Health disparities in HPV-related cancers

Almost everyone gets it, but human papillomavirus (HPV) At some point in their lives, some populations are significantly more likely to develop HPV-related cancers. These differences in cancer incidence and mortality are an example of health disparities and can have significant impacts on individuals, families, and entire communities.

Ethnic minorities, especially black women, are disproportionately affected by HPV-related cancers.

HPV-related cancer

HPV is the most common sexually transmitted disease in the United States. According to the Centers for Disease Control and Prevention (CDC), more than 42 million people in the United States were infected with the virus in 2018, including an estimated 13 million new HPV infections.

Most HPV cases are cleared by the immune system within one to two years, but some progress to cancer. So far, HPV is thought to be associated with six types of cancer.

Approximately 37,000 new cases of HPV-related cancer occur in the United States each year. This virus is probably best known as a cause of cervical cancer, but HPV-related oropharyngeal cancer is the most common. Together, both cancers account for more than two-thirds of all cancers caused by HPV.

Known health disparities

Most people have been affected by cancer in some way, either through their own experiences or the experiences of loved ones. According to the American Cancer Society, Americans have an approximately 40% lifetime risk of developing cancer. Some groups are more affected by cancer than others.

Health disparities are differences in health outcomes due to social or economic disadvantage or the unequal distribution of resources based on factors such as socioeconomic status, race, gender, or geography.

These differences affect not only individuals but also entire communities, as disease cycles can have intergenerational effects. It’s also expensive. A 2011 study estimated that the United States could have saved about $230 billion in direct costs between 2003 and 2006 if it had eliminated health disparities nationally. The authors also estimated that more than $1 trillion could be saved in indirect costs, such as costs associated with lost worker productivity and premature death due to illness.

These health disparities exist across a wide range of conditions and diseases, including HPV-associated cancers. Some of the largest disparities are reported along racial and ethnic lines, but other factors such as age, gender, and income also appear to be at play.

sex

Currently, more women than men develop HPV-related cancers, but the situation appears to be changing. The incidence of cervical cancer, the most common HPV-related cancer in women, has decreased in recent decades, primarily due to increased early screening with pap smears. Meanwhile, the incidence of all other HPV-related cancers is rising, especially in men.

Although men have a much higher incidence of oropharyngeal cancer than women, survival rates are similar in both groups.

However, when it comes to anal cancer, mortality rates vary widely. About 70% of women with anal cancer survive, compared to 60% of men.

race and ethnicity

Black women in the United States also have the highest rates of cervical and vaginal cancer, while Asian/Pacific Island women have the lowest rates. Similarly, black men have the highest penile cancer rates, while Asian/Pacific Island men have the lowest rates.

At every age, survival for whites was higher than for blacks for all HPV-related cancers. This is especially true for oropharyngeal cases, with one study showing a 5-year survival rate of 53.5% for whites and 32.4% for blacks, a difference of more than 21 percentage points.

This is despite the fact that whites in general have much higher rates of oropharyngeal cancer than other groups, and non-Hispanic white men in particular have the highest rates of any race, ethnicity, or gender. be.

Similarly, although Hispanic women have the highest incidence of cervical cancer, black women are most likely to die from cervical cancer. Although the rates of black women who undergo regular Pap smears are not much different than white women, research shows that black women are more often diagnosed at a later stage, making their cancer more difficult to treat.

Year

HPV-related cancers affect adults of almost all ages, but older adults tend to be disproportionately affected.

The incidence of HPV-related vaginal, vulvar, penile, and rectal cancers increases with age.

However, for cervical and oropharyngeal cancer, the incidence was higher among middle-aged adults than among the youngest or oldest adult age groups.

According to the CDC, women between the ages of 30 and 60 have the highest incidence of cervical cancer, and the incidence decreases for women over 70.

Oropharyngeal cancer predominantly affects slightly older adults (adults between 50 and 80 years old). However, as with cervical cancer, the incidence decreases in the oldest age groups.

Age appears to play a major role in survival. Generally, the younger you are when you are diagnosed with HPV-related cancer, the more likely you are to survive. For example, in one study, more than 82% of women were diagnosed with cervical cancer. in front Women aged 40 were still alive after five years, while only 52% of women aged 60 and older were alive.

This is also true when considering the stage of the cancer. In the same study, 48% of patients with late-stage oropharyngeal cancer under the age of 40 survived at least 5 years, while only 30% of similar cases over the age of 60 survived.

Possible factors

It is difficult to pinpoint the specific factors behind the differences in who gets cancer and who dies from cancer. Many factors can influence your chances of getting cancer, including diet, exercise, and stress, and these factors can be shaped and influenced by socio-economic issues and culture.

behavioral factors

Several things can increase your chances of getting HPV and/or HPV-related cancers. When some groups engage in these behaviors more than others, it can create a gap in both getting cancer and surviving cancer.

