June 27th, 2022 by Tyler Scott | NAACCReview Home Leave a comment

Jeanne M. Ferrante, MD, MPH
Professor, Family Medicine and Community Health
Director, New Jersey Primary Care Research Network
Rutgers Robert Wood Johnson Medical School

Racial/Ethnic Disparities in HPV-Related Oropharyngeal Cancer Outcomes among Males in the United States: A National Cohort Study

·         Human papillomavirus (HPV)-associated oropharyngeal cancer among males has surpassed cervical cancer as the most prevalent HPV-associated cancer in the US, with the majority of cases diagnosed at late stage.
·         While incidence rates of HPV-associated oropharyngeal cancer have remained stable for racial/ethnic minority groups from 2005-2016, rates of late-stage cancer increased over 50% among non-Hispanic (NH) white males.
·         There were no differences in late-stage diagnosis between Hispanic or NH black males compared with NH white males.
·         Hispanic and NH black males had higher oropharyngeal cancer mortality that was not explained by stage at diagnosis and treatment modality.

Background: Little is known regarding differences in male human papillomavirus-related oropharyngeal cancer incidence and outcomes by race/ethnicity. We evaluated age-adjusted incidence trends, late-stage diagnosis, survival, and cancer-specific mortality among males diagnosed with human papillomavirus-related oropharyngeal cancer.

Methods: In this population-based retrospective cohort study, we identified males diagnosed with oropharyngeal cancer in the United States from 2005 to 2016 in the North American Association of Central Cancer Registries. Associations of race/ethnicity with late-stage diagnosis, cancer-specific survival, and mortality were compared using multivariable logistic and Cox proportional hazard analysis, respectively, adjusting for age, health insurance, county level attributes of residence and poverty, stage at diagnosis, and geographic region of the United States.

Results: The majority of the 162,183 human papillomavirus-related oropharyngeal cancers were in Non-Hispanic White males (84.2%), with 50% increase in late-stage cancer incidence among White males from 2005 to 2016. Despite having similar odds of late-stage diagnosis as White males, Hispanic and Non-Hispanic Black males had higher cancer-specific mortality (adjusted hazard ratios [aHR] 1.17; 95% CI 1.08, 1.26, and aHR 1.79; 95% CI 1.71, 1.88, respectively). Adjusting for treatment attenuated, but did not eliminate, the higher mortality in Hispanic and Black males.

Conclusions: Non-Hispanic White males are disproportionately affected by late-stage human papillomavirus-related oropharyngeal cancer, while Hispanic and Non-Hispanic Black males have higher cancer-specific mortality that was not explained by stage or treatment modality. Interventions to increase human papillomavirus vaccine uptake, early detection, and treatment of oropharyngeal cancer in males are needed to decrease disparities in incidence and mortality.

Lay Summary: Oropharyngeal cancer in males is the most common cancer associated with human papillomavirus (HPV) in the US. Racial/ethnic groups are affected differently, with White males accounting for the largest increases in newly diagnosed oropharyngeal cancers each year. Although Hispanic and Black males were not more likely to have late-stage diagnosis, they had higher death rates from oropharyngeal cancers associated with HPV. Public health campaigns are needed to increase awareness of HPV, its link to oropharyngeal cancer, and to promote uptake of HPV vaccinations in adolescent and young adult males.

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