About 58,000 cases are diagnosed each year and 12,000 people die from the disease. Oral cavity, oropharynx, and larynx are the most frequent sites of primary lesions in the United States; nasopharyngeal primaries are more common in the Far East and Mediterranean countries. Alcohol and tobacco (including smokeless) abuse are risk factors. Human papillomavirus (usually types 16 and 18) is associated with about half of oropharynx cancers in Western countries.