HPV-Related Late-Stage Throat Cancer Rises in Males and Displays Racial Disparities

Human papillomavirus (HPV)-related oropharyngeal cancer (OPC) was found to be most prevalent among White males, with a large increase in late-stage incidence, as well as a higher cancer-specific mortality (CSM) among Black and Hispanic males, according to a study conducted by investigators at Rutgers University, School of Public Health.¹

A total of 162,183 male HPV-related OPC cases were collected from 2005 to 2016. From the cases, 84.2% (n = 136,537) of patients were White, 8.8% (n = 14,283) were Black, 4.8% (n = 7825) were Hispanic, 1.7% (n = 2714) were non-Hispanic other, and 0.5% (n = 824) were of an unknown racial profile. CSM among Black and Hispanic males revealed an adjusted hazard ratio of 1.79 (95% CI, 1.71-1.88; P ≤ .01) and 1.17 (95% CI, 1.08-1.26; P ≤ .01), respectively.

“Since these oropharyngeal cancers are all potentially preventable through the administration of the HPV vaccine, public health campaigns are needed to increase awareness of HPV’s link to throat cancer, its signs and symptoms, and to promote uptake of HPV vaccinations in all adolescent and young adult males,” said Jeanne Ferrante, MD, MPH, the study’s senior author and professor in the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, in a press release. “In addition, clinicians need to be aware of who is at risk and the common clinical presentations.”²

This population-based, retrospective, cohort study examined males diagnosed with OPC in the United States using the North American Association of Central Cancer Registries in North America Research Analytic File between January 1, 2005 to December 31, 2016. Investigators used the Centers for Disease Control and Prevention’s definitions of HPV-associated cancers to identify the existence in the male patients.³

The age-adjusted HPV-related early stage OPC incidence rates remained stable across all races, but investigators found that late-stage OPCs increased at a steady rate among White males. Late stage OPC incidence for other racial groups remained stable. Most cases were diagnosed at the regional stage (66.1%), then local stage (12.6%), distant stage (17.4%), and unknown stage (3.9%).

The most common age at diagnosis was between 55 and 64 years (38.7%). A very large portion of identified cases resided in metropolitan counties (82.0%), followed by non-metropolitan (16.4%), and unknown county types (1.6%). Identified cases more commonly had private insurance (33.7%) vs Medicare (27.7%) or Medicaid (7.7%). More than half of cases lived in counties where the poverty level is between 10% and 19.99% (68.5%). Cases were found mostly from those who hailed from the South (40.2%), followed by the Midwest (22.2%), West/Pacific region (20.5%), and the Northeast (17.1%).

It should be noted that 13.1% of Hispanic patients and 13.8% of Black patients received no treatment.

The overall mean survival was 96.58 months (95% CI, 96.16-97.00). All races had a similar mean survival except for Black patients who had a mean survival of 69.72 months (95% CI, 68.14-71.31) compared with 91.89 months (95% CI, 89.87-93.91) among Hispanic patients, 99.63 months (95% CI, 99.18-100.07) among White patients, and 96.55 months (95% CI, 93.25-99.84) among patients with other racial identities.

“The new statistics should spotlight male throat cancer as an important new public health concern,” said Ferrante, a research member in the Cancer Prevention and Control Program at Rutgers Cancer Institute of New Jersey, in the press release.²

References

1. Villalona S, Stroup AM, Villalona S, Ferrante JM. Racial/ethnic disparities in HPV-related oropharyngeal cancer outcomes among males in the United States: a national cohort study. Annals of Cancer Epidemiology. 2022; doi:10.21037/ace-22-1

2. MacPherson K. Black and hispanic men with throat cancer experiencing higher death rates; white men increasingly being diagnosed at a late stage. Press release. Rutgers, the State University of New Jersey; July 6, 2022. Accessed July 11, 2022. https://bit.ly/3uD76zA

3. Definitions of risk factor-associated cancers. U.S. cancer statistics public use database. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. 2020. Accessed July 11, 2022. https://www.cdc.gov/cancer/uscs/public-use/predefined-seer-stat-variables.htm