• Substance use: Smoking is associated with all cancers, including some HPV-related cancers such as cervical cancer. Tobacco and alcohol can also increase the risk of oropharyngeal cancer, so some head and neck cancers may be caused by a combination of HPV infection and alcohol or smoking. This association may contribute to sex differences in oropharyngeal cancer. smoking Both types of drinking are more common among men than women.
• Medical participation: Non-white people in the United States tend to visit doctors and receive treatment less often than white people. Nonwhites are more likely than whites to forgo or delay needed medical care. In addition to high uninsured rates in these populations, cultural influences may also be a factor. Additionally, non-Hispanic blacks surveyed expressed less trust in doctors than whites.
• Sexual activity: HPV is primarily spread through anal, vaginal, or oral sex. As with other sexually transmitted infections, high-risk sexual behaviors, such as having multiple partners or starting sexual activity at an early age, can lead to her contracting HPV, which causes at least one type of cancer. It becomes more sexual. However, it is unclear how individual behaviors directly or indirectly contribute to disparities in HPV-related cancers. For example, a partner’s previous sexual activity may play an important role in the probability of HPV exposure. Variable factors beyond the individual’s own choices and differences in sexual behavior within certain demographics may be at play.

Access to medical services

Non-white groups often have difficulty accessing routine medical care that prompts cancer screening.

Nonwhite adults are more likely to refrain from seeking health care due to cost concerns and are less likely than white adults to have a regular health care provider. Adults who are not white or Asian are more likely to be uninsured, which may make it more difficult for them to get tested for cancer.

When underserved populations are diagnosed with cancer, it is often diagnosed at a later stage.

income

A study comparing high-income and low-income counties found that people in low-income counties had higher rates of cervical, oropharyngeal, anal, and vulvar cancer.

Although not all of these cases were caused by HPV infection, the CDC estimates that the virus is responsible for 63% to 93% of these types of cancer.

implicit bias

Research shows that most healthcare providers show signs of implicit bias in their interactions with patients and medical decisions.

Whether they realize it or not, physicians often have more negative attitudes toward minority patients in their care.

Further research is needed to determine how these biases specifically impact HPV-related cancer incidence and mortality. But if these attitudes lead doctors to treat minority and older cancer patients differently, they could explain why some groups are more likely to die from certain HPV-related cancers. There is sex.

Gaps in vaccination coverage

Because HPV is a sexually transmitted disease and can be spread through contact alone, condoms are not as effective at stopping HPV infection as they are with other sexually transmitted infections.

Additionally, although cervical cancer can be detected in its precancerous stage by a Pap smear, there are currently no screening tests available for other HPV-related cancers. The best way to prevent HPV and related cancers is vaccination.

Scientists have known about the link between HPV and cancer since the early 1980s, but it wasn’t until 2006 that the first HPV vaccine was approved in the United States. There are more than 200 types of HPV, 12 of which are most likely to cause cancer. Two of them cause most HPV-related cancers.

When the first vaccines were released, they protected against four types of viruses. Two types caused nearly all cases of genital warts, and two were most likely to cause cancer. Since then, he has also discovered that two vaccines have been approved to prevent HPV infections, and that the current (and currently only) vaccine in the United States protects against nine different strains of his bacteria, seven of which are carcinogenic. is.

It will take years to see the impact of vaccination on cancer rates, but early research is promising. Research has shown that HPV subtypes that cause cancer, cervical dysplasia (precancerous lesions). In the coming decades, public health experts expect a similar decline in HPV-related cancers, especially in vaccinated populations.

Disparities in HPV vaccination coverage may provide early information on how disparities in HPV-related cancers will change in coming decades. So far, vaccination rates remain relatively low but are steadily increasing. Only about 62% of U.S. teens (ages 13 to 17) were up to date on vaccinations in 2021, but vaccination rates varied widely across the country. For example, more than 83% of Rhode Island teens were up to date with the news that year, while less than 33% of Mississippi teens were up to date. It was.

Disparities in HPV vaccination coverage have been reported by a variety of factors, including individual income, race, ethnicity, and place of residence.

socio-economic status

HPV vaccination rates among adolescents living above the poverty level are much lower than among adolescents living in poverty. This is in sharp contrast to other vaccines given at roughly the same age, where uptake by income level is less clear.

In 2021, only 56% of teens living above the poverty line were up to date on the HPV vaccine series, compared to 56% of teens living below the poverty line. Among young people, it was 66%.

race/ethnicity

In 2021, HPV vaccination rates among non-Hispanic white teens were lower than any other race or ethnicity, at just 54.8%. In contrast, the HPV vaccination rate among black teens was 64.2%.

position

Where you live also matters. In 2021, HPV vaccination rates were higher for people living in metropolitan areas than for people living in nonmetropolitan areas, but the gap has narrowed in recent years.

In 2018, the difference was 11 percentage points, but in 2021, 52.2% of teens in nonmetropolitan areas were fully vaccinated against HPV, compared to 52.2% of teens in metropolitan areas. It was 59.2%.

geographical location

Northeastern states such as Massachusetts and Rhode Island had the highest vaccination rates against HPV in 2021, while southern states such as Mississippi and Florida had some of the lowest.