Human Papillomavirus (HPV)-Associated Cancers Among Hispanic Males in the United States: Late-Stage Diagnosis by Country of Origin

INTRODUCTION

The epidemiology of human papillomavirus (HPV)-associated cancers has changed since the development of the multivalent vaccine. This is evidenced by the decline in incidence of cervical cancers in the post-vaccine era. By contrast, studies have reported the rise in incidence of these cancers in males. Though little is known regarding HPV-associated cancers in males, Hispanic males have been largely excluded from research on these cancers.

OBJECTIVE

The purpose of this study was to examine the differences in late-stage diagnosis of HPV-associated cancers (oropharyngeal, anorectal, or penile) among subgroups of Hispanic males in the U.S.

METHODS

We performed a population-based retrospective cohort study using the 2005-2016 North American Association of Central Cancer Registries Cancer in North America Deluxe data file (n = 9242). Multivariable logistic regression modeling was used in studying late-stage diagnosis.

RESULTS

There were no differences in late-stage diagnosis of oropharyngeal cancer between Hispanic subgroups. Higher odds of late-stage penile cancers were observed among Mexican and Puerto Rican males relative to European Spanish males. Lower odds of late-stage anorectal cancers were observed among Central or South American and Puerto Rican males. Having Medicaid or no insurance were associated with late-stage diagnosis for all cancers.

CONCLUSION

Certain subgroups of Hispanic males have higher odds of late-stage HPV-associated cancer diagnosis based on country of origin and insurance status. These findings call for improved efforts to increase HPV vaccination, particularly among these subgroups of Hispanic males. Efforts to improve health care access and early detection from health care providers are also needed.

Racial/ethnic disparities in HPV-associated anogenital cancers among males in the United States (2005-2016): A population-based retrospective cohort study

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Background: Among the HPV-associated cancers, research has primarily focused on understanding prevention and outcomes among females with cervical cancer. Limited data is available on health outcomes of male HPV-associated anogenital cancers, particularly among racial/ethnic minority groups. Methods: This population-based retrospective cohort study included 39,601 males diagnosed with HPV-associated invasive penile and anorectal cancers between 2005-2016 in the North American Association of Central Cancer Registries. Outcomes included: age-adjusted incidence, late-stage diagnosis, survival, and cancer-specific mortality. We evaluated association of race/ethnicity with outcomes using multivariable logistic regression, adjusted survival curves, and Cox proportional hazard modeling, adjusting for age, insurance, residential characteristics (metropolitan/non-metropolitan, area poverty, and geographic region), stage, and treatment. Results: Hispanic and Non-Hispanic (NH) Black males had the highest age-adjusted incidence of penile and anorectal cancer, respectively. Higher odds of late-stage penile cancer were observed among NH Black (adjusted odds ratios [aOR] 1.22, 95% CI 1.07-1.39) and Hispanic males (aOR 1.17, 95% CI 1.04-1.31). Higher odds of late-stage anorectal cancer were observed among NH Black (aOR 1.25, 95% CI 1.14-1.36) and NH Other males (aOR 1.29, 95% CI 1.01-1.66). Compared to all other groups, NH Black males had the lowest cumulative and mean survival of both cancers and higher cancer-specific mortality (penile adjusted hazards ratios [aHR] 1.23, 95% CI 1.01-1.49; anorectal aHR 1.25, 95% CI 1.10-1.42). Adjusting for treatment attenuated associations but did not eliminate the observed cancer-specific mortality. Conclusions: Hispanic males had the highest incidence of penile cancer and were diagnosed at later stages than non-Hispanic (NH) White counterparts. NH Black males had the highest incidence of anorectal cancers, and regardless of anatomic site, they had the highest rates of late-stage diagnosis and mortality even when controlling for all other covariates, including treatment. The findings highlight the necessity of interventions to increase HPV vaccination rates, early detection, and treatment of anogenital cancers in males, particularly among men of color.