Racial Disparities in HPV-Related Oropharyngeal Cancer Outcomes

Interventions to increase HPV vaccine uptake, early detection, and treatment of oropharyngeal cancer in males are needed to decrease disparities in incidence and mortality.

A national cohort study was released that addresses both racial and ethnic disparities in HPV-related oropharyngeal cancer outcomes among males in the United States. Highlights include:

• Human papillomavirus (HPV)-associated oropharyngeal cancer among males has surpassed cervical cancer as the most prevalent HPV-associated cancer in the U.S., 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 by 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 HPV-related oropharyngeal cancer incidence and outcomes by race or ethnicity. We evaluated age-adjusted incidence trends, late-stage diagnosis, survival, and cancer-specific mortality among males diagnosed with HPV-related oropharyngeal cancer.

Methods

In this population-based retrospective cohort study, we identified males diagnosed with oropharyngeal cancer in the U.S. 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 U.S.

Results

The majority of the 162,183 HPV-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 HPV 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 HPV 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 HPV in the U.S. 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.