OBJECTIVE Oral cancer remains a significant issue for many communities of the world. In Australia, there are approximately 2000 new diagnoses each year, and the rates are growing. The divide between city and rural, rich and poor, is, in many countries, found to be linked to the incidence of oral cancer. The aim of this study was to determine the trends in the incidence of oropharyngeal cancer (specifically cancer of the parotid and major salivary glands, pharynx, and tongue) in Western Australia over a 27-year period, from 1982 to 2009, and determine the geographic distribution of incidence within the state. METHODS The de-identified data were provided by the Western Australian Cancer Registry, as oral cancer is a notifiable condition in Australia. RESULTS There were a total of 2801 cases reported with pharynx, tongue, major salivary glands and parotid cancers over a 27-year period: 73.2 percent were male and 26.8 percent were female. The age-standardized incidence rate was 67.4 per 100 000 persons per annum for pharyngeal cancer, 54.1 for tongue cancer, 22.2 for parotid gland cancer and 5.5 for major salivary gland cancer. The age-standardized rates for pharyngeal and tongue cancer (but not parotid) were higher in country areas of Western Australia than in the metropolitan areas. The burden of some site-specific oral cancers is continuing to rise. An increasing trend with older age is also consistent throughout the study period. CONCLUSIONS This study finds that the incidence of oral cancers in Western Australia is not inconsistent with other parts of Australia and fundamentally shows there is a rural-urban difference for oral cancer.