HPV-related Cancers in Mississippi, 2003-2019

The Human Papilloma Virus (HPV) increases the risk of certain types of cancer. A vaccine is available that can prevent the most common cancer-causing types of HPV. Unfortunately, data from the 2020 National Immunization Survey-Teen reported by the National Cancer Institute’s State Cancer Profiles shows that only 34.5% of Mississippi teens between ages 13 and 17 have received two or more doses of the HPV vaccination. Mississippi has the lowest rate of vaccination in the U.S.¹ Cancers associated with HPV infections include squamous cell carcinoma of the oropharynx, rectum, anus, vagina, vulva, and penis, as well as, carcinoma of the cervix.⁴ According to the Behavioral Risk Factor Surveillance System for 2020, 82.3% of women ages 21 to 65 in Mississippi report having had a Pap test in the past three years. Mississippi has the second highest rate among US states and the District of Columbia.² Below are graphs of the trends in HPV-related cancers over the period 2003 to 2019 by race and sex where the counts allow for such breakdown with a description of the trends occurring in each group both for the full time period and for the most recent period between 2015 and 2019. All analysis was done using SEER*Stat software³.

Approximately 70% of squamous cell carcinomas of the oropharyngeal cancers are likely associated with HPV.⁴ Additionally, cancers of the oral cavity and pharynx including the oropharynx can be associated with other modifiable risk factors, tobacco and alcohol use. The rate of oropharyngeal squamous cell carcinoma cannot be broken down by both race and sex due to how rare this cancer is particularly in black females. Over the period from 2003 to 2019, the white population had significantly higher rates of oropharyngeal squamous cell carcinoma than the black population in 2008, 2012, 2014, 2016, and 2017-2019. The white population experienced a statistically significant increase between 2003 and 2019 of 2.16% annually. The rate for the black population decreased annually at an observed rate of 1.48%. The graph clearly demonstrates the widening of the gap between the rates beginning in 2011. For the latest five-year time period between 2015 and 2019, the trend for the white population was a decrease of 5.16% annually. The rate for the black population during this period decreased at a rate of 7.89% annually. The changes for both groups between 2015 and 2019 were not statistically significant.

Approximately 91% of the squamous cell carcinomas of the anus and rectum are associated with HPV infection.⁴ Cancers of the rectum can also be associated with other modifiable risk factors, tobacco use, alcohol use, and obesity. Squamous cell carcinoma of the anus and rectum are rare cancers. Thus, the data can only be presented for Mississippi as a whole and not broken down by race and sex. Between 2003 and 2019, the rates for squamous cell carcinoma of the rectum and anus increased significantly at a rate of 1.90% annually. The greatest increases were seen in both white and black females. For the latest five-year time period between 2015 and 2019, anal and rectal squamous cell carcinoma was observed to be decreasing at a rate of 6.29% annually, though this change was not statistically significant due to the small number of cases. Black females were the only group with a significant change during the period from 2015 to 2019, which a significant decrease of 21.24%.

Approximately 69% of squamous cell carcinomas of the vulva are associated with HPV infection.⁴Squamous cell carcinoma of the vulva is a rare cancer. Therefore, the rates cannot be broken out by race. For the time period between 2003 and 2019, the rates of squamous cell carcinoma of the vulva increased significantly at a rate of 2.08% annually. In the most recent five-year time period between 2015 and 2019, the rate of squamous cell carcinoma of the vulva increased at a rate of 0.25% annually, though this increase was not statistically significant.

Approximately 75% of the squamous cell carcinomas of the vagina are associated with an HPV infection.⁴ Squamous cell carcinoma of the vagina is also a rare cancer. Therefore, the rates cannot be broken out by race. For the time period between 2003 and 2019, the rates of squamous cell carcinoma of the vagina remained relatively stable with only a 0.02% increase annually. However, for the latest five-year time period between 2015 and 2019, the rate of squamous cell carcinoma of the vagina fell 5.78% annually. This change was not significant due to the low numbers of cases.

Approximately 63% of squamous cell carcinomas of the penis are associated with HPV infection.⁴ Like most of the other HPV-related cancers, squamous cell carcinoma of the penis is a rare cancer. Therefore, the rates cannot be broken out by race. For the time period between 2003 and 2019, the rates of squamous cell carcinoma of the penis increased 0.87% annually though this increase was not significant due to the small number of cases. For the latest five-year time period between 2015 and 2019, the rate of squamous cell carcinoma of the penis increased 24.41% annually. This change was statistically significant.

Approximately 91% of cervical carcinomas are associated with an HPV infection.⁴ Cancers of the cervix uteri can also be associated with another modifiable risk factor, tobacco use. The rates of cervical carcinoma were higher for black females than white females between 2003 and 2015, but this difference was only statistically significant for 2003, 2004, 2006, 2009, 2010, and 2013. Over the time period from 2003 to 2019, the rate for black females dropped significantly at a rate of 2.51% annually. The rate for white females increased at a rate of 1.37% annually. This increase was not statistically significant. Over the latest five-year period of 2015 to 2019, the rate for white females rose 0.81% annually, though this change was not statistically significant. The rate for black females decreased significantly 2.02% annually. The falling rate for black females coupled with the observed increasing rate for white females closed the disparity between the two groups.

The rates of all HPV-related cancers are primarily driven by oropharyngeal carcinoma and cervical carcinoma. During the period from 2003 to 2019, the rate for the white population increased significantly at an annual rate of 1.92%. Conversely, the rate for the black population significantly decreased at a rate of 1.31% annually. Thus, the rates begin to diverge from each other beginning in 2014. From 2014 to 2019, the rate for the white population is significantly higher for all years except 2015 and 2018.

For the most recent five-year time period from 2015-2019, the rates for both the white and black populations were decreasing, though the changes were not statistically significant. The rates for the white population decreased at an observed rate of 2.22% annually, and the rate for the black population decreased at an observed rate of 4.48% annually.

Definitions

Age Adjusting: A statistical method that allows comparisons of populations that take into account age-distribution differences between the populations. The 2000 U.S. standard population is used and applied to all of the time periods being considered. This assures that the rates do not reflect differences in the age distribution of the population.

Annual Percent Change (APC): The average annual percent change over several years. It is used to measure the change in rates over time. Calculating the APC involves fitting a straight line to the natural logarithm of the data when it is displayed by calendar year.

Statistical Significance: This is a mathematical measure of the difference between groups. A difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone 95% of the time. Rate ratios were used to assess the statistical significance between groups.

Citations

¹The National Immunization Survey - Teen, Hyattsville, MD: Centers for Disease Control and Prevention. Created by statecancerprofiles.cancer.gov on 04/18/2022 1:08 pm.

²Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2020. [accessed Apr 18, 2022]. URL: https://www.cdc.gov/brfss/brfssprevalence/index.html.

³ Surveillance Research Program, National Cancer Institute SEER*Stat software (seer.cancer.gov/seerstat) version 8.3.9.1.

⁴ Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. HPV and Cancer [online]. 2021. [accessed Jun 13, 2022]. URL: https://www.cdc.gov/cancer/hpv/statistics/cases.htm

Source of Data: SEER*Stat Database: MS0219. Created on 11/30/2021. Mississippi Cancer Registry 2021 Submission (2002-2019) to Centers for Disease Control and Prevention, National Program of Cancer Registries.

Acknowledgement

We acknowledge the Centers for Disease Control and Prevention for their financial support under a cooperative agreement awarded to the Mississippi Cancer Registry.