A recent review article highlighted the disparity in the incidence of head and neck cancers between African Americans and whites, as well as identified a potential explanation for this disparity as it relates to human papillomavirus (HPV) infection. The review article was published online January 5, 2019 in the Journal of the National Cancer Institute.
Several disparities exist in head and neck cancer that affect prognosis. Overall, African American patients typically have worse prognoses than white patients, and this is often linked to socioeconomic status and type of health care insurance coverage.
Furthermore, site of origin for head and neck cancers and prevalence rates for certain somatic mutations vary between African American patients and white patients. For instance, African American patients had a lower incidence of oral cavity cancer than white patients (33.8% vs 23.4%, respectively) and higher prevalence of EGFR, KRAS, HRAS, and TP53 mutations than white patients.
In regard to HPV infection, African Americans have lower rates of HPV infection than whites and this, the review authors wrote, is “one of the primary reasons for high mortality and low response to chemo-radiation therapy” among African Americans. HPV infection is linked to certain malignancies, including oral, pharynx, nasal, or larynx squamous cell carcinoma, and these cancer types are less likely to occur in African American patients.
“Although accumulating evidence supports SES [socioeconomic status] and sexual lifestyle preference as the primary determinant of differential HPV infection and overall prognosis of AA [African American] and white patients,” the study authors wrote, “it is worth mentioning that the inherent somatic variations and the HPV-driven intratumoral immune-metabolic phenotype of these races are not exclusive phenomenon but interdependent crucial contributors in the disparity.”
- Chaudhary S, Ganguly K, Muniyan S, et al. Immunometabolic alterations by HPV infection: New dimensions to head and neck cancer disparity [published online January 5, 2019]. J Natl Cancer Inst. doi: 10.1093/jnci/djy207