HPV-Associated Cancers

Transcription

1 HPV-Associated Cancers HPV Vaccination Summit: Debunking Myths and Preventing Cancer Thursday, February 2, 2017 St. Luke s Anderson Center Chris Johnson, MPH Cancer Data Registry of Idaho

2 Outline Human papillomaviruses (HPV) Oncogenic HPV CDRI involvement in ABHACUS ARN 2013 CDC 2016 study Terms HPV-associated and HPV-attributable Current Idaho statistics 2

3 Sexually transmitted HPV types fall into two categories: Low-risk HPVs, which do not cause cancer but can cause skin warts (condylomata acuminata) on or around the genitals, anus, mouth, or throat. HPV types 6 and 11 cause 90 percent of all genital warts. High-risk HPVs, which can cause cancer. About a dozen high-risk HPV types have been identified. Two of these, HPV types 16 and 18, are responsible for most HPV-caused cancers 3

4 HPV Infections are Common Around one-half are with a high-risk HPV type. HPV is cleared from the body in 90% of infected individuals within two years and consequently does not cause health problems. The remaining 10% of infected persons have persistent infection and, within 30 years, about half of these develop cancer. 4

5 Oncogenic HPV Types 13 oncogenic HPV types HPV 16 is the most likely to both persist and to progress to cancer Vaccines are available for HPV types 16 and 18 Cause 63% of all HPV-associated cancers in the United States, And for HPV types 31, 33, 45, 52, and 58, which cause an additional 10% 5

6 How does high-risk HPV cause cancer? 6

7 High-risk HPV and Cancer Body Parts Cervix Vagina Vulva Penis Anus Rectum Oropharynx back third of the tongue soft palate and uvula tonsils side and back wall of the throat 7

8 HPV and Cancer Treatment and Outcomes HPV-infected individuals who develop cancer generally receive the same treatment as patients whose tumors do not harbor HPV infections, according to the type and stage of their tumors. Patients with HPV-related oropharyngeal cancer have improved survival vs. HPV-negative. May do just as well on less intense treatment. Different staging systems have been proposed for HPV-related oropharyngeal SCC. 8

9 HPV cofactors Smoking or chewing tobacco (for increased risk of oropharyngeal cancer) Having a weakened immune system Having many children (for increased risk of cervical cancer) Long-term oral contraceptive use (for increased risk of cervical cancer) Poor oral hygiene (for increased risk of oropharyngeal cancer) Chronic inflammation 9

10 Timeline HPV vaccines available to US market 2008 ABHACUS published based on data; baseline for vaccine era ARN featured burden and trends in HPVassociated cancers CDC study published in MMWR 2017 Idaho HPV Vaccination Summit 10

11 Small World CDC-EIS ABHACUS Idaho 11

12 Assessing the Burden of HPV-Associated Cancer in the U.S. (ABHACUS) 23 papers published in Cancer supplement (2008) 39 states contributed data 2B/issuetoc 12

13 Role of cancer registries in monitoring impact of HPV vaccines 13

14 Cancer Data Registry of Idaho CDRI is a statewide cancer registry that collects incidence and survival data on all cancer patients who reside in the state of Idaho or who are diagnosed and/or treated for cancer in the state of Idaho. CDRI was established in 1969 and became populationbased in Cancer is a reportable disease under state law, and operations of the registry are mandated by Idaho Code.

15 ABHACUS States Included 15

16 ARN 2013 Provided estimates of numbers of new HPVassociated cancers in the US. Increases in incidence rates for some HPVassociated cancers and low vaccination coverage among adolescents underscored the need for additional prevention efforts for HPVassociated cancers, including efforts to increase vaccination coverage. Jemal A, Simard EP, Dorell C, Noone AM, Markowitz LE, Kohler B, Eheman C, Saraiya M, Bandi P, Saslow D, Cronin KA, Watson M, Schiffman M, Henley SJ, Schymura MJ, Anderson RN, Yankey D, and Edwards BK. Annual Report to the Nation on the Status of Cancer, , Featuring the Burden and Trends in HPV-Associated Cancers and HPV Vaccination Coverage Levels. J Natl Ca Inst 2013 Feb;105(3). Epub 2013 Jan 7. 16

17 2016 CDC Study Human Papillomavirus Associated Cancers United States, Viens LJ, Henley SJ, Watson M, et al. Human Papillomavirus Associated Cancers United States, MMWR Morb Mortal Wkly Rep 2016;65: DOI: 17

18 HPV-associated HPV-associated cancers were defined as cancers at specific anatomic sites with specific cell types in which HPV DNA frequently is found. 18

19 HPV-associated Cancers <Body Part> ICD-O-3 <Body Part & Hist Type> HPV-associated Primary Site Category Primary Site Codes Histology Types Histology Codes Cervix C53.0 C53.9 Carcinomas , Vulva C51.0 C51.9 Vagina C52.9 Penis Oropharynx C60.0 C60.9 C01.9, C02.4, C02.8, C05.1, C05.2, C09.0, C09.1, C09.8, C09.9, C10.0, C10.1, C10.2, C10.3, C10.4, C10.8, C10.9, C14.0, C14.2, C14.8 Anus C21.0 C21.9 Rectum C20.9 Invasive cases only. Squamous Cell Carcinomas ,

