Examining the Incidence of Human Papillomavirus-Associated Head and Neck Cancers by Race and Ethnicity in the U.S., 1995–2005

Lauren Cole,Vishnu Chaturvedi,Linda Polfus,Edward S Peters

doi:10.1371/journal.pone.0032657

Abstract

BackgroundHead and neck cancer (HNC) incidence, mortality and survival rates vary by sex and race, with men and African Americans disproportionately affected. Risk factors for HNC include tobacco and alcohol exposure, with a recent implication of human papillomavirus (HPV) in the pathogenesis of HNC. This study describes the epidemiology of HNC in the United States, examining variation of rates by age, sex, race/ethnicity and potential HPV-association.MethodsWe used the North American Association of Central Cancer Registries (NAACCR) Cancer in North America (CINA) Deluxe Analytic Data to analyze HNC incidence for 1995–2005 from forty population-based cancer registries. We calculated age-adjusted incidence rates and incidence trends using annual percent change by age, sex, race/ethnicity and HPV-association.ResultsMales and Non-Hispanic Blacks experienced greater HNC incidence compared to women and other race/ethnicity groupings. A significant overall increase in HNC incidence was observed among HPV-associated sites during 1995–2005, while non HPV-associated sites experienced a significant decline in HNC incidence. Overall, younger age groups, Non-Hispanic Whites and Hispanics experienced greater increases in incidence for HPV-associated sites, while HNC incidence declined for Non-Hispanic Blacks independent of HPV-association. In particular, for HPV-associated sites, HNC incidence for Non-Hispanic White males aged 45–54 increased at the greatest rate, with an APC of 6.28% (p<0.05). Among non HPV-associated sites, Non-Hispanic Black males aged 0–44 years experienced the greatest reduction in incidence (APC, −8.17%, p<0.05), while a greater decline among the older, 55–64 year age group (APC, −5.44%, p<0.05) occurred in females.ConclusionsThis study provides evidence that HPV-associated tumors are disproportionately affecting certain age, sex and race/ethnicity groups, representing a different disease process for HPV-associated tumors compared to non HPV-associated tumors. Our study suggests that HPV tumor status should be incorporated into treatment decisions for HNC patients to improve prognosis and survival.

Highlights

In the United States, it is expected that 36,540 new cases of oral, pharyngeal, and laryngeal cancer, known as head and neck cancer (HNC), will be diagnosed in 2010, and 7,880 deaths will occur from Head and neck cancer (HNC) [1,2]
HNC: head and neck cancer; HPV: human papillomavirus; 95% confidence intervals (95% CIs): 95% Confidence Interval; NH: Non-Hispanic
HNC cases were more commonly diagnosed at older age groups, with the majority of cases diagnosed at 65 years of age or older (47.0%)

Summary

Introduction

In the United States, it is expected that 36,540 new cases of oral, pharyngeal, and laryngeal cancer, known as head and neck cancer (HNC), will be diagnosed in 2010, and 7,880 deaths will occur from HNC [1,2]. The term head and neck cancer represents a broad range of anatomic sub-sites and often there is no consensus as to what locations should be included under this allencompassing, yet generic label. While there have been advances in treatment modalities, five-year relative survival has remained low (61%) and relatively unchanged for the past three decades [2,4,5] Both incidence and mortality rates depend upon the anatomic location of the tumor and vary considerably. Head and neck cancer (HNC) incidence, mortality and survival rates vary by sex and race, with men and African Americans disproportionately affected. This study describes the epidemiology of HNC in the United States, examining variation of rates by age, sex, race/ethnicity and potential HPV-association

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