Clinical Review Abstract
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Differences in sexual practices and their role in gender, age, and racial disparities in HPV-positive HNSCC.
Head and Neck Cancer
Head and Neck Cancer
2013 ASCO Annual Meeting
J Clin Oncol 31, 2013 (suppl; abstr 6032)
Author(s): Carole Fakhry, Kevin J. Cullen, Janice Bowie, Roland Thorpe, Gypsyamber D'Souza; Johns Hopkins University, Baltimore, MD; University of Maryland, Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background: Human papillomavirus associated head and neck cancers (HPV-HNC) have been steadily rising in the U.S., while HPV-unassociated HNCs have declined due to reductions in tobacco use. The trend of increasing HPV-HNC has been attributed to the sexual revolution, but not well explored. Individuals with HPV-HNC tend to be younger, white, and male and HPV-HNC is strongly associated with sexual behaviors. Methods: This analysis included 2270 men and 2261 womenfrom the 2009-10 National Health and Nutrition Examination Survey (NHANES) who answered a survey on demographic and behavioral risk factors. Participants also provided an oral rinse and gargle sample for HPV DNA analysis. Prevalence of sexual behaviors and oral HPV infection were calculated by gender, age cohort (18-29, 30-44, 45-59, 60-69), and race using NHANES samples weights to provide unbiasedestimates for the US population. Results: Men (85%) and women (83%) were similarly likely to have ever performed oral sex, but men had more lifetime oral and vaginal sexual partners and higher oral HPV16 prevalence (each p<0.001).Ever having performed oral sex was less common among 60-69 than 30-44 year old men (74% vs. 92%, p<0.001) and women (71% vs. 91%, p<0.001). Older individuals also had less lifetime sexual partners, but marginally higher oral HPV16 prevalence. Whites were more likely than blacks (90%vs69%, p<0.001) to have ever performed oral sex, to have more lifetime oral sex partners and higheroral HPV16 prevalence(each p<0.001). Prevalence ratios of ever performing oral sex for men vs. women (PR=1.03), 45-59 vs 60-69 year olds(PR=1.25), and whites compared to blacks (PR=1.32) were modest relative to more striking prevalence ratios for oral HPV infection andHPV-HNC(each PR>1.5). Conclusions: There are significant gender, age-cohort, and racial differences in oral sexual practices in a representative sample of the U.S population. Although men, younger age-cohorts, and whites have higher exposures to sexual behaviors of interest, the magnitude of these behavioral differences does not appear large enough to explain the observed disparities in oral HPV infection and HPV-HNC.
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