20 HPV-attributable Cancer registries do not routinely collect information on HPV DNA presence in cancer tissues, and HPV-associated cancers defined by anatomic site and cell type include cancers not caused by HPV. To calculate HPV-attributable cases, the number of HPV-associated cancers was multiplied by the percentage of each cancer type attributable to HPV based on polymerase chain reaction genotyping studies. Saraiya M, Unger ER, Thompson TD, et al.; HPV Typing of Cancers Workgroup. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst 2015;107:djv

21 USCS (CDC 2016) <Body Part> <Body Part & Hist Type> HPV-attributable Total (all histologies) HPV-associated Any HPV type HPV 16/18 HPV 16/18/31/33/ 45/52/58 Primary Site Annual Cases Annual Cases Percent AF Est. Cases AF Est. Cases AF Est. Cases Cervix 12,399 11,771 95% 91% 10,700 66% 7,800 81% 9,500 Vagina 1, % 75% % % 600 Vulva 4,608 3,554 77% 69% 2,400 49% 1,700 63% 2,200 Anus-Female 3,771 3,260 86% 93% 3,000 80% 2,600 90% 2,900 Rectal-Female 12, % 93% % % 500 Oropharynx-Female 3,861 3,100 80% 63% 2,000 51% 1,600 60% 1,900 Penis 1,276 1,168 92% 63% % % 700 Anus-Male 2,260 1,750 77% 89% 1,600 79% 1,400 83% 1,500 Rectal-Male 17, % 89% % % 200 Oropharynx-Male 13,944 12,638 91% 72% 9,100 63% 8,000 68% 8,600 Total 72,835 38,793 53% 30,700 24,600 28,500 AF = Attributable Fraction. HPV types detected in genotyping study; most were high-risk HPV types known to cause cancer (Saraiya M et al. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. Journal of the National Cancer Institute 2015;107:djv086). HPV types 16/18 can be prevented by the bivalent, quadrivalent, and 9-valent HPV vaccines. HPV types 31/33/45/52/58 can be prevented by the 9-valent HPV vaccine. 21

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23 MMWR (2016) Table 1 24

24 MMWR (2016) Table 1 (cont.) 25

25 MMWR (2016) Table 2 26

26 State incidence of HPV-associated cancers, by cancer site and sex,

27 CDC 2016 How did Idaho compare? HPV-associated Combined M&F 28

28 CDC 2016 How did Idaho compare? HPV-associated Cervix 29

29 CDC 2016 How did Idaho compare? HPV-associated Oropharyngeal Male 30

30 CDC 2016 How did Idaho compare? HPV-associated Anal-female 31

31 Cancer in Idaho Leading cause of death since 2008 In 2014: 7,605 invasive cases 2,789 cancer deaths 3,773 invasive cases among males 3,832 invasive cases among females 32

32 Cancer Burden in Idaho Idaho consistently ranks in the range of 8th-11 th among states for overall cancer mortality rate, with #1 being lowest. This is strongly tied to our lung cancer mortality rate, which is related to our relatively low smoking prevalence. Idaho has the lowest, or among the lowest screening rates in the country for cancers of the Colon and rectum (44 th ) Breast (50 th ) Cervix (51 st ) 33

33 Top 10 Cancers in Idaho and US Males Females 34

34 HPV-associated Cancers in Idaho <Body Part> <Body Part & Hist Type> HPV-attributable Total (all histologies) HPV-associated Any HPV type HPV 16/18 HPV 16/18/31/33/ 45/52/58 Primary Site Annual Cases Annual Cases Percent AF Est. Cases AF Est. Cases AF Est. Cases Cervix % 91% 44 66% 32 81% 39 Vagina % 75% 3 55% 2 73% 3 Vulva % 69% 12 49% 8 63% 11 Anus-Female % 93% 21 80% 18 90% 21 Rectal-Female % 93% 2 80% 2 90% 2 Oropharynx-Female % 63% 10 51% 8 60% 9 Penis % 63% 3 48% 2 57% 3 Anus-Male % 89% 7 79% 6 83% 6 Rectal-Male 84 ^ ^ 89% ^ 79% ^ 83% ^ Oropharynx-Male % 72% 49 63% 43 68% 46 Total % ^ Data suppressed; <6 cases for 5-year time period. AF = Attributable Fraction. HPV types detected in genotyping study; most were high-risk HPV types known to cause cancer (Saraiya M et al. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. Journal of the National Cancer Institute 2015;107:djv086). HPV types 16/18 can be prevented by the bivalent, quadrivalent, and 9-valent HPV vaccines. HPV types 31/33/45/52/58 can be prevented by the 9-valent HPV vaccine. 35

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36 Cancer in Idaho Total All Sites HPV-associated HPV-attributable Sex All Invasive Cancers Cases % Cases % Female 18, % % Male 19, % % Total 37, % % 37

37 Race/Ethnicity Rate Lower CI Upper CI Cases Rate Ratio P-Value Non-Hispanic White Hispanic (any race)

38 Geography Rate Lower CI Upper CI Cases Rate Ratio P-Value State of Idaho Health District Health District Health District Health District Health District Health District Health District

39 Thank You Further questions please contact: Chris Johnson, CDRI Epidemiologist