Trends in Human Papillomavirus-Associated Cancers, Demographic Characteristics, and Vaccinations in the US, 2001-2017

Abstract

Importance: Nearly 45000 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 657317 HPV-associated cancers (exact ages not collected by the United States Cancer Statistics); of these, 264019 (40.2%) developed in men and 393298 (59.8%) in women; 14520 individuals (2.2%) were non-Hispanic Asian/Pacific Islander, 74641 (11.4%) were non-Hispanic Black, 59841 (9.1%) were Hispanic, and 499899 were non-Hispanic White (76.1%). More than half (206 075 [52.4%]) of cancers in women were cervical, whereas most (211421 [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