Racial disparities and sex differences in the incidence of HPV-positive cancers: A SEER database study.

Abstract

e22619 Background: Human papilloma virus (HPV) is a viral infection that can cause malignant changes in infected tissues and is linked with multiple cancers affecting both males and females. The incidence and outcomes of HPV-positive cancer differ by cancer type, race and sex This study evaluates differences in HPV-positive cancer incidence and mortality across racial subgroups with additional evaluation of sex-based differences. Methods: A retrospective analysis of HPV-positive cancers was conducted using the Surveillance, Epidemiology, and End Results (SEER) database from 2018 to 2022. Included cancer types were tonsil, tongue, cervical, oropharyngeal, vulvar, vaginal, anal, and penile cancers. Descriptive statistics were used to summarize patient characteristics by sex and race. Chi-square test was performed to evaluate the association of race and sex with cancer incidence and mortality. Results: Among 5,472 HPV-positive cancers, the most common sites were tonsil (35.6%), tongue (29.6%), cervical (18.8%), and oropharyngeal (10.3%). Males comprised 66% of cases. Significant sex differences were observed for tonsil (χ² = 492.7, p < 0.001) and tongue cancers (χ² = 606.7, p < 0.001), demonstrating clear male predominance. Overall incidence differed by race (χ² = 42.9, p = 0.003), with White patients representing the majority across all sites. Cervical cancer was the only cancer in site-specific analysis showing a statistically significant racial disparity (White 72.9%, Black 14.0%, API* 11.2%, AIAN* 1.9%; p = 0.004), while differences for other cancers were not significant, likely due to smaller sample sizes in racial subgroups. A total of 548 deaths occurred, most frequently from tongue and tonsil cancers, with no significant mortality differences by race (χ² = 28.48, p = 0.127). Conclusions: While overall racial differences were observed, only cervical cancer demonstrated a significant disparity in site-specific analysis, highlighting the need for targeted prevention strategies. Moreover, HPV-positive cancers showed a clear male predominance. This may be explained by lower vaccination rates and differences in exposure. These findings support the need for broad HPV vaccination programs that include all populations, along with continued prevention and education to address disparities and improve outcomes. Incidence and mortality of hpv-positive cancers by race. Cancer Type Total Cases White (%) Black (%) API (%) AIAN (%) p-value Tongue 1,618 91.9 4.9 2.5 0.7 0.774 Tonsil 1,950 91.5 5.2 2.5 0.8 0.232 Cervix Uteri 1,029 72.9 14 11.2 1.9 0.004 Oropharynx 563 91.1 5 2.3 1.6 0.567 Vulva 225 88.4 7.6 2.7 1.3 0.876 Vagina 64 84.8 7.6 7.6 0 0.864 Anus / Anal / Anorectum 17 73.7 26.3 0 0 0.153 Penis 6 50 33.3 16.7 0 0.153 Overall 5,472 — — — — 0.003 API = Asian/Pacific Islander; AIAN = American Indian/Alaska Native. P-values were calculated using chi-square tests; p < 0.05 was considered statistically significant.