A national, Rutgers-led study examines U.S. trends in a potentially preventable disease

Hispanic and Black men are dying from HPV-associated throat cancer at a higher rate, and most new cases are being diagnosed in white men at late-stage when it’s more difficult to treat, according to a new Rutgers study.

The research published in the Annals of Cancer Epidemiology is the largest and most comprehensive population-based study of its kind.

“Since these oropharyngeal cancers are all potentially preventable through the administration of the HPV vaccine, public health campaigns are needed to increase awareness of HPV’s link to throat cancer, its signs and symptoms, and to promote uptake of HPV vaccinations in all adolescent and young adult males,” said Jeanne Ferrante, the study’s senior author and professor in the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School. “In addition, clinicians need to be aware of who is at risk and the common clinical presentations.”

While the rates of new cases of HPV-associated cancers affecting the throat have been stable in minority groups since 2005, Black and Hispanic men are dying at higher rates compared with white men, regardless of the stage at which diagnosis occurs or the type of treatment they receive. In addition, the incidence of late-stage diagnosis increased by over 50 percent among non-Hispanic white men over the period spanning from 2005 to 2016.

The disease is transmitted to the throat area during heterosexual or homosexual oral sex with an infected partner. Last year in the U.S., more than 7,000 men died from cancers of the mouth and throat, and an estimated 38,800 men were diagnosed with the disease. Male incidence of these cancers is more than double that among females. Symptoms include hoarseness, persistent throat pain or difficulty swallowing, pain while chewing, a lump in the neck, a feeling of a persistent lump in the throat, a change in voice quality or the appearance of nonhealing sores in the throat.

For years, throat cancer was linked to excessive tobacco and alcohol use. In the 1980s, as the associated behaviors of smoking and drinking declined, the incidence of throat cancer caused by HPV, the most common sexually transmitted infection in the U.S., started to rise and is now the main cause of the disease.

Men are three times as likely to test positive for HPV as females and are five times more likely to develop throat cancer. The number of new male HPV-related throat cancer now exceeds cases of HPV-related cervical cancer in the U.S.

“The new statistics should spotlight male throat cancer as an important new public health concern,” said Ferrante, a research member in the Cancer Prevention and Control Program at Rutgers Cancer Institute of New Jersey.

The study represents the largest population-based analysis of racial and ethnic disparities in incidence, stage at diagnosis, survival and mortality of HPV-related throat cancer among males throughout the U.S. The researchers analyzed data from the North American Association of Central Cancer Registries of males in the U.S. diagnosed with throat cancer from 2005 to 2016. Some of the factors examined in the analysis included associations of race and ethnicity with late-stage diagnosis, survival and death rates, while controlling for age, health insurance, county level characteristics of residence and poverty, and geographic region.

The HPV 9-valent vaccine (Gardasil 9), approved by the Food and Drug Administration in 2014, prevents HPV-related infections. Even though the U.S. Centers for Disease Control and Prevention recommends routine HPV vaccination for all adolescents and young adults through age 26, about 58% of that population completed the vaccine series in 2020, with males having lower completion rates than females. Further, studies show a declining awareness of HPV and the vaccine, with the lowest awareness among males, racial minorities, residents in rural counties and those of low socioeconomic status.

Other Rutgers researchers involved in the study include Seiichi Villalona, the paper’s first author and a recent medical school graduate of Robert Wood Johnson Medical School, and Antoinette Stroup, professor in the Department of Biostatistics and Epidemiology at the Rutgers School of Public Health and the Cancer Institute of New Jersey.