updated: hpv-related cancer rates...• hpv-associated cancers and tobacco-related cancers *pawlish...
TRANSCRIPT
New Jersey State Cancer Registry
Rutgers, The State University of New Jersey
120 Albany Street, Tower 2, 8th Floor
New Brunswick, NJ 08903-2681
http://www.nj.gov/health/ces/
(609) 633-0500
Updated: HPV-Related Cancer Rates
Antoinette M. Stroup, PhD, Director
HPV NJ Roundtable
October 10, 2017
East Windsor, NJ
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HPV-associated cancers: Percent attributable to HPV infection*
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Cervical Vaginal Vulvar Penile Anal Oralpharyngeal
HPV Other
*Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control.
“HPV-Associated Cancer Rates by State,” HPV and Cancer. U.S. Department of Health & Human
Services. 20 Aug 2018, https://www.cdc.gov/cancer/hpv/statistics/state/.
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Incidence Trends (APC*) of HPV-associated cancers in NJ (Females)**
0
2
4
6
8
10
12
14
16
18
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Ag
e-A
dju
ste
d R
ate
per
100,0
00
Diagnosis Year
Invasive Cervical Cancer Rectum Oral Cavity & Pharynx
Falling since 1990: APC -2.6
Falling since 1979: APC -0.6
Falling since 1986: APC -1.9
*APC=Annual Percent Change; **Data Source: https://www.cancer-rates.info/nj/
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Incidence Trends (APC*) of HPV-associated cancers in NJ (Males)**
0
5
10
15
20
25
30
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Ag
e-A
dju
ste
d R
ate
pe
r 1
00
,00
0
Diagnosis Year
Oral Cavity & Pharynx Rectum
*APC=Annual Percent Change; **Data Source: https://www.cancer-rates.info/nj/
Declines from 1979-2003: APC -1.4 Rising from 2003: APC 0.9
Declines from 1986-1994: APC -3.5
Declines from 2000-2009: APC -4.0
Declines from 2009-2015: APC -1.2
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6.3
2.4
10.1
7.7
0.7
2.9
4.9
2.0
9.7 9.9
0.7
1.5
5.0
3.0
8.6
11.4
0.8
2.6
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
Oral Cavity &Pharyx
Anal Rectum Cervix Vagina Vulva
Ag
e-A
dju
ste
d R
ate
pe
r 1
00
,00
0
Incidence Rates for HPV-associated Cancers in New Jersey:Females 2011-2015 by Race and Ethnicity**
White Black Hispanic*
**Adapted from Pawlish, et al. (2018). *Could be any raceRates age-adjusted to 2000 U.S. standard population. Rectum Includes Rectosigmoid Junction.* Source: https://www.cancer-rates.info/nj/ n=number of new cases from 2011-2015
State Rate: 455.3*
Breast Rate: 133.4*
n=1,897*n=2,892*
n=1,754*n=644* n=197* n=754*
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16.2
1.3
15.7
0.9
12.4
2.0
14.2
1.1
10.7
1.0
12.7
2.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
Oral Cavity & Pharyx Anal Rectum Penis
Ag
e-A
dju
ste
d R
ate
pe
r 1
00
,00
0
Incidence Rates for HPV-associated Cancers in New Jersey:Males 2011-2015 by Race and Ethnicity**
White Black Hispanic*
State Rate: 537.6*
Prostate Rate: 134.7*
n=3,833*
n=319* n=3,639*
n=198*
**Adapted from Pawlish, et al. (2018). *Could be any raceRates age-adjusted to 2000 U.S. standard population. Rectum Includes Rectosigmoid Junction.* Source: https://www.cancer-rates.info/nj/ n=number of new cases from 2011-2015
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SUBSEQUENT CANCER RISK
Risk of subsequent primary cancers among cervical cancer
survivors
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Risk of subsequent cancers*
• What is the risk of subsequent primary cancers after invasive
cervical cancer diagnosis?
• 1990-2015 surveillance data from NJSCR
• Standard Incidence Ratios (SIRs)
• By race and ethnicity
• HPV-associated cancers and tobacco-related cancers
*Pawlish K, Paddock L, Stroup A. Risk of subsequent invasive cancer among cervical cancer survivors in
New Jersey, 1990-2015. Poster presentation at the North American Association of Central Cancer
Registries (NAACCR) 2018 Annual Conference, June 9-14, 2018, Pittsburgh, PA.
