Background: Head and neck cancer (HNC) is the seventh most common cancer worldwide. Incidence rates of these tumors vary between countries and change over time depending on the prevalence of risk factors such as tobacco and alcohol consumption, betel nut chewing habits or human papillomavirus infection. This makes it necessary to periodically study HNC incidence trends in each geographic area. Methods: To determine trends in the incidence of HNC, all cancer cases diagnosed in Girona and Tarragona (northeastern Spain) between 1994 and 2018, except mesenchymal and hematological neoplasms, were included. Crude and standardized incidence rates and the annual percentage change (APC) were calculated. Results: We identify 7,966 cases of HNC, 83.7% in men. A significant decrease in incidence, with an APC of – 1.83, was observed in all HNC as a whole and in cancers of the lip (APC = – 5.34), salivary glands (APC = – 2.22), nasopharynx (APC = – 2.01), hypopharynx (APC = – 3.15), and larynx (APC = – 1.97). In men, a significant decline in incidence was observed in overall HNC and in cancers of the lip, oral cavity, salivary glands, nasopharynx, hypopharynx, and larynx. In women, a significant increase was identified in overall HNC and in cancers of oral cavity, oropharynx, hypopharynx, and larynx. Conclusion: A decline in the overall incidence of HNC has been observed in this area of southern Europe, mainly based on a decrease in men of cancers of the lip, oral cavity, salivary glands, nasopharynx, hypopharynx, and larynx
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