Survival Disparities in Smoking Status and HPV-Associated Oropharyngeal and Cervical Cancers: An Analysis of Population-Based Florida Cancer Registry (1981-2009)
Methods:Using the Florida Cancer Registry (1981-2009) that was linked with US census we examined median survival, survival rates, and the prevalence of HPV-associated oropharyngeal (tongue, tonsil) and cervical cancers by smoking status (never, former, current) in Floridian adults (≥18yrs). A multivariable Cox regression for overall survival is used to calculate adjusted hazard ratio (AHR) and 95% confidence interval (95%CI) for smoking status.
Results:Of 186,631 patients, 6.9% had tongue cancer, 3.8% tonsil, and 21% cervical (30%). Except cervical (30% current-smokers), current-smokers consisted of the majority of tonsil (42%), tongue (37%) cancers. For tongue cancer, current (AHR=[1.3];95%CI:1.2- 1.4) and former (1.1];1.0-1.2) smokers had worse survival than non-smokers. Median survival time was 1.6yrs (1.5-1.7) in current, 2.3yrs (2.1-2.5) in former and 2.7yrs (2.4-3.0) in non-smokers. Among males, current ([1.4];1.3-1.5) and former ([1.1];1.0-1.2) smokers had worse survival than non-smokers. Among females, current ([1.2];1.1-1.4) and former ([1.1];1.0-1.3) smokers had worse survival than non-smokers. For tonsil cancer, current ([1.5];1.3-1.6) and former ([1.2];1.1-1.4) smokers had worse survival than non-smokers. Median survival was the shortest in current-smokers (1.9;1.7-2.0), then in former (2.6;2.3-2.8) and non-smokers (3.2;2.9-3.9). Among males, current ([1.4];1.2-1.6) and former ([1.2];1.0-1.3) smokers had worse survival than non-smokers. Among females, current ([1.5];1.3-1.9) and former ([1.3];1.1-1.6) smokers had worse survival than non-smokers. For cervical cancer, median survival was slightly longer for current-smokers (3.8;3.6-4.1) and similar for former (3.5;3.1-4.0) and non-smokers (3.4;3.2-3.5).
Conclusions:Overall, both current and former male and female smokers had worse survival in HPV-associated tongue/tonsil/cervical cancers. Such survival disparities highlight the importance of anti-smoking and HPV prevention campaigns. These results may provide a foundation for targeted and gender specific cancer screening and prevention programs and added smoking cessation and HPV vaccination efforts.
Implementation of health education strategies, interventions and programs
Public health or related public policy
Public health or related research
Describe survival disparities between smoking status and HPV-associated oropharyngeal and cervical cancers in Florida. Identify gender differences in survival between smoking status and HPV-associated oropharyngeal and cervical cancers in Floridian adults.
Keyword(s): Cancer, Tobacco Use
Qualified on the content I am responsible for because: I am a second-year medical student who researches cancer epidemiology and disparities.
Any relevant financial relationships? No
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