title: Human papillomavirus-active head and neck cancer and ethnic health disparities.
abstract: OBJECTIVE
  Mortality for black males with head and neck squamous cell carcinoma (HNSCC) is twice that of white males or females. Human papillomavirus (HPV)-active HNSCC, defined by the concurrent presence of high-risk type HPV DNA and host cell p16(INK4a) expression, is associated with decreased mortality. We hypothesized that prevalence of this HPV-active disease class would be lower in black HNSCC patients compared to white patients.
  
  
  METHODS
  Multi-institutional retrospective cohort analysis.
  
  
  METHODS
  Real-time polymerase chain reaction was used to evaluate for high-risk HPV DNA presence. Immunohistochemistry for p16(INK4a) protein was used as a surrogate marker for HPV oncoprotein activity. Patients were classified as HPV-negative (HPV DNA-negative, p16(INK4a) low), HPV-inactive (HPV DNA-positive, p16(INK4a) low), and HPV-active (HPV DNA-positive, p16(INK4a) high). Overall survival and recurrence rates were compared by Fisher exact test and Kaplan-Meier analysis.
  
  
  RESULTS
  There were 140 patients with HNSCC who met inclusion criteria. Self-reported ethnicity was white (115), black (25), and other (0). Amplifiable DNA was recovered from 102/140 patients. The presence of HPV DNA and the level of p16(INK4a) expression were determined, and the results were used to classify these patients as HPV-negative (44), HPV-inactive (33), and HPV-active (25). Patients with HPV-active HNSCC had improved overall 5-year survival (59.7%) compared to HPV-negative and HPV-inactive patients (16.9%) (P = .003). Black patients were less likely to have HPV-active disease (0%) compared to white patients (21%) (P = .017).
  
  
  CONCLUSIONS
  The favorable HPV-active disease class is less common in black than in white patients with HNSCC, which appears to partially explain observed ethnic health disparities.
authors.affiliation: Department of Otolaryngology, Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Weinberger
authors.forename: Mark A
authors.initials: MA
authors.lastname: Merkley
authors.forename: Sunny S
authors.initials: SS
authors.lastname: Khichi
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Lee
authors.forename: Amanda
authors.initials: A
authors.lastname: Psyrri
authors.forename: Lana L
authors.initials: LL
authors.lastname: Jackson
authors.forename: William S
authors.initials: WS
authors.lastname: Dynan
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae; D016019:Survival Analysis; D014412:Tumor Virus Infections / Q000453:epidemiology* / Q000821:virology; D014481:United States; D044465:White People