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Recent Trends in HPV-Associated Cancers among Women

Recent Trends in HPV-Associated Cancers among Women. Meg Watson, MPH. Epidemiology and Applied Research Branch Division of Cancer Prevention and Control National Center Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention, Atlanta, GA.

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Recent Trends in HPV-Associated Cancers among Women

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  1. Recent Trends in HPV-Associated Cancers among Women Meg Watson, MPH Epidemiology and Applied Research Branch Division of Cancer Prevention and Control National Center Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention, Atlanta, GA.

  2. Background: HPV-associated cancer • Human papillomavirus (HPV) associated with several cancers: • Cervical • Vaginal • Vulvar • Penile • Anal • Certain oral cavity/oropharyngeal sites

  3. Background • Changes in screening and prevention • HPV vaccine • HPV DNA test • Extended screening intervals • Current guidelines successful for cervical cancer; other HPV-associated cancers rare • Monitoring impact of future changes is important • National need for surveillance to document vaccine impact • Cancer registries uniquely positioned

  4. Background: Estimated reduction in cervical cancer after onset of HPV vaccination program Cervical cancer ages 15-29 Cervical cancer ages 12-99 Source: Chesson & Markowitz, International Society for Sexually Transmitted Diseases Research, London, 2009

  5. Background:Rates of HPV-Associated Cancers among Women, 1998-2003 Adapted from Watson et al. Using population-based cancer registry data to assess the burden of human papillomavirus-associated cancers in the United States: Overview of methods. Cancer,113:10;2841-2854.

  6. Background:Trends in HPV-associated cancers, 1973-2004 Adapted from Gillison, Chaturvedi, and Lowy. HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women.

  7. KY CA LA Cancer registries included in our analysis, NPCR/SEER Seattle/ Puget Sound Detroit CT IA San Francisco/ Oakland NJ UT San Jose/ Monterey Los Angeles NM Atlanta ALASKA HAWAII * † NPCR PUERTO RICO PACIFIC ISLAND JURISDICTION SEER NPCR/SEER *National Program of Cancer Registries (CDC) †Surveillance, Epidemiology, and End Results Program (NCI) Excluded from analysis

  8. Methods • NPCR and SEER incidence data, 1999-2004 • 92% of the U.S. population • Invasive cancers only • Race/ethnicity • Race: white, black, Asian-Pacific Islander (API), American Indian/Alaska Native (AI/AN) • Ethnicity: Hispanic • Annual percent change (APC) • Weighted least squares • Statistical significance based on APC different from zero (p<0.05)

  9. Methods: Defining HPV-associated cancers Squamous cell carcinomas (SCCs) 8050-8084, 8120-8131

  10. Results

  11. Trends in HPV-associated cancers among US women, 1999-2004 * Denotes statistical significance based on APC different from zero (p<0.05)

  12. Trends in HPV-associated cancers among US women, NPCR/SEER, 1999-2004(excluding cervical, for larger scale) * Denotes statistical significance based on APC different from zero (p<0.05)

  13. Trends in cervical cancer by race/ethnicity, NPCR/SEER, 1999-2004 * Denotes statistical significance based on APC different from zero (p<0.05)

  14. Trends in vulvar SCC by race/ethnicity, NPCR/SEER,1999-2004 * Denotes statistical significance based on APC different from zero (p<0.05)

  15. Trends in anal SCC among women by race/ethnicity, NPCR/SEER, 1999-2004 * Denotes statistical significance based on APC different from zero (p<0.05)

  16. Trends in oral cavity/oropharyngeal SCC among women by race/ethnicity, NPCR/SEER, 1999-2004 * Denotes statistical significance based on APC different from zero (p<0.05)

  17. Summary and discussion of results = overall trend stable

  18. Large population coverage Ability to examine trends by race/ethnicity of rare cancers Important in the context of vaccine and screening changes Potential mis-classification of HPV status Unknown co-factors such as smoking Inconsistent reporting of some precancers known to be strongly HPV-associated Strengths and Limitations

  19. Conclusions • Cervical screening programs continue to be effective • Despite common risk factor (HPV), cancers vary by site • Changes evident in some HPV-associated cancers among women, prior to the vaccine • These changes should be taken into account in future efforts to monitor the potential impact of the HPV vaccine on these cancers.

  20. Acknowledgements • Co-authors: Mona Saraiya, Hannah Weir, Cheryll Thomas • Deblina Datta • The findings and conclusions in this presentation are those of the presenter, and do not necessarily represent the official position of the Centers for Disease Control and Prevention. • Contact: eze5@cdc.gov

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