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- Title
Trends in Human Papillomavirus–Associated Cancers, Demographic Characteristics, and Vaccinations in the US, 2001-2017.
- Authors
Liao, Cheng-I.; Francoeur, Alex Andrea; Kapp, Daniel S.; Caesar, Michelle Ann P.; Huh, Warner K.; Chan, John K.
- Abstract
Key Points: Question: Are human papillomavirus (HPV) vaccinations and screening associated with trends in HPV-associated cancers in the US? Findings: In this cross-sectional study using 3 national databases, the incidence of cervical cancer has decreased, especially in younger women, after HPV vaccine approval. However, oropharyngeal and anal/rectal cancers have increased among men. Meaning: These findings suggest that the decrease in the incidence of cervical cancers, particularly in young women may be associated with HPV vaccination approval; however, it may be too early to evaluate this association in oropharyngeal and anal cancers, which occur later in life. Importance: Nearly 45 000 human papillomavirus (HPV)-associated cancers are diagnosed annually in the US. The HPV vaccine has been approved since 2006, but information on the association between vaccination and the incidence of HPV-attributable cancers is unclear. Objective: To evaluate the potential association of screening and vaccination on the trends of HPV-associated cancers. Design, Setting, and Participants: A retrospective, population-based cross-sectional study was conducted using data on HPV-associated (oropharyngeal squamous cell carcinoma [SCC], anal/rectal SCC, vulvar SCC, vaginal SCC, cervical carcinoma, and penile SCC) cancers from the US Cancer Statistics Public Use Database, representing 99% of the US population, between January 1, 2001, and December 31, 2017; HPV vaccination and screening data from the Behavioral Risk Factor Surveillance between January 1, 2001, and December 31, 2016; and TeenVaxView between January 1, 2008, and December 31, 2018. National Cancer Database and Behavioral Risk Factor Surveillance were used to correct for hysterectomy. Data analysis was performed from April 1, 2020, to June 30, 2021. Exposures: Patient demographic characteristics, including age, race and ethnicity, sex, region, and vaccination status. Main Outcomes and Measures: The main outcomes examined in this study were diagnoses of any HPV-associated cancer and HPV vaccination status. Results: A total of 657 317 HPV-associated cancers (exact ages not collected by the United States Cancer Statistics); of these, 264 019 (40.2%) developed in men and 393 298 (59.8%) in women; 14 520 individuals (2.2%) were non-Hispanic Asian/Pacific Islander, 74 641 (11.4%) were non-Hispanic Black, 59 841 (9.1%) were Hispanic, and 499 899 were non-Hispanic White (76.1%). More than half (206 075 [52.4%]) of cancers in women were cervical, whereas most (211 421 [80.1%]) cancers in men were oropharyngeal. In female adolescents (aged 13-17 years), the vaccination rate increased from 37.2% to 69.9% from 2008 to 2018 (annual percent change: 6.57% [95% CI, 5.83%-7.32%]). Before vaccination approval, cervical cancer rates in the 20- to 24-year age group were decreasing at 2.29% annually (P =.045); after vaccine approval, this rate has been decreasing at 9.50% (P =.003). In men, annual increases were noted in oropharyngeal (2.71%) and anal/rectal (1.83%) cancers (P <.001); in women, the incidence of oropharyngeal remained stable but anal/rectal cancer increased at 2.83% every year (P <.001). Conclusions and Relevance: In the US, cervical cancer rates have decreased at a population level, especially in younger women. The findings of this study suggest this decrease may be associated with vaccination. Given the increase in oropharyngeal and anal/rectal cancers, particularly in men, it may be important to highlight vaccination uptake in both sexes. This cross-sectional study examines changes in the incidence of human papillomavirus–associated cancers in the US and the rate of screening and vaccination before and after approval of the vaccine.
- Subjects
UNITED States; TUMOR risk factors; CROSS-sectional method; MEDICAL screening; RETROSPECTIVE studies; PAPILLOMAVIRUS diseases; HUMAN papillomavirus vaccines; DESCRIPTIVE statistics; TUMORS; DISEASE complications
- Publication
JAMA Network Open, 2022, Vol 5, Issue 3, pe222530
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.2530