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Risk of Subsequent Cancers
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Risk of subsequent HPV-associated cancers among
cervical cancer survivors 1990-2015 by Race/Ethnicity
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NJCEED-NJSCR LINKAGE
Determinants of follow-up care, delays in follow-up care, and
invasive cervical cancer after abnormal cervical cancer screening
result (Co PI: Jennifer Tsui and Adana Llanos)
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NJCEED-NJSCR LINKAGE
• Identify determinants of receipt of follow-up care, delays in
care (>90 days), and subsequent diagnosis of invasive
cervical cancer (ICC)
• Linkage between NJSCR and NJCEED (2000-2015)
• Women age 21-64
• Health care facility, area-level, and Individual-level factors
– Place of screening: NJCEED lead agency, health care system-
affiliated hospital or clinic, private physician practice, FQHC, county
dept. of health clinic, and other (health fairs, mobile clinics, etc.)
– Individual-level (NJCEED): age @Pap, race/ethnicity, country of birth,
# cervical cancer screening visits
– Area-level zip code tabulation area (ZCTA) Census ACS 2010-2014 –
poverty, race/ethnicity, unemployment, health insurance coverage,
language spoken at home
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NJCEED-NJSCR Results
• Descriptive statistics, multivariable logistic regression (aOR),
and generalized estimating equation (GEE) to account for
county-level clustering
• Cohort 80,634
– 73% age 40+
– 74% race/ethnic minority
– 69% foreign-born
– 67% only one Pap test
– 9,688 (12%) at least one abnormal Pap test
• 6,200 (64%) ACS-US*, 2,247 (23%) HPV+ LGSIL*
• 71% first time screeners
• 3,488 (36%) required follow-up care per standard guidelines**
– 29% private physician office, 27% NJCEED lead, 25% health care
system-affiliated hospital or clinic
*ACS-US=Atypical squamous cell of undetermined significant; LGSIL=Low grade squamous
intraepithelial lesion; **Includes high-grade squamous epithelial lesions (HGSIL), LGSIL, squamous
cell carcinoma, adenocarcinoma in situ, adenocarcinoma
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NJCEED-NJSCR Results
• Of the women who required follow-up care (n=3,488)
– 91% received the follow-up care within NBCCEDP* standard guideline
of 90 days
– 82% received their follow-up care at the same facility
• Adjusted odds of NOT receiving follow-up care
– Compared to private physician practice
• County dept of health clinic: 3.11 (2.3-4.20)
• Health system affiliated hospital/clinic: 1.71 (1.11-2.64)
– Compared to women in ZCTAs with lowest unemployment rates
• Highest unemployment ZCTAs: 1.48 (1.07-2.06)
– Compared to women with HPV+ LGSIL
• HPV+ HGSIL pap results less likely to be lost to follow-up: 0.50 (0.28-0.88)
*National Breast and Cervical Cancer Early Detection Program
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NJCEED-NJSCR Results
• Adjusted odds of DELAYS in receiving follow-up care
– Compared to private physician practice
• FQHCs: 2.77 (1.23-6.23)
– Compared to US-born women
• Central/South American born:1.46 (1.12-1.92)
– Compared to women who received follow-up care in another county
• Same county less likely to experience delays: 0.14 (0.06-0.30)
• Diagnosis of ICC
– 4,835 cases in NJ 2000-2015
– 42% (n=77) were NJCEED that required follow-up care
– Lower odds of ICC if receive follow-up care: 0.40 (0.17-0.92)
– FQHCs higher odds of ICC compared to private physician practice 3.24
(1.46-7.18)
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Conclusions
• Overall good follow-up and minimal delays over 90 days in
NJCEED population
• Evidence of facility-related factors that contribute to lack of
follow-up as well as delays
• More in-depth understanding of risk factors associated with
FQHCs and county dept of health clinics
• Low adherence to screening in this population - Progress
toward the continued reductions in ICC incidence requires
efforts to improve Pap screening among the poor and
underserved
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Thank you!
Nan Stroup, PhD, Director
Acknowledgement: Cancer data used in this study was provided by the New
Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey
Department of Health. Data were collected through funding by the
Surveillance, Epidemiology and End Results (SEER) Program of the National
Cancer Institute under contract HHSN261201300021I, the National Program of
Cancer Registries (NPCR), Centers for Disease Control and Prevention under
grant 5U58DP003931-02 as well as the State of New Jersey and the Rutgers
Cancer Institute of New Jersey.