Abstract
BACKGROUND: Although recent global studies have highlighted shifting patterns in oropharyngeal cancer, Korea lacks comprehensive epidemiological data on oral cancer, including detailed prevalence by anatomical subsites, age, and sex. This study aims to analyze long-term trends in oral cancer incidence and mortality in Korea, with particular attention to disease spectrum across subsites. METHODS: Patient data from individuals diagnosed between 2001 and 2021 were obtained from Cancer Registration Statistics by the Ministry of Health and Welfare, while cause-of-death statistics from Statistics Korea provided information on deaths due to malignant neoplasms of the lip, oral cavity, and pharynx. Age-standardized incidence and mortality rates were calculated using the direct method, with the 2000 Korean mid-year population as the standard. Temporal trends were assessed using joinpoint regression analysis to estimate annual percentage changes (APCs) and to identify significant shifts in incidence and mortality across sex, age group, and subsites. RESULTS: The overall trend in oral cancer incidence among males was modest (APC: 0.30), with the most notable increase observed in those aged 45 or younger (APC: 2.13). In females, oral cancer incidence showed a significant increase (APC: 2.19), with the highest rise occurring in those aged 45 or younger (APC: 3.20). Subsite-specific trends showed that in males, the greatest increases were in cancers of the tonsils (APC: 3.11), salivary glands (APC: 2.01), and tongue (APC: 1.95), whereas in females, the tongue (APC: 3.97), tonsils (APC: 3.85), and salivary glands (APC: 3.09) showed the highest increases. CONCLUSIONS: These findings demonstrate distinct epidemiological shifts in oral cancer in Korea over the past two decades, particularly by age, sex, and anatomical subsite. While incidence increased notably among younger females, mortality declined in males, suggesting improved survival outcomes. These results underscore the importance of continuous monitoring and subsite-specific prevention strategies tailored to evolving demographic and clinical patterns.