Racial disparities and human papillomavirus status in oropharyngeal cancer: A systematic review and meta‐analysis

Lenze, Nicholas R.; Farquhar, Douglas R.; Mazul, Angela L.; Zevallos, José P.

doi:10.1002/hed.25414

Cited by 20 publications

(23 citation statements)

References 22 publications

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“…Similar to previous larger studies and published metanalysis focused on racial disparities in HNC [8,9,64,65], our pilot study results support that Black and White HNC patients differ significantly in terms of highest educational obtainment and annual income level. Exposure to other known HNC risk factors appeared similar between Whites and Blacks, including alcohol use and current smoking status.…”

Section: Discussionsupporting

confidence: 90%

Disparities in Head and Neck Cancer: A Case for Chemoprevention with Vitamin D

et al. 2020

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Blacks experience disproportionate head and neck cancer (HNC) recurrence and mortality compared to Whites. Overall, vitamin D status is inversely associated to HNC pointing to a potential protective linkage. Although hypovitaminosis D in Blacks is well documented it has not been investigated in Black HNC patients. Thus, we conducted a prospective pilot study accessing vitamin D status in newly diagnosed HNC patients stratified by race and conducted in vitro studies to investigate mechanisms associated with potential cancer inhibitory effects of vitamin D. Outcome measures included circulating levels of vitamin D, related nutrients, and risk factor characterization as well as dietary and supplemental estimates. Vitamin D-based in vitro assays utilized proteome and microRNA (miR) profiling. Nineteen patients were enrolled, mean circulating vitamin D levels were significantly reduced in Black compared to White HNC patients, 27.3 and 20.0 ng/mL, respectively. Whites also supplemented vitamin D more frequently than Blacks who had non-significantly higher vitamin D from dietary sources. Vitamin D treatment of HNC cell lines revealed five significantly altered miRs regulating genes targeting multiple pathways in cancer based on enrichment analysis (i.e., negative regulation of cell proliferation, angiogenesis, chemokine, MAPK, and WNT signaling). Vitamin D further altered proteins involved in cancer progression, metastasis and survival supporting a potential role for vitamin D in targeted cancer prevention.

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Section: Discussionsupporting

confidence: 90%

Disparities in Head and Neck Cancer: A Case for Chemoprevention with Vitamin D

et al. 2020

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“…We recently conducted a meta‐analysis in which we concluded that HPV accounts for much of the observed racial disparity in survival for OPSCC 14 . However, this conclusion was reached without directly measuring racial disparities by HPV status, but rather by adjusting for HPV status in the overall model.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by HPV status

et al. 2020

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Background There is a well documented racial disparity in overall survival for oropharyngeal squamous cell carcinoma (OPSCC); however, it is unknown to what extent this disparity varies by HPV‐status. Methods A literature search was conducted through December 2019 using Ovid Medline, Cochrane Library, Embase, Scopus, and http://Clinicaltrials.gov. PRISMA guidelines were followed. A meta‐analysis was conducted using random effects models to obtain pooled hazard ratios (HRs). Results Of 649 studies initially identified, 20 studies met criteria for the narrative review. There were four studies evaluating survival by race in HPV‐positive OPSCC and five studies in HPV‐negative OPSCC suitable for pooling. The pooled HR associated with black race was 1.10 (95% CI 0.96‐1.23) among patients with HPV‐positive (n = 23 608) and 1.50 (95% CI 1.12‐1.88) among patients with HPV‐negative (n = 12 112). There was notable heterogeneity (I2 = 83%) and publication bias among the HPV‐negative OPSCC studies. Conclusions The racial disparity in OPSCC survival persists for HPV‐negative disease and is nonsignificant for HPV‐positive disease. Unmeasured differences in socioeconomic status and access to care may contribute to this disparity.

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“…HPV-related oropharyngeal cancer has a lower incidence in Black Americans and may have a significant impact on the survival differences. 6,12,55 Finally, the SEER registry does not have accurate tobacco use data, although prior studies that have stratified patients by smoking habits showed no impact on disparaties. 10,11,24…”

Section: Discussionmentioning

confidence: 97%

“…[2][3][4] Oropharyngeal and oral cavity cancers have similar incidence rates across cohorts, although the prevalence of HPV, a significant positive prognostic factor, is much lower in Black individuals. 5,6 Despite ongoing advancements in surgery, radiation therapy (RT), and chemotherapy, survival in HNC remains poor, particularly among Black patients. 7 Multiple studies examining racial/ethnic disparities have found worse outcomes in Black NH patients than in White NH patients, although there has not been a comparison with Hispanic patients.…”

Section: Introductionmentioning

confidence: 99%

Elderly Black Non-Hispanic Patients With Head and Neck Squamous Cell Cancer Have the Worst Survival Outcomes

McDermott¹,

Eguchi²,

Morgan

et al. 2021

Journal of the National Comprehensive Cancer Network

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Background: In this population study, we compared head and neck cancer (HNC) prognosis and risk factors in 2 underserved minority groups (Hispanic and Black non-Hispanic patients) with those in other racial/ethnicity groups. Methods: In this SEER-Medicare database study in patients with HNC diagnosed in 2006 through 2015, we evaluated cancer-specific survival (CSS) between different racial/ethnic cohorts as the main outcome. Patient demographics, tumor factors, socioeconomic status, and treatments were analyzed in relation to the primary outcomes between racial/ethnic groups. Results: Black non-Hispanic patients had significantly worse CSS than all other racial/ethnic groups, including Hispanic patients, in unadjusted univariate analysis (Black non-Hispanic patients: hazard ratio, 1.48; 95% CI, 1.33–1.65; Hispanic patients: hazard ratio, 1.12; 95% CI, 0.99–1.28). To investigate the association of several variables with CSS, data were stratified for multivariate analysis using forward Cox regression. This identified socioeconomic status, cancer stage, and receipt of treatment as predictive factors for the survival differences. Black non-Hispanic patients were most likely to present at a later stage (odds ratio, 1.62; 95% CI, 1.38–1.90) and to receive less treatment (odds ratio, 0.67; 95% CI, 0.55–0.81). Unmarried status, high poverty areas, increased emergency department visits, and receipt of healthcare at non-NCI/nonteaching hospitals also significantly impacted stage and treatment. Conclusions: Black non-Hispanic patients have a worse HNC prognosis than patients in all other racial/ethnic groups, including Hispanic patients. Modifiable risk factors include access to nonemergent care and prevention measures, such as tobacco cessation; presence of social support; communication barriers; and access to tertiary centers for appropriate treatment of their cancers.

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Racial disparities and human papillomavirus status in oropharyngeal cancer: A systematic review and meta‐analysis

Cited by 20 publications

References 22 publications

Disparities in Head and Neck Cancer: A Case for Chemoprevention with Vitamin D

Disparities in Head and Neck Cancer: A Case for Chemoprevention with Vitamin D

Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by HPV status

Elderly Black Non-Hispanic Patients With Head and Neck Squamous Cell Cancer Have the Worst Survival Outcomes

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