Racial and ethnic differences in HPV-related cancer incidence in the United States, 2001-2020

Background Human papillomavirus (HPV) causes cervical cancer and a proportion of oropharyngeal, vulvar, vaginal, penile, and anal cancers. Evaluating racial and ethnic heterogeneity by anatomic site will identify populations with the highest cancer incidence rates (IRs) and help to optimize available prevention strategies. Methods Using the 2001-2020 US Cancer Statistics database, we estimated age-standardized IRs cervical carcinoma, oropharyngeal, anal, vaginal, vulvar, and penile squamous cell carcinomas (SCCs) by race and ethnicity. We examined changes over time by comparing IRs in 2016-2020 with 2001-2005. Results Between 2001-2020, 750,897 HPV-related cancers occurred among 6,168,715,419 total person-years, with 61% (n = 455,475) in females. Among females, the highest IRs of oropharyngeal (1.6/100,000 person-years), vulvar (2.3/100,000 person-years), and anal (2.1/100,000 person-years) SCC were among White females. The highest IR for vaginal SCC (0.6/100,000 person-years) was among Black females and for cervical carcinoma (10.0/100,000 person-years) among Hispanic females. Among males, the highest IR for oropharyngeal SCC (8.0/100,000 person-years) was among White males, penile SCC (1.3/100,000 person-years) among Hispanic males, and anal SCC (1.5/100,000 person-years) among Black males. From 2001-2005 to 2016-2020, for most racial and ethnic groups, both in terms of absolute incidence, and proportion of the total HPV-related cancer burden, cervical carcinoma and vaginal SCC rates decreased, vulvar and anal SCC increased, and there was no clear pattern in oropharyngeal and penile SCC rates. Conclusion For all cancer types, there were disparate racial and ethnic patterns by anatomic site likely caused by a constellation of factors, including access to preventive care and site-specific HPV prevalence.