Comprehensive assessment of burden of HPV-associated cancers in the U.S.

Professor Vivien Chen, PhD,. Associate Professor Xiao Cheng Wu, MD, PhD and Assistant Professor Edward Peters, DMD, SM, ScD, at LSU Health Sciences Center New Orleans School of Public Health contributed five papers to the largest most comprehensive assessment of the burden of human papillomavirus (HPV)-associated cancers in the United States to date.

The report, "Assessing the Burden of Human Papillomavirus (HPV)-Associated Cancers in the United States (ABHACUS)," is available now online and will be published in the November 15, 2008 supplement to the journal Cancer .

The publication reports that 25,000 cases of HPV-associated cancers were diagnosed in 38 states and the District of Columbia from 1998-2003. These include cancers of the cervix, vagina, vulva, penis, anus, oral cavity and oropharynx. Human papillomaviruses comprise about 100 different types, more than 30 of which are sexually transmitted. As the data were collected prior to the development of the HPV vaccine, they will provide baseline incidence rates to determine the effectiveness of the vaccine as well as cervical cancer screening programs in reducing the incidence of HPV-associated cancers and precancers.

The most comprehensive analysis studied data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) cancer registries, including the Louisiana Tumor Registry at LSU Health Sciences Center New Orleans, and the Centers for Disease Control's National Program of Cancer Registries.

The papers on which the LSUHSC public health faculty are co-authors are Incidence of in situ and invasive vulvar cancer in the US, 1998-2003 (p 2865-2872), Descriptive epidemiology of vaginal cancer incidence and survival by race, ethnicity, and age in the United States (p 2873-2882), Understanding the burden of human papillomavirus-associated anal cancers in the US (p 2892-2900), Burden of potentially human papillomavirus-associated cancers of the oropharynx and oral cavity in the US, 1998-2003 (p 2901-2909), and Cancer registries and monitoring the impact of prophylactic human papillomavirus vaccines: The potential role (p 3047-3057).

"The Louisiana Tumor Registry, housed in the LSUHSC School of Public health, has the academic infrastructure and expertise to monitor and evaluate the impact of HPV vaccination on the community," notes Vivien W. Chen, PhD, Director of Louisiana Tumor Registry at LSU Health Sciences Center New Orleans School of Public Health.

"Incidence and mortality rates among African American women in Louisiana are significantly higher than both the rates of Louisiana white women and other African American women in the United States," said Xiao Cheng Wu, MD, MPH, Associate Professor of Public Health and Associate Director of the Louisiana Tumor Registry at LSU Health Sciences Center New Orleans. "This observed black-white disparity can be reduced by equal access to and utilization of HPV vaccination."

"As the Principal Investigator of two CDC funded projects in LA to examine the impact on cancer after introduction of the HPV vaccine I expect we will observe a decrease in HPV related cancers such as cervical and oral cancer," said Edward Peters, DMD, ScD, Assistant Professor of Public Health at LSU Health Sciences Center New Orleans. "For example, about a third of oral cancers are due to HPV infection (the rest due to smoking and drinking) and oral cancers are twice as common in men than women. However, we currently do not vaccinate boys against HPV. We have tremendous opportunity to increase the level of cancer prevention for HPV associated cancers if our current HPV vaccination recommendations expand to include boys and young men ."

Significant findings include:
(Age-adjusted rates are presented in parentheses where appropriate and are per 100,000 persons.)

• CERVIX: More HPV-associated cancers occur in the cervix than any other site – about 10,800 per year. The incidence rate of cervical cancer was 8.9 women during 1998-2003. Black and Hispanic women had higher rates of cervical cancer (12.6 and 14.2, respectively) than white and non-Hispanic women (both 8.4).
• ORAL CAVITY AND OROPHARYNX: Cancers in some areas of the head and neck (oral cavity and oropharynx) are more likely to be HPV-associated than other areas. There were nearly 7,400 potentially HPV-associated cancers of the oral cavity and oropharynx per year – nearly 5,700 among men and about 1,700 among women. Incidence rates for a subset of the HPV-associated cancers of the oral cavity and oropharynx (cancers of the tonsil and cancers of the base of the tongue) were higher in men than women. These cancers significantly increased (3.0 percent) per year during the reporting period.
• ANAL: There were more than 3,000 HPV-associated anal cancers per year – about 1,900 in women and 1,100 in men. HPV-associated anal cancer occurs more frequently among women (1.5) compared to men (1.0). Whites had the highest rates among women (1.6), while blacks had the highest rates among men (1.2).
• VULVAR: There were about 2,300 new cases of vulvar cancer each year during the study period. In contrast to cervical cancer, white women (1.8) had higher rates of vulvar cancer than black (1.3) and Asian/Pacific Islander (0.4) women.
• PENILE: Penile cancer is relatively rare, striking about 800 men each year. Incidence rates were higher among Hispanic men (1.3) than non-Hispanic men (0.8).
• VAGINAL: About 600 women a year developed vaginal cancers. Incidence rates were higher among black women than white women (0.7 and 0.4, respectively), and incidence rates were lowest among Asian/Pacific Islander women (0.3).

Women with a history of cervical cancer have an increased risk of developing subsequent in situ (non-invasive) cancers of the vagina and vulva, as well as invasive cancers of the vagina, vulva, and rectum.

The Cancer supplement chapters also focus on disparities of HPV-associated cancers, how CDC and state and local programs address such disparities, background of the HPV vaccine, the economic impact of HPV-associated cancer mortality, the burden of cervical cancers in specific states with a high burden of disease, and surveillance of behavioral risk factors related to these cancers. The online article is available at: http://www3.interscience.wiley.com/journal/121498429/issue.