Racial, Ethnic, and Neighborhood Poverty Status Survival Disparities in HPV-Associated Anogenital Cancers: Analysis of Population-Based Florida Cancer Registry (1981-2009)

Background: Specific Human Papillomaviruses(HPVs) have been implicated in cervical, vaginal, vulvar, anal, and penile cancers. HPV is associated with the majority of cervical and anal cancers and almost half of all vaginal, vulvar, and penile cancers. We looked at HPV-associated anogenital cancer survival across race, ethnicity and neighborhood poverty status(NPS) among Floridian adults(≥18yrs old).

Methods:Florida Cancer Data System(1981-2009) was linked with US census to explore median survival and 5-year survival rates by sociodemographics for anogenital cancers. Survival was compared by type, gender, race/ethnicity, NPS and modeled with multivariate Cox regression to calculate hazard ratio(HR) and 95% confidence interval(95%CI).

Results: There were 39272cervical, 2264vaginal, 7253anal, 10106vulvar and 2148penile cancers in Florida.  Cervical cancer median survival was 3.5yrs(3.4-3.7). Blacks vs. Whites(HR=[1.2];95%CI:1.1-1.3) and Hispanics vs. non-Hispanics([1.1];1.0-1.1) had worse survival while highest NPS compared to lowest([0.9];0.8-1.0) had better survival. Vaginal cancer median survival was 2.7yrs(2.4-2.9) and highest NPS had better survival compared to lowest NPS([0.7];0.6-0.9). Vulvar cancer median survival was 5.2yrs(4.9-5.4). Anal cancer median survival was 2.7yrs(2.6-2.9), and Blacks had worse survival compared to Whites([1.3];1.2-1.5). Penile cancer median survival was 3.5yrs(3.2-3.8). Blacks had worse survival than Whites([1.3];1.0-1.6) and highest NPS had better survival compared to lowest([0.8];0.6-1.0).

Conclusions: Understanding survival disparities within and among anogenital cancers associated with HPV, the US’s most common sexually transmitted infection, is important. Among races, Blacks showed worst survival for cervical, anal, and penile cancers. These results may provide a foundation for culturally competent cancer screening and prevention programs via HPV vaccination efforts and increased health promotion and literacy.