Trends in HPV associated Cancers, Demographic Characteristics, and Vaccinations: JAMA
A large amount of human papillomavirus (HPV)-associated cancers are diagnosed annually in the US, with nearly 60% detected in women and 40% in men. Many cervical, anal, vaginal, oropharyngeal, vulvar, and penile cancers are attributable to HPV. Although cervical cancers are mostly preventable with screening, other HPV-associated cancers do not have any screening guidelines.
The HPV vaccine was approved by the US Food and Drug Administration, providing protection against 90% of cervical cancer–causing strains of HPV. Currently in the US, the HPV vaccine is recommended for males and females ages 9 to 26 years and can be offered to selected individuals aged 27 to 45 years with shared clinical decision-making. The vaccine is also approved for prevention of anal, vulvar, and oropharyngeal cancers in men and women.
This cross-sectional study evaluated HPV-associated cancers that can vs cannot be identified through screening to determine the potential association of vaccination with the incidence of these cancers. Using a large, national database representing approximately 99% of the population of the US, authors sought to evaluate the trends in HPV-associated cancer incidence by age, race and ethnicity, and tumor stage from 2001 to 2017.
A retrospective, population-based cross-sectional study was conducted using data on HPV-associated (oropharyngeal squamous cell carcinoma [SCC], anal/ rectal SCC, vulvar SCC, vaginal SCC, cervical carcinoma, and penile SCC) cancers from the US Cancer Statistics Public Use Database, representing 99% of the US population, between January 1, 2001, and December 31, 2017; HPV vaccination and screening data from the Behavioral Risk Factor Surveillance between January 1, 2001, and December 31, 2016; and TeenVaxView between January 1, 2008, and December 31, 2018. National Cancer Database and Behavioral Risk Factor Surveillance were used to correct for hysterectomy. Data analysis was performed from April 1, 2020, to June 30, 2021.
A total of 6,57,317 HPV-associated cancers; of these, 264 019 (40.2%) developed in men and 393 298 (59.8%) in women; 14 520 individuals (2.2%) were non-Hispanic Asian/Pacific Islander, 74 641 (11.4%) were non-Hispanic Black, 59 841 (9.1%) were Hispanic, and 499 899 were non-Hispanic White (76.1%). More than half (206 075 [52.4%]) of cancers in women were cervical, whereas most (211 421 [80.1%]) cancers in men were oropharyngeal. In female adolescents (aged 13-17 years), the vaccination rate increased from 37.2% to 69.9% from 2008 to 2018 (annual percent change: 6.57%).
Before vaccination approval, cervical cancer rates in the 20- to 24-year age group were decreasing at 2.29% annually (P = .045); after vaccine approval, this rate has been decreasing at 9.50% (P = .003). In men, annual increases were noted in oropharyngeal (2.71%) and anal/rectal (1.83%) cancers (P < .001); in women, the incidence of oropharyngeal remained stable but anal/rectal cancer increased at 2.83% every year (P < .001).
In this study, authors found differences in the incidence and trends of HPV-associated cancers. Most notably, cervical cancer rates have decreased. There are also sex disparities in HPV-associated cancers, with more than 80% of men with HPV-associated cancers diagnosed with oropharyngeal cancer—a nearly 5-fold higher incidence compared with women. In addition, the incidence of anal/ rectal cancers is increasing in both men and women. The US Food and Drug Administration has approved the HPV vaccine owing to its efficacy in preventing cervical, oropharyngeal, and anal/rectal cancer.
Overall, the incidence of HPV-associated cancers is increasing. The results of this early report suggest that vaccination may be associated with a decrease in invasive cervical cancer on a population level. The data also suggest that rates of HPV-associated oropharyngeal cancer may be increasing, particularly among men. This increase, along with that seen in anal/rectal cancer, may be attributed to a later median age of onset of this cancer and lower HPV vaccination rates in men. Although the HPV vaccine has been approved for more than 15 years in women, uptake has been slower than other recommended childhood vaccinations. Study results highlight the importance of the HPV vaccine. Continued efforts are needed to increase rates of vaccination as well as eliminate racial and ethnic disparities in cancer screening in the US.
Source: Cheng-I. Liao; Alex Andrea Francoeur; Daniel S. Kapp et al; JAMA Network Open. 2022;5(3):e222530.
doi:10.1001/jamanetworkopen.2022.2530
