title: Racial disparities in Human Papillomavirus (HPV) associated head and neck cancer.
abstract: OBJECTIVE
  Poorer survival from head and neck squamous cell carcinoma (HNSCC) in African Americans (AA) may be due to disparity in the prevalence of Human Papillomavirus (HPV) but earlier studies often failed to control other etiological factors. We aimed to elucidate whether racial disparities in HPV prevalence and overall survival were due to confounding from smoking or alcohol use.
  
  
  METHODS
  385 patients with SCC of the mouth, pharynx, nose, or larynx who had surgical resection at Wayne State University affiliated hospitals were identified through a population-based cancer registry. Formalin fixed paraffin embedded tissue blocks were used to determine the presence of HPV DNA and its genotype using a sensitive broad-spectrum PCR technique. Patients' demographics, tumor characteristics and vital status were obtained through record linkage with the registry data and smoking and alcohol information was abstracted from medical record. Cox's proportional hazard model and unconditional logistic regression models were employed to analyze the overall survival and tumor HPV-positivity, respectively.
  
  
  RESULTS
  HPV positivity in oropharyngeal cancer was substantially lower in AA than in other racial groups (odds ratio 0.14, 95% confidence interval (CI) 0.05-0.37) and adjustment for smoking or alcohol did not change this association. However, a significantly increased hazard ratio of death in AA oropharyngeal cancer patients (univariable hazard ratio (HR) 2.55, 95% CI 1.42-4.59) decreased to almost unity (HR 1.49, 95% CI 0.75-2.93) after adjustment for HPV and smoking.
  
  
  CONCLUSIONS
  Lower HPV prevalence in AA largely accounts for their poorer survival from oropharyngeal cancer, but not other HNSSC.
authors.affiliation: Department of Otolaryngology, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Jiron
authors.affiliation: Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Seema
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Rouba
authors.initials: R
authors.lastname: Ali-Fehmi
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
authors.affiliation: DDL Diagnostic Laboratory, Rijswijk, the Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: Struijk
authors.affiliation: DDL Diagnostic Laboratory, Rijswijk, the Netherlands.
authors.forename: Leen-Jan
authors.initials: LJ
authors.lastname: van Doorn
authors.affiliation: DDL Diagnostic Laboratory, Rijswijk, the Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Quint
authors.affiliation: Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA. Electronic address: katoi@karmanos.org.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000208:ethnology* / Q000821:virology; D004279:DNA, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D006258:Head and Neck Neoplasms / Q000208:ethnology* / Q000821:virology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D016017:Odds Ratio; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000208:ethnology* / Q000821:virology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011379:Prognosis; D044469:Racial Groups; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D004279:DNA, Viral