National trends in oropharyngeal cancer incidence and survival within the Veterans Affairs Health Care System

Abstract

Background: Oropharyngeal squamous cell carcinoma (OPSCC) epidemiology has not been examined previously in the nationwide Veterans Affairs (VA) population. Methods: Joinpoint regression analysis was applied to OPSCC cases identified from VA administrative data from 2000 to 2012. Results: We identified 12 125 OPSCC cases (incidence: 12.2 of 100 000 persons). OPSCC incidence declined between 2000 and 2006 (annual percent change [APC] = −4.27, P < .05), then increased between 2006 and 2012 (APC = 7.02, P < .05). Significant incidence increases occurred among white (APC = 7.19, P < .05) and African American (APC = 4.87, P < .05) Veterans and across all age cohorts. The percentage of never-smokers increased from 8% in 2000 to 15.7% in 2012 (P < .001), and 2-year overall survival improved from 31.2% (95% confidence interval (CI) [30-33.4]) to 55.7% (95% CI [54.4-57.1]). Conclusions: OPSCC incidence is increasing across all racial and age cohorts in the VA population. Smoking rates remain high among Veterans with OPSCC and gains in survival lag those reported in the general population.

Deployment of cisplatin in Veterans with oropharyngeal cancer: toxicity and impact on oncologic outcomes

“…On one hand, Veterans with OPSCC are older, with a higher comorbidity burden compared to the general population and thus a reduced ability to tolerate toxic chemotherapy regimens. On the other hand, Veterans consistently demonstrate inferior oncologic outcomes to the general population, which we have shown is driven by more aggressive disease biology which extends to the otherwise favorable HPV‐associated OPSCC subset of disease 10–13 . Optimal deployment of cisplatin in this population remains far from clear and granular institutional datasets are lacking.…”

Human Papillomavirus Vaccination Prevalence and Disproportionate Cancer Burden Among US Veterans

“…Prevalence of HPV vaccination among eligible veterans was one-half that among civilians. High HPV-infection prevalence, rising HPV-associated oropharyngeal cancer incidence, and low vaccination rates may be associated with increases in HPV-associated cancer morbidity and mortality among veterans.…”

“…The Advisory Committee on Immunization Practices recommends HPV vaccination until age 26 years to prevent HPV-associated malignant neoplasms in males and females. Active-duty military service members and veterans are twice as likely as the general population to develop oncogenic HPV infections, resulting in a higher risk of HPV-associated cancers and mortality, and HPV-associated oropharyngeal cancer, which occurs predominantly in males, is rising more rapidly among veterans than civilians . There are no universal HPV vaccination requirements or campaigns targeted at service members or veterans .…”

Current Therapeutic Strategies in Patients with Oropharyngeal Squamous Cell Carcinoma: Impact of the Tumor HPV Status

“…Head and neck squamous cell carcinoma (HNSCC) accounts for more than 600,000 new cases each year worldwide and represents the 6th cause of cancer deaths [1][2][3]. In western countries, about 25% of all HNSCC arise from the oropharynx [2].…”