title: HPV-related cancers after solid organ transplantation in the United States.
abstract: Transplant recipients have elevated cancer risk including risk of human papillomavirus (HPV)-associated cancers of the cervix, anus, penis, vagina, vulva and oropharynx. We examined the incidence of HPV-related cancers in 187 649 US recipients in the Transplant Cancer Match Study. Standardized incidence ratios (SIRs) compared incidence rates to the general population, and incidence rate ratios (IRRs) compared rates across transplant subgroups. We observed elevated incidence of HPV-related cancers (SIRs: in situ 3.3-20.3, invasive 2.2-7.3), except for invasive cervical cancer (SIR 1.0). Incidence increased with time since transplant for vulvar, anal and penile cancers (IRRs 2.1-4.6 for 5+ vs. <2 years). Immunophenotype, characterized by decreased incidence with HLA DRB1:13 and increased incidence with B:44, contributed to susceptibility at several sites. Use of specific immunosuppressive medications was variably associated with incidence; for example, tacrolimus, was associated with reduced incidence for some anogenital cancers (IRRs 0.4-0.7) but increased incidence of oropharyngeal cancer (IRR 2.1). Thus, specific features associated with recipient characteristics, transplanted organs and medications are associated with incidence of HPV-related cancers after transplant. The absence of increased incidence of invasive cervical cancer highlights the success of cervical screening in this population and suggests a need for screening for other HPV-related cancers.
authors.affiliation: Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: M M
authors.initials: MM
authors.lastname: Madeleine
authors.forename: J L
authors.initials: JL
authors.lastname: Finch
authors.forename: C F
authors.initials: CF
authors.lastname: Lynch
authors.forename: M T
authors.initials: MT
authors.lastname: Goodman
authors.forename: E A
authors.initials: EA
authors.lastname: Engels
mesh_terms: D000293:Adolescent; D000328:Adult; D001005:Anus Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D009959:Oropharyngeal Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D010412:Penile Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D012042:Registries; D016559:Tacrolimus / Q000009:adverse effects; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D014846:Vulvar Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D055815:Young Adult
chemical_list: D016559:Tacrolimus
keywords: HPV-related cancer; Transplant Cancer Match Study; immunosuppression; organ transplant cohort