Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas, USA.
Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas, USA.
Cancer Med. 2024 Aug;13(16):e70133. doi: 10.1002/cam4.70133.
While cervical cancer incidence rates (IR) in the United States have dropped in the last 20 years, non-cervical human papillomavirus (HPV) associated cancers increased. Many people in Texas (TX) live in medically underserved areas and have higher risk of developing HPV-associated cancers. Since previous studies of these regions focused on cervical cancer, we included other HPV-associated cancers in our analysis of IR in East TX and the TX-Mexico Border compared to other TX regions.
Cancer data from 2006 to 2019 were obtained from the TX Cancer Registry. Cases of HPV-associated cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers and corresponding patient-level demographic data were included. We calculated IR per 100,000 and drew heat maps to visualize cancer IR by county. To control potential confounders, we added county-level risk factors: rates for smoking, excessive drinking, obesity, STIs, primary care provider availability and dentist availability, from the County Health Rankings and Roadmaps program. We reported IRs by region and time and estimated unadjusted and adjusted risk ratio (RR) for association of each type of cancer and region. Lastly, we created adjusted models for each cancer by period to see time trends of regional differences.
Risk of anal, cervical, and oropharyngeal cancer was lower at parts of the Border than in the rest of TX in the adjusted model. We also observed increasing anal and oropharyngeal cancer risk and decreasing cervical and vaginal cancer risk over time.
Patient sociodemographics, behavioral risk factors, and access to care may contribute to some observed differences in cancer IR across regions. This indicates that targeted prevention efforts towards these regions, especially in low socioeconomic status communities, may benefit future generations.
尽管美国的宫颈癌发病率在过去 20 年有所下降，但与非宫颈人乳头瘤病毒（HPV）相关的癌症却有所增加。德克萨斯州（TX）的许多人生活在医疗服务不足的地区，患 HPV 相关癌症的风险更高。由于之前这些地区的研究重点是宫颈癌，因此我们将其他 HPV 相关癌症纳入了我们对东 TX 和 TX-Mexico 边境与其他 TX 地区 HPV 相关癌症发病率的分析。
我们从 TX 癌症登记处获取了 2006 年至 2019 年的癌症数据。包括 HPV 相关的宫颈、阴道、外阴、阴茎、肛门和口咽癌症病例以及相应的患者水平人口统计学数据。我们计算了每 10 万人的发病率，并通过县绘制了热图以可视化癌症发病率。为了控制潜在的混杂因素，我们添加了县一级的风险因素：吸烟、酗酒、肥胖、性传播感染、初级保健提供者的可用性和牙医的可用性，这些数据来自县健康排名和路线图计划。我们按地区和时间报告发病率，并估计了每种癌症与地区关联的未调整和调整后的风险比（RR）。最后，我们为每个癌症创建了调整后的模型，以观察不同时期的区域差异的时间趋势。
在调整后的模型中，与 TX 其他地区相比，边境地区的肛门、宫颈和口咽癌风险较低。我们还观察到，随着时间的推移，肛门和口咽癌的风险增加，而宫颈和阴道癌的风险降低。
患者的社会人口统计学、行为风险因素和获得医疗保健的机会可能导致不同地区癌症发病率的一些差异。这表明，针对这些地区，特别是在社会经济地位较低的社区，开展有针对性的预防工作，可能会使未来几代人受益。
