Although the incidence of cervical cancer has decreased 1.03% a year over the past 17 years in the United States, likely due to screening or vaccination, other human papillomavirus (HPV)-associated cancers are increasing in both men and women, according to a study by Cheng-I Liao, MD, currently of Kaohsiung Veterans General Hospital, Taiwan, and colleagues. Presented during the 2021 ASCO Annual Meeting, the study’s findings show that oropharyngeal, anal/rectal, and vulvar cancers are all increasing, especially in older adults.1
Cheng-I Liao, MD
In 2006, the U.S. Food and Drug Administration (FDA) approved the vaccine Gardasil for girls and young women between the ages of 9 and 26 to protect against cervical, vulvar, and vaginal cancers caused by HPV types 16 and 18 and genital warts caused by HPV types 6 and 11. In 2014, the FDA approved Gardasil 9, which covers an additional five types of HPV, in males and females between the ages of 9 and 26. Today, the vaccine is approved for men and women between the ages of 27 and 45.2 However, there are no clear screening or vaccination guidelines for other HPV-associated cancers, including oropharyngeal, vulvar, vaginal, penile, anal, and rectal cancers.
To determine the incidence and trends of HPV-associated cancers in the United States, including oropharyngeal squamous cell carcinoma (SCC), anal and rectal SCCs, vaginal SCC, cervical carcinoma, and penile SCC, the researchers obtained data from the U.S. Cancer Statistics program from 2001 to 2017. They used SEER*Stat 8.3.8 software to calculate the incidences and trends of HPV-associated cancers per 100,000 population.
The researchers found that the overall incidence of HPV-associated cancers for women was 13.68 of 100,000, more than half of which (52%) was cervical cancer, at 7.12 of 100,000 in 2017. Over the past 17 years, the incidence of cervical cancer has decreased at an annual percent change (APC) of 1.03% (P < .001). In contrast, oropharyngeal (APC = 0.77%, P < .001), anal/rectal (APC = 2.75%, P < .001), and vulvar SCCs all increased significantly (APC = 1.27%, P < .001).
For older women, the incidence of anal/rectal cancer approached that of cervical cancer. In those older than age 80, the incidence of cervical cancer was 6.95 (APC = –2.90%, P < .001), compared with 6.36 for anal/rectal cancer (APC = 1.23%, P < .001). Using a projection model, the researchers found that the incidence of anal/rectal cancer is expected to surpass cervical cancer by 2025 for every age over 50.
For men, the incidence of all HPV-associated cancers was 11.0 of 100,000 in 2017, with 81% associated with oropharyngeal cancer. Over the past 17 years, there was an overall annual increase in HPV-associated cancers at 2.36% per year (P < .001), with the highest increase in oropharyngeal (APC = 2.71%, P < .001) and anal/rectal SCCs (APC = 1.71%, P < .001). Those at greatest risk of oropharyngeal cancer were older men (aged 65–69), with an incidence of 36.5 of 100,000 and an annual percent increase of 4.24% (P < .001). The intersectionality of age and race showed that White men between the ages of 65 and 69 had the highest incidence of oropharyngeal cancer, at 41.6 of 100,000.
“Overall, there was a decrease in cervical cancer incidence likely due to screening or vaccination. However, more than 80% of men with HPV-associated cancers had oropharyngeal cancer, a nearly fivefold higher incidence compared with women. In contrast, there was a significant increase in nonscreenable HPV-associated cancers, and anal and rectal SCC incidence is projected to surpass that of cervical cancer within 5 years for certain at-risk groups. Further resources and research should be conducted to address the lack of screening or vaccination in these preventable cancers,” concluded the study authors.
Tracking Trends in HPV-Associated Cancers
Lori J. Pierce, MD, FASTRO, FASCO
“This study shows that with cervical cancer, where there are clear screening and vaccine guidelines, the incidence has decreased annually over the past 17 years, which is certainly very gratifying to see,” said 2020–2021 ASCO President Lori J. Pierce, MD, FASTRO, FASCO. “However, for the other HPV-related cancers, for which we don’t have screening guidelines or consistent vaccine guidelines, we are seeing a large increase in incidence. I think this study is important, highlighting where we are in the United States with regard to HPV-related cancers, and it suggests where resources and research are needed as we go forward. There is much work to be done.”
DISCLOSURE: Funding for this study was provided by the Fisher Foundation and Denise Cobb Hale. Dr. Liao reported no conflicts of interest; see coi.asco.org for disclosure information for the other study authors. Dr. Pierce holds stock or other ownership interests in PFS Genomics; holds intellectual property in PFS Genomics and UpToDate; and holds uncompensated relationships with Bristol Myers Squibb and Exact Sciences.
1. Liao CI, Caesar MAP, Chan C, et al: HPV-associated cancers in the United States over the last 15 years: Has screening or vaccination made any difference? 2021 ASCO Annual Meeting. Abstract 107. Presented June 5, 2021.
2. U.S. Food and Drug Administration: FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old. Available at www.fda.gov/news-events/press-announcements/fda-approves-expanded-use-gardasil-9-include-individuals-27-through-45-years-old. Accessed June 2, 2021.