Examining the incidence of human papillomavirus-associated head and neck cancers by race and ethnicity in the U.S., 1995-2005

Abstract

Background: Head 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.

Methods: We 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.

Results: Males 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.

Conclusions: This 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.

Figure 1. Annual percent change for age-adjusted HNC incidence rates by age, 1995–2005.

AAIR: age-adjusted incidence rate; HNC: head and neck cancer; HPV: human papillomavirus; APC: annual percent change. *Rates are significantly different from zero (p<0.05). Rates are per 100,000 and age-adjusted to the 2000 US Standard Population (19 age groups – Census P25-1130). Annual percent change was calculated using the least squares method. Only registries contributing data to the entire 1995–2005 period were used in the analysis.

Figure 2. Annual percent change for age-adjusted HNC incidence rates by race, 1995–2005.

AAIR: age-adjusted incidence rate; HNC: head and neck cancer; HPV: human papillomavirus; APC: annual percent change; NHW: Non-Hispanic Whites; NHB: Non-Hispanic Blacks. *Rates are significantly different from zero (p<0.05). Rates are per 100,000 and age-adjusted to the 2000 US Standard Population (19 age groups – Census P25-1130). Annual percent change was calculated using the least squares method. Only registries contributing data to the entire 1995–2005 period were used in the analysis.

Figure 3. Annual percent change for age-adjusted HNC incidence rates by age, sex and race/ethnicity for HPV-associated sites, 1995–2005.

AAIR: age-adjusted incidence rate; HNC: head and neck cancer; HPV: human papillomavirus; APC: annual percent change; NHW: Non-Hispanic Whites; NHB: Non-Hispanic Blacks. *Rates are significantly different from zero (p<0.05). Rates are per 100,000 and age-adjusted to the 2000 US Standard Population (19 age groups – Census P25-1130). Annual percent change was calculated using the least squares method. Only registries contributing data to the entire 1995–2005 period were used in the analysis.

Figure 4. Annual percent change for age-adjusted HNC incidence rates by age, sex and race/ethnicity for Non HPV-associated sites, 1995–2005.

AAIR: age-adjusted incidence rate; HNC: head and neck cancer; HPV: human papillomavirus; APC: annual percent change; NHW: Non-Hispanic Whites; NHB: Non-Hispanic Blacks. *Rates are significantly different from zero (p<0.05). Rates are per 100,000 and age-adjusted to the 2000 US Standard Population (19 age groups – Census P25-1130). Annual percent change was calculated using the least squares method. Only registries contributing data to the entire 1995–2005 period were used in the analysis.