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Program Number: B258
Session Name: Poster Session

Incidence rate of oropharyngeal cancer in the United States: A systematic review and meta-analysis

Antonio Bandala-Jacques, MD, MPH, ScM; Ian J Saldanha, PhD; Gypsyamber D'Souza, PhD; Johns Hopkins Bloomberg School of Public Health

Introduction: Oropharyngeal cancer (OPC) is the most common human papilloma virus (HPV)-associated malignancy in the United States (US). Certain subgroups, such as middle-aged men and people living with HIV, are at higher risk, but patterns could shift due to changes in HPV prevalence and birth cohort effects. Our aim was to describe the incidence rates of oropharyngeal cancer in the US in an effort to understand risk groups to inform future screening guidelines.

Methods: We performed a systematic review and meta-analysis to explore incidence rates of OPC in the US by subgroup (race, ethnicity, sex, and HIV serostatus). We searched MEDLINE for articles published since 2000 using standardized terms for OPC, incidence rate, and the US. We excluded articles that provided only combined estimates of incidence of OPC and oral cavity cancer. For each subgroup, we conducted a meta-analysis of the incidence rate of OPC  per 100,000 person-years (PYs) using random-effects models. We assessed risk of bias for each included study. This review was not funded and is registered in PROSPERO: CRD4202458867.

Results: Our search found 2,210 records. We included 12 studies that reported a combined 398,094 cases of OPC diagnosed from 1999 to 2017 using data from SEER, cancer registries, and Medicaid. We rated 7 studies as low risk of bias, 4 moderate, and 1 high.  The overall incidence rate of OPC in the US was 8.4 cases per 100,000 PYs (95% confidence interval [CI] 5.8, 12.0). We found the highest overall incidence rate among people living with HIV (29.6 per 100,000 PYs, 95% CI 25.1, 34.1) (Figure 1). Among people living with HIV, the incidence rate was higher among men than women (45.9 vs. 20.9 per 100,000 PYs). Within each race or ethnicity, men consistently had over two times the incidence rate than women, with the largest absolute differences among those of White race (16.2 vs. 4.1 per 100,000 PYs) and Black race (16.3 vs. 3.9 per 100,000 PYs). The overall incidence rates by race or ethnicity were, in decreasing order: 9.1 per 100,000 PYs (95% CI 6.1, 12.2) for White, 8.3 (95% CI 0.1, 16.8) for Black, 2.3 (95% CI 0.1, 4.7) for Hispanic (regardless of race), and 1.3 (95% 0.1, 5.2) for Asian Americans or Pacific Islanders. When describing incidence rates by age group, regardless of race, men aged 55-74 years had an incidence rate of 27.9 per 100,000 PYs, and women, regardless of age strata, had an incidence rate below 5 per 100,000 PYs (range 0.2, 4.2).

Conclusions: People living with HIV and men (particularly those who identify as White or Black, and especially those aged 55-74) are at highest risk for oropharyngeal carcinoma and would be appropriate screening targets if screening technologies evolve to show sufficient benefit. More research is needed to sufficiently calculate incidence rates by age strata within each race or ethnicity. The high OPC incidence rates among middle-aged men and people living with HIV underscores the need to increase HPV vaccination efforts to decrease OPC risk.

 

 

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