OBJECTIVES: To explore the incidence and treatment pattern of head and neck cancer in different age groups. DESIGN: cohort study. SETTING: Netherlands Cancer Registry. PARTICIPANTS: All new primary head and neck cancer cases diagnosed between 2010 and 2014 were included and categorized in different age groups. MAIN OUTCOME MEASURES: Tumour site, stage, treatment modality, location of diagnosis and treatment. RESULTS: The study population was composed of 11,558 tumours. Oral cancer was the most common primary site (31%), followed by laryngeal (25%) and oropharyngeal cancer (22%). Ninety-six percent of the entire study population was diagnosed and/or treated in a certified head and neck oncology centre which was lower in the 80+ population (92%). Multimodality treatment was less frequently applied with increasing age (e.g. oral cavity: 17% in 80+ vs. 34% in 60-; p<0.001). The percentage of patients not receiving tumour directed treatment increased with age (e.g. oropharyngeal cancer: 25% in 80+ vs. 6% in 80-; p<0.001). CONCLUSIONS: This study confirms that less multimodal and tumour directed treatment is applied with the increasing age of head and neck cancer patients. This article is protected by copyright. All rights reserved.