A significant analysis of cancer data found that the cervical cancer rate moved lower over the last 17 years, attributed to the human papillomavirus (HPV) screening and vaccination. However, the incidence of other HPV-associated cancers is increasing. It is expected that they will surpass cervical cancer soon, a researcher announced to the press in advance of the 2021 ASCO Annual Meeting.
Cervical cancer decreased annually by 1 percent from 2001 to 2017. During that period, cervical cancer accounted for 52 percent of all HPV-related cancers in the US.
“It is likely that the significant decrease in cervical cancer incidence results from clear guidelines for cervical cancer screening and may also reflect promotion and acceptance of vaccination, particularly in younger women,” said lead author Cheng-I Liao, MD Kaohsiung Veterans General Hospital, in Kaohsiung, Taiwan.
This, of course, is good news, but at the same time, the frequency of other HPV-related cancers that do not have standardized screening grew significantly. According to the report, oropharyngeal, anal, and rectal squamous cell carcinoma all increased significantly. If the upward trajectory continues, these cancers will surpass cervical cancer within five years for certain at-risk groups.
Data was gathered from the United States Cancer Statistics program from 2001 to 2017 on 657,317 individuals. Frequency trends were calculated for HPV-associated cancers, including oropharyngeal, anal and rectal vulvar, vaginal, and penile all squamous cell carcinoma cancers plus cervical carcinoma.
Researchers also assessed age-specific cervical cancer frequency for people in the age group 20 to 24 years. Women in this age group had a disproportionately more significant decrease in the frequency of cervical cancer—4.63 percent per year—compared to those in the older age groups.
In 2006, the HPV vaccine was approved for girls and young women ages 9-26 years. In 2011, HPV was approved for boys ages 11-12 years. Today, the vaccine is approved for everyone up to age 45; however, there are no widely followed guidelines for these other cancers that are known to be associated with HPV.
The study found that the frequency of HPV-related cancers without standardized screening guidelines dramatically increased in women over those 17 years. The overall annual increase in oropharyngeal, anal, rectal, and vulvar cancers among women was 1.3 percent per year.
The prevalence of anal and rectal cancer rates should continue to grow and surpass cervical cancer in every age group over 50 by 2025, Liao noted.
The numbers are similar for men, where HPV-related cancers increased by 2.36 percent per year in men, with the most significant increase in oropharyngeal cancer. Oropharyngeal cancer accounted for 81 percent of all HPV-related cancers from 2001 to 2017—in men, a fivefold higher frequency than women.
“Without standardized screening, HPV-related cancers, such as oropharyngeal cancers and anal rectal cancers, are increasing,” said Liao. “To reduce these trends and achieve success comparable to what we see with cervical cancer, we must develop effective screening strategies and determine vaccine efficacy in these patient populations.”
Statistically, the overall incidence of HPV-related cancers for women over the 17 years was 13.68/100,000, of which 52 percent were cervical cancer or 7.12/100,000 in the year 2017. The incidence of cervical cancer decreased at an annual percent change of 1.03 percent. In contrast, the incidence of oropharyngeal cancers rose by 0.77 percent, anal and rectal cancers by 2.75 percent, and vulvar cancers increased by 1.27 percent.
For older women, the incidence of anal and rectal cancer approached that of cervical cancer. In those over 80, the incidence of cervical cancer was 6.95 (annual percentage of change (APC) 2.90%), compared to 6.36 for anal and rectal cancer (1.23% APC). The incidence of anal and rectal cancer is projected to surpass cervical cancer by 2025 for age groups over 55.
For men, the incidence of all HPV-related cancers was 11.0/100,000 in the year 2017; 81 percent were associated with oropharyngeal cancer.
Those at the most significant risk of oropharyngeal cancer were older men ages 65-69 years with an incidence of 36.5/100,000, an annual percentage increase of 4.24 percent (p< 0.001). The intersectionality of age and race showed that White men ages 65-69 years had the highest incidence of oropharyngeal at 41.6/100,000.
The researchers next plan to analyze the rates of HPV testing and vaccination from other databases to get additional information.
Commenting on the study, ASCO President Lori J. Pierce, MD, FASTRO, FASCO, said the study provided good and bad news.
“The decrease in cervical cancer is welcome news and may reflect intensive efforts to screen and vaccinate patients at risk,” she noted. “Clearly, this study shows that we still have a great deal of work to do to reverse the increasing incidence rates of other HPV-related cancers. Further research should be conducted to address the lack of screening or vaccination in these preventable cancers.”