July 30, 2009

Differences in HPV Rates May Contribute to Racial Differences in Head and Neck Cancer Survival


Among patients with head and neck cancer, the better survival among white patients than black patients appears to be due at least in part to the higher prevalence of HPV-related oropharyngeal cancer in white patients. These results were published in Cancer Prevention Research.

Head and neck cancers originate in the oral cavity (lip, mouth, tongue), salivary glands, paranasal sinuses, nasal cavity, pharynx (upper back part of the throat), larynx (voice box), and lymph nodes in the upper part of the neck.

Oropharyngeal cancer is a type of head and neck cancer. The oropharynx is the part of the throat that includes the soft palate, the base of the tongue, and the tonsils. Exposures that are known to increase the risk of oropharyngeal cancer include tobacco and alcohol use, as well as infection with high-risk types of human papillomavirus (HPV).

Human papillomaviruses (HPV) consist of more than 100 different viruses. Some types of HPV cause warts on the hands or feet; others cause genital warts; and some have been linked with cancer, most notably cervical cancer.

Previous studies have suggested that oropharyngeal cancer that is linked with HPV infection has a better prognosis than oropharyngeal cancer that is linked with other causes such as smoking.

To explore racial differences in head and neck cancer survival, researchers evaluated information from patients with Stage III or Stage IV head and neck cancer and no evidence of distant metastases. Patients were treated with a combination of chemotherapy and radiation therapy.

  • Among patients with types of head and neck cancer other than oropharyngeal cancer, overall survival was similar in white and black patients.
  • Among patients with oropharyngeal cancer, white patients had significantly better survival than black patients (69.4 months in white patients versus 25.2 months in black patients).
  • HPV rates also differed by race: 34% of white patients had HPV-positive cancer, compared with 4% of black patients.
  • Among patients with HPV-negative cancer, survival was similar in black and white patients.

These results suggest that white patients have better oropharyngeal cancer survival than black patients at least in part because white patients are more likely to have HPV-related cancer. The reasons for the higher rates of HPV-related cancers among white patients remain uncertain, but may involve differences in sexual behavior.

Reference:Settle K, Posner MR, Schumaker LM et al. Racial survival disparity in head and neck cancer results from low prevalence of human papillomavirus infection in black oropharyngeal cancer patients. Cancer Prevention Research. Early online publication July 29, 2009.

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