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India has a National Cancer Registry Program initiated in 1964 based upon Population Based Cancer Registries (PBCR), and the incidence of hypopharyngeal cancer is reported to be comparatively higher in the western and southern parts of the country in both sexes. Data for the entire country was collected by 26 PBCRs and 7 hospital-based registries. In the period 2012–2014, the ASR recorded for men and women illustrates the geographical variations: for men in East Kjasi Hills District, ASR has been recorded as 22.2; in the Kamrup Urban District, 17.5; the Aizawi District, 17.2; the Meghalaya, 15.1; the Cachar District, 11.1; and for women in the Kamrup Urban District, ASR was 3.2; in the Cachar District, 2.2; in Meghalaya, 2.2; the Diburgaeh District, 2.2; and the East Khasi Hills District, 2.2 [24]. The PBCR system covers less than 10% of the Indian population, and it is estimated that within this small catchment population, the incidence of hypopharyngeal cancer in men and women will increase by 6.0% or more by 2020. More than 90% of the Indian population have no cancer data registration, suggesting that the present data should be considered only the “tip of the iceberg” [25].

In France, there is an absence of a nationwide registry of cancer. The cancer incidence over 2 periods 1980–1985 and 2000–2004 was estimated by applying the incident/mortality ratios observed in the area covered by 11 regional contributing cancer registries and applied to the French National Mortality estimate [26]. Two time periods have been reported – during the period 1980–1985, the ASR of piriform sinus cancer (C12) in men was 7.67 and during the period 2000–2004 was 3.92, a reduction in the APC was –48.9%. A similar reduction was also recorded in men with hypopharyngeal cancer (C13) with the ACR reducing from 2.39 to 1.89, an ACR reduction of 20.9%. Data for women over the same time periods showed that for piriform sinus cancer (C12) in the early period, the ASR 0.24 had reduced by –4.2% to ASR 0.23, whereas for hypopharyngeal cancer (C13) in the early period, which was recorded as 0.06 had increased by +116.7% to 0.13. The reduction in the incidence of hypopharyngeal cancer is because the use of tobacco has been regularly decreasing in men – 71% in 1953 vs. 31.8%, but has increased in women 17% in 1953 vs. 25.7% in 2010. A similar reduction in the mean consumption of alcohol has been reported, decreasing from 26 L of pure alcohol per person in the 1980s to 13 L in 2005. Geographically there is a higher incidence of hypopharyngeal cancers in the northern, western and eastern regions than in the southern ones. It is worth recording that in the late 1980s, the ASR for hypopharyngeal cancer in the registry of Northern France (Nord et Pas-de-Calais) was 17.0 per 100,000 men and 0.5 per 100,000 women [27].

Spain has no national cancer registry, but there are 12 population-based registries in a country of 50 provinces. Data on hypopharyngeal cancer from 7 of these PBCR with a minimum follow-up period of 10 can be analysed, representing approximately 14% of the country’s population [28]. Over the period 1980 to early 2000, statistically significant differences in hypopharyngeal cancer trends in men were found between registries. In the provinces (Albacete and Asturias), there was an increasing trend, but the ACR was statistically significant only in Navarra. Trend analysis of hypopharyngeal cancer in women was not possible due to the low incidence in all individual registries. However, analysis of the pooled data demonstrated an increase of 2.8% per year, although this was not statistically significant. The ASIR per 100,000 person/years for men in 2001 was 2.5 and women 0.1. Using the data analysis mentioned above, the authors predict that the annual number of cases between 1998–2002 and 2013–2017 will continue to reduce by –3% in men, but because of the small numbers of cases, no prediction could be forecast for women [29].

Italy has no uniform Tumour Registry, but data from an aggregation of nine Regional Tumour Registries [30] reports that incidence of hypopharyngeal cancer during the period 1997–2009 the ASR had decreased; APC was 5.5% over the past 5 year-period (2005–2009), whereas for women the incidence has remained stable around 0.2 during the same time period. The age-specific rate per 100,000 was maximal for men and women, aged 65 years.

In Germany, there is lack of detailed epidemiological information on the sub-sites of head and neck cancer, but a study from the Thuringian Cancer Registry Database [31] with a population-based (2.3 million representing 2.8% of the German population) registry has been reported to have been conducted over the period 1996 to 2005. They reported an incidence of hypopharyngeal cancer and ACR for men and women has significantly increased.

In North America, hypopharyngeal cancer is one of the least common sub-sites for head and neck cancers, with an estimated 3,000 new cases registered annually in the United States (326 million population 2017), and 210 new cases registered in Canada (31.5 million population) in 2016 [32, 33]. The incidence in the United States during the period 1973 to 2010 has been decreasing with an average annual percentage change of –2.0% every year (p < 0.05), with an average incidence for adults of 0.7 per 100,000 [34]. In Ontario, Cancer Registry has also fallen to 0.90 per 100,000 population [33].