Investigators Find Large Survival Disparities Among Patients with HPV-Associated Cancers

Human papillomavirus (HPV) is a very common virus; the Centers for Disease Control and Prevention (CDC) estimates that a staggering 80 million individuals are currently infected in the United States alone. It is known that there is a link between the virus and cancer; in fact, in the United States, 38,000 HPV-associated cancers are diagnosed on a yearly basis.

In a recent CDC study, investigators found that younger patients, women, and white individuals infected with HPV-associated cancers have superior survival at 5 years, indicating that increased HPV vaccination and better access to cancer screening and treatment are likely needed to reduce survival disparities.¹

Five-year relative survival was consistently higher among white patients than black patients for all HPV-associated cancers and all age groups. The largest differences were for oropharyngeal squamous cell carcinomas (SCCs) among those under 60 years of age and for penile SCCs among those between the ages of 40 and 49 compared with other age groups. Investigators also found that older patients with HPV-associated cancers tended to die sooner after diagnosis than younger patients did, and men with an HPV-associated cancer of the anus were likely to die sooner than women.

“This new study shows that race, sex, and age can make a difference in surviving HPV-associated cancers,” coauthor Mona Saraiya, MD, MPH, associate director of the CDC’s Office of International Cancer Control and a captain in the US Public Health Service, said in a press release. “There are things that people can do to avoid getting an HPV-related cancer, or to help improve their chances of survival, such as getting the HPV vaccine when recommended at the age of 11 or 12 years old (or as early as age 9 and as late as age 26); getting screened for cervical cancer at the recommended ages; and for those who have been diagnosed with an HPV-associated cancer, working with their healthcare provider to create a personalized plan for care. Healthcare providers can take steps to assure that they are offering the recommended screening and treatment, regardless of a patient’s race, age, or sex.”

DATA FROM 27 REGISTRIES IN STUDY

For the study, investigators examined data gleaned from 27 population-based cancer registries covering approximately 59% of the US population to determine how survival rates vary for each of these cancers by certain demographic characteristics, such as race and age. Investigators focused on patients with invasive cancers diagnosed from 2001 to 2011 and followed them through 2011.

Physicians diagnosed a total of 220,211 HPV-related cancers during the study period. Oropharyngeal SCCs were the most common malignancy (36.4%), followed by cervical carcinomas (36.1%) and anal SCCs (11.8%). Four in 5 patients were white, and more than 85% of patients in each disease cohort were white, except for cervical carcinomas (77.2%) and vaginal SCCs (80.9%).

The 5-year age-standardized relative survival was highest for vulvar (66%) and anal (65.9%) SCCs, and lowest for penile (47.9%) and oropharyngeal (51.2%) SCCs compared with other primary disease sites.

Investigators found the largest differences in survival between whites and blacks in patients with oropharyngeal SCCs between the ages of 40 and 49 (73.2% vs 40%), 50 and 59 (67.6% vs 38.6%), and under 40 years of age (76% vs 51.7%) at the time of diagnosis. Furthermore, there were large differences in survival between whites (58.5%) and blacks (34.5%) for men between the ages of 40 and 49 with penile SCCs.

For cancers that occurred in both men and women, women experienced roughly two-thirds of anal (63.6%) and rectal (68.2%) SCCs compared with only 20% of oropharyngeal SCCs. However, compared with men, women had higher 5-year relative survival for anal SCCs (69.3% vs 59.8%) and rectal (61.2% vs 45.5%) SCCs, but slightly decreased survival for oropharyngeal SCCs (49.8% vs 51.7%). Women experienced the largest survival benefit for rectal SCCs (61.2% vs 45.5%).

When examining 5-year relative survival by population characteristics and disease stage at diagnosis, men with rectal SCCs (6.9%) and patients 60 years of age or under who had rectal (10.5%) and vulvar (10.9%) SCCs diagnosed at distant stage had the poorest survival.

In an accompanying editorial, first author Nosayaba Osazuwa-Peters, BDS, MPH, CHES, an adjunct assistant professor of otolaryngology at Saint Louis University in Missouri, and colleagues, said that the HPV vaccine was “probably the most important primary preventive strategy for preventing HPV-associated cancers.”² However, he noted that individuals who were exposed to HPV before the vaccine was available or who are older than the recommended vaccination age remain at risk.

“We hope that more studies in the future will focus on survival outcomes for patients with HPV-associated cancers. We also hope that the disparities described in the current article will lead to interventions aimed at improving access to cancer care irrespective of race or ethnicity,” Drs. Osazuwa-Peters et al wrote. “For a group of highly preventable cancers, the current reality exposed by Dr. Razzaghi et. al is that at least one-third of all patients die within 5 years of developing an HPV-associated cancer. In some racial groups, survival is even more dismal; and all of this occurs among largely preventable cancers.”²

References:

1. Razzaghi H, Saraiya M, Thompson TD, et al. Five-year relative survival for human papillomavirus-associated cancer sites [published online November 6, 2017]. Cancer. doi: 10.1002/cncr.30947.

2. Osazuwa-Peters N, Massa ST, Simpson MC, et al. Survival of human papillomavirus-associated cancers: filling in the gaps [published online November 6, 2017]. Cancer. doi: 10.1002/cncr.30945.

A previous version of this article was published on OncLive.com.