EJ. The joinpoint-jump and joinpoint-comparability ratio model for trend analysis with applications to coding changes in health statistics. J Off Stat [Internet]. 2020; 36(1): 49–62. Available from: https://doi.org/10.2478/jos-2020-0003
  22. Seymour L, Brockwell PJ, Davis RA. Introduction to Time Series and Forecasting. Vol. 92, Journal of the American Statistical Association. Springer; 1997. 1647 p.
  23. dos Santos Silva I. Cancer epidemiology: principles and methods. IARC; 1999.
  24. World Health Organization. Cancer Fact Sheets. Globocan 2012 [Internet]. 2012;0–5. Available from: http://globocan.iarc. fr/Pages/ fact_ sheets_ cancer.aspx
  25. Bray F, Haugen M, Moger TA, Tretli S, Aalen OO, Grotmol T. Age-incidence curves of nasopharyngeal carcinoma worldwide: Bimodality in low-risk populations and aetiologic implications. Cancer Epidemiol Biomarkers Prev. 2008; 17(9): 2356–65.
  26. Khan G, Fitzmaurice C, Naghavi M, Ahmed LA. Global and regional incidence, mortality and disability-adjusted life-years for Epstein-Barr virus-attributable malignancies, 1990-2017. BMJ Open. 2020 Aug; 10(8):e037505.
  27. Alotaibi AD, Ahmed HG, Elasbali AM. Nasopharyngeal cancer in Saudi Arabia: Epidemiology and possible risk factors. J Oncol Sci. 2019; 5(1):23–30.
  28. Carioli G, Negri E, Kawakita D, Garavello W, La Vecchia C, Malvezzi M. Global trends in nasopharyngeal cancer mortality since 1970 and predictions for 2020: Focus on low-risk areas. Int J Cancer. 2017 May; 140(10):2256–64.
  29. Ferdosi S, Farsi L, Tajali SM, Soltani H. Seroprevalence Anti-Toxoplasma gondii antibodies and Anti- Epstein-Barr virus (EBV) Antibody among volunteer blood donors Referred Gonabad Blood Transfusion. Zbmujournal. 2013; 5(2):60–9.
  30. Faghihloo E, Saremi MR, Mahabadi M, Akbari H, Saberfar E. Prevalence and characteristics of epstein–barr virus-associated gastric cancer in Iran. Arch Iran Med. 2014; 17(11):763–70.
  31. Tabibzadeh A, Niya MHK, Esghaei M, Bokharaei-Salim F, Ataei-Pirkooh A, Kiani SJ, et al. Molecular epidemiology of epstein-barr virus (ebv) in patients with hematologic malignancies. Asian Pacific J Cancer Prev. 2020; 21(3):693–8.
  32. Zaidi ARZ, Al-Ammari MO, AlNoamani M, Altaf SY, AlShehry N, Tailor IK, et al. Very High Seroprevalence of CMV and EBV Among a Large Series of Patients with Hematological Malignancies at a Tertiary Care Center in Saudi Arabia - a Case for Investigating Cooperativity of Viruses in Carcinogenesis? 2019 Nov;134 (Supple ment_1): 5818–5818.
  33. Farrell PJ. Epstein-Barr Virus and Cancer. Annu Rev Pathol Mech Dis. 2019;14(3):29–53.
  34. Motamedi M, Merghati-Khoei E, Shahbazi M, Rahimi-Naghani S, Salehi M, Karimi M, et al. Paradoxical attitudes toward premarital dating and sexual encounters in Tehran, Iran: A cross-sectional study. Reprod Health. 2016; 13(1):1–10.
  35. Sharifipour S, Davoodi Rad K. Seroprevalence of Epstein–Barr virus among children and adults in Tehran, Iran. New Microbes New Infect. 2020;34: 100641.
  36. Martin JN. The epidemiology of KSHV and its association with malignant disease. Hum Herpesviruses Biol Ther Immunoprophyl. 2007;
  37. RIDEN K, address P. Classification of Head and Neck Tumours. Key Topics in Oral and Maxillofacial Surgery. International Agency for Research on Cancer (IARC); 2010. 64–68 p.
  38. Geck C. The World Factbook. Vol. 19, The Charleston Advisor. 2017. p. 58–60.
  39. Patel VJ, Chen NW, Resto VA. Racial and Ethnic Disparities in Nasopharyngeal Cancer Survival in the United States. Otolaryngol - Head Neck Surg (United States). 2017; 156(1):122–31.
  40. Bhopal R, Donaldson L. White, European, Western, Caucasian, or what? Inappropriate labeling in research on race, ethnicity, and health. Am J Public Health. 1998 Sep; 88(9):1303–7.
  41. Azizi F, Rahmani M, Allahverdian S, Hedayati M. Effects of salted food consumption on urinary iodine and thyroid function tests in two provinces in the Islamic Republic of Iran. East Mediterr Heal J. 2001; 7(1–2):115–20.
  42. Almasi Z, Mohammadian-Hafshejani A, Salehiniya H. Incidence, mortality, and epidemiological aspects of cancers in Iran; differences with the world data. J BUON. 2016; 21(4): 994–1004.
  43. Soong YL, Tham IWK. Epidemiology of nasopharyngeal carcinoma. In: Clinical Insights: Nasopharyngeal Carcinoma: Management Strategies. Elsevier; 2014. p. 5–20.
  44. Xiao G, Cao Y, Qiu X, Wang W, Wang Y. Influence of gender and age on the survival of patients with nasopharyngeal carcinoma. BMC Cancer. 2013;13(1):1–8.
  45. Polesel J, Serraino D, Negri E, Barzan L, Vaccher E, Montella M, et al. Consumption of fruit, vegetables, and other food groups and the risk of nasopharyngeal carcinoma. Cancer Causes Control. 2013; 24(6):1157–65.
  46. Lee AWM, Foo W, Mang O, Sze WM, Chappell R, Lau WH, 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.
  47. Pan XX, Liu YJ, Yang W, Chen YF, Tang WB, Li CR. Histological subtype remains a prognostic factor for survival in nasopharyngeal carcinoma patients. Laryngoscope. 2020;130(3):E83–8.
  48. Marks JE, Phillips JL, Menck HR. The national cancer data base report on the relationship of race and national origin to the histology of nasopharyngeal carcinoma. Cancer. 1998 Aug; 83(3): 582–8.
  49. Qaisi M, Eid I. Pediatric Head and Neck Malignancies. Oral Maxillofac Surg Clin North Am. 2016; 28(1):11–9.
  50. Abdulamir AS, Hafidh RR, Abdulmuhaimen N, Abubakar F, Abbas KA. The distinctive profile of risk factors of nasopharyngeal carcinoma in comparison with other head and neck cancer types. BMC Public Health. 2008;8(1):400.
  51. Hashim D, Genden E, Posner M, Hashibe M, Boffetta P. Head and neck cancer prevention: From primary prevention to impact of clinicians on reducing burden. Ann Oncol. 2019;30(5):744–56.
  52. Dasari V, Bhatt KH, Smith C, Khanna R. Designing an effective vaccine to prevent Epstein-Barr virus-associated diseases: challenges and opportunities. Expert Rev Vaccines. 2017; 16(4): 377–90.