Dr. Ameen, ENT Specialist in Kuala Lumpur

Part 1: Introduction and Epidemiology

Have you ever heard of nasopharyngeal carcinoma (NPC)? It’s a sneaky head-and-neck cancer that most people outside Asia never see. In fact, NPC is extremely rare globally – only about 1–2 cases per 100,000 people per year outside endemic areas. But imagine a map with a heat-spot in southern China and Southeast Asia lighting up in bright red: that’s exactly where NPC thrives. In some parts of southern China and East Malaysia, rates soar to as high as 20 per 100,000 – dozens of times higher than in the West. No wonder early researchers dubbed it the “Cantonese cancer,” after Hong Kong’s Cantonese community where it was first described. Today China still contributes over half of all NPC cases worldwide.

In 2022, an astonishing 83% of new NPC cases occurred in Asia. China alone accounted for about 51% of global NPC cases – that’s one in every two. The rest of Southeast Asia is no slouch: Indonesia (18.8%), Malaysia, Vietnam, Singapore, Thailand and the Philippines all report much higher NPC rates than the global average. For example, nearly 19% of all NPC cases were in Indonesia. In fact, nine of the world’s top ten regions for NPC incidence are in Southeast Asia. Even within countries, pockets of high risk exist – indigenous groups in East Malaysia, for instance, have “striking” NPC rates far above their neighbors.

Why Asia, and why only some people? We’ll dig into that soon. But first: NPC is truly a disease of geography and ancestry. Think of it like a plant that only grows in a particular climate. In North America or Europe, NPC is practically unheard of. On the other hand, in Singapore, Malaysia, Indonesia, southern China and Vietnam it’s part of the landscape. In fact, Southeast Asia accounted for about 36% of new NPC cases in 2022. To put it in perspective, China had 51,010 cases that year (50.9% of all cases), while Indonesia had 18,835 (18.8%). The pie chart above shows this imbalance clearly.

Wait for part 2 tomorrow..😄