Study Finds Significant Survival Disparities in HPV-related Cancer

Younger patients, women, and white patients with HPV-related cancers had 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 among those younger than 60 years and for penile squamous cell carcinomas among those aged 40 to 49 years compared with other age groups.

Investigators also found that older patients with HPV-associated cancers tended to die sooner after diagnosis than younger people, 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, 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.”

Investigators at the CDC’s National Center for Chronic Disease Prevention and Health Promotion examined data 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 invasive cancer diagnosed from 2001 to 2011, and followed those patients through 2011.

Physicians diagnosed a total of 220,211 HPV-related cancers during the study period. Oropharyngeal squamous cell carcinomas (OPSCC; 36.4%) were the most common malignancy 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 SCCs (65.9%), and lowest for penile (47.9%) and oropharyngeal SCCs (51.2%) compared with other sites.

The 5-year relative survival was 64% for patients with cervical carcinomas, 53% for vaginal, 66% for vulvar, 47% for penile, 66% for anal, 56% for rectal, and 51% for oropharyngeal squamous cell carcinomas.

Investigators found the largest differences in survival between whites and blacks in patients with OPSCCs aged 40 to 49 years (73.2% vs 40%), 50 to 59 years (67.6% vs 38.6%), and <40 years (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 aged 40 to 49 years with penile SCCs.

For cancers that occurred among both men and women, women experienced roughly two-thirds of anal (63.6%) and rectal SCCs (68.2%) compared with only 20% of OPSCCs. However, compared with men, women had higher 5-year relative survival for anal SCCs (69.3% vs 59.8%) and rectal SCCs (61.2% vs 45.5%), but slightly decreased survival for OPSCCs (49.8% vs 51.7%). Women enjoyed 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 aged ≥60 years who had rectal (10.5%) and vulvar SCCs (10.9%) diagnosed at distant stage had the poorest survival.

Writing in an accompanying editorial, first author Nosayaba Osazuwa-Peters, BDS, MPH, CHES, adjunct assistant professor of otolaryngology at St. Louis University, et al, said that the HPV vaccine was “probably the most important primary preventive strategy for preventing HPV-associated cancers.”² However, he noted that people 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,” Osazuwa-Peters et al wrote. “For a group of highly preventable cancers, the current reality exposed by 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.”

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.