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With the Exception of Cervical Cancer, HPV-Related Cancers Are on the Rise, Especially in Older Adults


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Although the incidence of cervical cancer has decreased by 1.03% a year over the last 16 years—likely due to screening or human papillomavirus (HPV) vaccination—other HPV-related cancers are increasing in both men and women, according to a study by Liao et al presented at a presscast in advance of the 2021 ASCO Annual Meeting (Abstract 107). Rates of oropharyngeal, anal/rectal, and vulvar cancers are all increasing, especially in older adults.

Additional resources and research are needed to address the lack of screening or vaccination in these preventable cancers, according to the study authors.

Study Methodology

To determine the incidence and trends of HPV-related cancers in the United States—including oropharyngeal squamous cell carcinoma (SCC), anal and rectal SCC, 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 and Joinpoint regression program 4.8.0.1 to calculate incidence trends of HPV-associated cancers per 100,000.

Results

KEY POINTS

  • Over the last 16 years, the incidence of cervical cancer has decreased 1.03% per year, likely due to screening or vaccination. However, other HPV-related cancers are increasing in both men and women.
  • For women, the incidence of oropharyngeal, anal and rectal, and vulvar cancers increased significantly, especially anal and rectal cancer, which is expected to surpass the incidence of cervical cancer by 2025 for women 55 and older.
  • Over 80% of men were diagnosed with oropharyngeal cancer, a nearly fivefold increase in incidence compared with women. Older White men had the highest incidence of oropharyngeal cancer.

The researchers found that the overall incidence of HPV-related cancers for women was 13.68/100,000, more than half of which (52%) was cervical cancer, at 7.12/100,000 in 2017. Over the last 16 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 and rectal (APC = 2.75%, P < .001), and vulvar SCC all increased significantly (APC = 1.27%, P < .001).

For older women, the incidence of anal and rectal cancer approached that of cervical cancer. In those over age 80, the incidence of cervical cancer was 6.95 (APC = -2.90%, P < .001), compared to 6.36 for anal and rectal cancer (APC = 1.23%, P < .001). Using a projection model, the researchers found that the incidence of anal and rectal cancer is expected to surpass cervical cancer by 2025 for every group aged 55 and older.

For men, the incidence of all HPV-related cancers was 11.0/100,000 in 2017, and 81% were associated with oropharyngeal cancer. Over the last 16 years, there was an overall annual increase in HPV-related cancers at 2.36% per year (P < .001) with the highest increase in oropharyngeal (APC = 2.71%, P < .001) and anal and rectal SCC (APC = 1.71%, P < .001). Those at greatest risk of oropharyngeal cancer were older men aged 65 to 69, with an incidence of 36.5/100,000 and annual percent increase of 4.24% (P < .001). The intersectionality of age and race showed that White men aged 65 to 69 had the highest incidence of oropharyngeal cancer, at 41.6/100,000.

“Overall, there was a decrease in cervical cancer incidence, likely due to screening or vaccination. However, over 80% of men with HPV-related cancers had oropharyngeal cancer, a nearly fivefold higher incidence compared to women. In contrast, there was a significant increase in HPV-related cancers [that are difficult to screen for], 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 the Trends in HPV-Associated Cancers in the United States

Lori J. Pierce, MD, FASTRO, FASCO

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 last 17 years, which is certainly very gratifying to see,” said ASCO President Lori J. Pierce, MD, FASTRO, FASCO, during a media presscast highlighting this study abstract. “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 Fisher Foundation and Denise Cobb Hale. For full disclosures of the study authors, visit coi.asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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