Assessing the burden of HPV-related cancers in Appalachia

Appalachia is a geographic region with existing cancer disparities, yet little is known about its burden of HPV-related cancers outside of cervical cancer. We assessed the burden of HPV-related cancers in three Appalachian states and made comparisons to non-Appalachian regions. We examined 1996-2008 cancer registry data for Ohio, Kentucky, West Virginia and the Surveillance, Epidemiology and End Results (SEER) 9 program. For each gender, we calculated age-adjusted incidence rates per 100,000 population for each HPV-related cancer type (cervical, vaginal, vulvar, penile, anal and oral cavity and pharyngeal cancers) and all HPV-related cancers combined. Incidence rates among females for all HPV-related cancers combined were higher in Appalachian Kentucky [24.6 (95% CI: 23.5-25.7)], West Virginia [22.8 (95% CI: 22.0-23.6)] and Appalachian Ohio [21.9 (95% CI: 21.0-22.8)] than SEER 9 [18.8 (95% CI: 18.6-19.0)]. Similar disparities were found among females when examining cervical and vulvar cancers separately. Among males, Appalachian [21.3 (95% CI: 20.2-22.4)] and non-Appalachian [21.9 (95% CI: 21.2-22.7)] Kentucky had higher incidence rates for all HPV-related cancers combined than SEER 9 [18.3 (95% CI: 18.1-18.6)]. The incidence rate of all HPV-related cancers combined was higher among males from Appalachian Ohio compared with those from non-Appalachian Ohio [17.6 (95% CI: 16.8-18.5) vs. 16.3 (95% CI: 16.0-16.6)]. Our study suggests that HPV-related cancer disparities exist in Appalachia beyond the known high cervical cancer incidence rates. These results have important public health implications by beginning to demonstrate the potential impact that widespread HPV vaccination could have in Appalachia.