Human Papillomavirus–Associated Cancers — United States, 2004–2008

Xiaocheng Wu, MD; Meg Watson, MPH; Reda Wilson, MPH; Mona Saraiya, MD; Jennifer L. Cleveland; Lauri Markowitz, MD

Disclosures

Morbidity and Mortality Weekly Report. 2012;61(15):258-261. 

In This Article

Abstract and Introduction

Introduction

Oncogenic human papillomavirus (HPV) has a causal role in nearly all cervical cancers and in many vulvar, vaginal, penile, anal, and oropharyngeal cancers.[1] Most HPV infections clear within 1–2 years, but those that persist can progress to precancer or cancer. In the United States, public health prevention of cervical cancer includes both secondary prevention through cervical cancer screening and primary prevention through HPV vaccination. Transmission of HPV also can be reduced through condom use and limiting the number of sexual partners. Two vaccines (bivalent and quadrivalent) are available to protect against HPV types 16 and 18, which are responsible for 70% of cervical cancers. HPV 16 also is the most common HPV type found in the other five cancers often associated with HPV.[2] To assess the incidence of HPV-associated cancers (i.e., cancers at specific anatomic sites and with specific cell types in which HPV DNA frequently is found), CDC analyzed 2004–2008 data from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) program. During 2004–2008, an average of 33,369 HPV-associated cancers were diagnosed annually (rate: 10.8 per 100,000 population), including 12,080 among males (8.1 per 100,000) and 21,290 among females (13.2). Multiplying the counts for HPV-associated cancers by percentages attributable to HPV,[3] CDC estimated that approximately 26,000 new cancers attributable to HPV occurred each year, including 18,000 among females and 8,000 among males. Population-based cancer registries are important surveillance tools to measure the impact on cancer rates of public health interventions such as vaccination and screening.

CDC analyzed NPCR and SEER data on cancers diagnosed during 2004–2008 in 50 states and the District of Columbia (data covering 100% of the U.S. population are now available through expansion of NPCR).[4] Case definitions based on expert consensus were used to examine the burden of invasive cancers at anatomic sites (cervix, vulva, vagina, penis, anus, and oropharynx[5]) and for cell types (carcinoma of the cervix and squamous cells for the other sites) in which HPV DNA is frequently found. Inclusion of oropharyngeal cancers as HPV-associated was further limited to specific sites where HPV is most likely to be found: base of tongue, tonsils, and "other oropharynx".[5]

Cancer data were analyzed by sex, age, race, Hispanic ethnicity, and state of residence. Race categories included white, black, Asian/Pacific Islander, and American Indian/Alaska Native; ''all races'' included other and unknown categories. American Indian/Alaska Native data were enhanced by linkage with Indian Health Service administrative records.[4] Hispanic ethnicity included persons of any race who were identified as being Hispanic in the medical record or by use of an algorithm*.[4] Age-adjusted incidence rates were calculated per 100,000 persons in SEER*Stat and were standardized to the 2000 U.S. Standard Population. Significant differences in rates were limited to comparisons at p<0.05. Because HPV-associated cancers defined by cell type and specific anatomic site might include cancers not caused by HPV, and because cancer registries typically do not capture information on HPV infection status, for this analysis, the average annual number of HPV-associated cancers was multiplied by the percentage of each cancer type found attributable to HPV based on genotyping studies.[3]

Overall, an average of 33,369 HPV-associated cancers (10.8 per 100,000 population) were diagnosed annually: 21,290 among females (13.2) and 12,080 among males (8.1). Cervical cancer was the most common of these cancers, with an average of 11,967 cases annually; oropharyngeal cancer was the second most common, with an average of 11,726 cases annually (2,370 among females and 9,356 among males) (Table 1 and Table 2). The rate of anal cancer among females (1.8 per 100,000) was higher than among males (1.2). The rate of oropharyngeal cancer among males (6.2) was four times that among females (1.4). Rates of cervical and penile cancer were higher among blacks (9.9) and Hispanics (11.3), when compared with whites (7.4) and non-Hispanics (7.4); however, the rate of vulvar cancer was lower among blacks (1.4) and Hispanics (1.2) than among whites (1.9) and non-Hispanics (1.9). Anal cancer in females was highest among whites (2.0), whereas rates in males were highest among blacks (1.6). For both sexes, rates of oropharyngeal cancer were higher among whites (males: 6.4, females: 1.4) and blacks (males: 6.3, females: 1.4) than other races (Table 1).

Rates varied by state, with rates of HPV-associated cancers combined ranging from 8.5 per 100,000 (Utah) to 16.3 (West Virginia) among females, and from 4.9 (Utah) to 11.6 (District of Columbia) among males. Although rates varied by anatomic site, some states had lower or higher rates across cancer sites. Maryland, Colorado, and Utah had cancer rates in the lowest tertile for most or all HPV-associated cancers, whereas Kentucky, Louisiana, and Tennessee had rates in the highest tertile for most of the cancer sites.§

Multiplying the number of HPV-associated cancers by the percentages attributable to HPV,[3] CDC estimated that approximately 26,000 new cancers attributable to HPV occurred each year: 18,000 among females and 8,000 among males (Table 2). Cervical and oropharyngeal cancers were the most common of these, with an estimated 11,500 cervical cancers and 7,400 oropharyngeal cancers (5,900 among men and 1,500 among women).

* The North American Association of Central Cancer Registries' Method to Enhance Hispanic/Latino Identification algorithm uses information on ethnicity from the medical record, information reported to the cancer registry, and information on surname (including maiden name, when available) to categorize patients as either Hispanic or non-Hispanic.
Available at https://seer.cancer.gov/seerstat.
§ Maps available at https://www.cdc.gov/cancer/hpv/statistics/state/index.htm.

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