Racial/ethnic disparities in HPV-related oropharyngeal cancer outcomes among males in the United States: a national cohort study

Background: Little is known regarding differences in male human papillomavirus (HPV)-related oropharyngeal cancer (OPC) incidence and outcomes by race/ethnicity. We evaluated age-adjusted incidence trends, late-stage diagnosis, survival, and cancer-specific mortality (CSM) among males diagnosed with HPV-related OPC. Methods: In this population-based retrospective cohort study, we identified males diagnosed with OPC in the United States from 2005 to 2016 in the North American Association of Central Cancer Registries (NAACCR). Associations of race/ethnicity with late-stage diagnosis, cancer-specific survival, and mortality were compared using multivariable logistic and Cox proportional hazard analysis, respectively, adjusting for age, health insurance, county level attributes of residence and poverty, stage at diagnosis, and geographic region of the United States. Results: The majority of the 162,183 HPV-related OPCs were in non-Hispanic (NH) White males (84.2%), with 50% increase in late-stage cancer incidence among White males from 2005 to 2016. Despite having similar odds of late-stage diagnosis as White males, Hispanic and NH Black males had higher CSM [adjusted hazard ratios (aHR) 1.17; 95% confidence interval (CI): 1.08, 1.26, and aHR 1.79; 95% CI: 1.71, 1.88, respectively]. Adjusting for treatment attenuated, but did not eliminate, the higher mortality in Hispanic and Black males. Conclusions: NH White males are disproportionately affected by late-stage HPV-related OPC, while Hispanic and NH Black males have higher CSM that was not explained by stage or treatment modality. Interventions to increase HPV vaccine uptake, early detection, and treatment of OPC in males are needed to decrease disparities in incidence and mortality.