IMPORTANCENearly 45 000 human papillomavirus (HPV)-associated cancers are diagnosed annually in the US. The HPV vaccine has been approved since 2006, but information on the association between vaccination and the incidence of HPV-attributable cancers is unclear. OBJECTIVE To evaluate the potential association of screening and vaccination on the trends of HPVassociated cancers. DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based cross-sectional study was conducted using data on HPV-associated (oropharyngeal squamous cell carcinoma [SCC], anal/ rectal SCC, vulvar SCC, vaginal SCC, cervical carcinoma, and penile SCC) cancers from the US Cancer

ObjectiveCervical cancer (International Federation of Gynecology and Obstetrics (FIGO)) stage IVA-B (distant stage) is a rare diagnosis with an approximate 5 year survival rate of 17% and with limited treatment options. The objective of this study was to determine the trends in distant stage cervical cancer in the USA and identify possible factors related to these trends.MethodsData were obtained from the United States Cancer Statistics program from 2001 to 2018. Rates of cervical cancer screening and vaccination were evaluated using the Behavioral Risk Factor Surveillance System and TeenVaxView. SEER*Stat 8.3.8.9.2 and Joinpoint regression program 4.9.0.0 were used to calculate incidence trends.ResultsOver the last 18 years, 29 715 women were diagnosed with distant stage cervical carcinoma. Black women have disproportionately higher rates at 1.55/100 000 versus 0.92/100 000 in White women (p<0.001). When examining the trends over time, there has been an annual increase in distant stage cervical cancer at a rate of 1.3% per year (p<0.001). The largest increase is seen in cervical adenocarcinoma with an average annual percent change of 2.9% (p<0.001). When performing an intersection analysis of race, region and age, White women in the South aged 40–44 have the highest rise in distant cervical cancer at a rate of 4.5% annually (p<0.001). Using the Behavioral Risk Factor Surveillance System and TeenVax data, compared with Black women, we found that White women have a nearly two-fold higher rate of missed or lack of guideline screening, 26.6% vs 13.8%. White teenagers (13–17 years) have the lowest human papillomavirus vaccination rate at 66.1% compared with others at 75.3%.ConclusionsBlack women have a higher incidence of distant stage disease compared with White women. However, White women have a greater annual increase, particularly in adenocarcinomas. Compared with Black women, White women also have lower rates of guideline screening and vaccination.

Objective: To describe the barriers and facilitators to integrating behavioral health services and pediatric primary care in federally qualified health centers (FQHCs) during the early stages of implementation. Method: We conducted 34 semistructured interviews with primary care providers (n ϭ 11), behavioral health clinicians (n ϭ 12), community health workers, and other pediatric staff (n ϭ 11) at 3 FQHCs. Themes were identified inductively using methods informed by grounded theory; inductively identified themes were then deductively organized within the Consolidated Framework for Implementation Research. Results: Interviewees perceived that the adoption and sustainability of behavioral health integration (BHI) in the pediatric practices of FQHCs were most dependent on barriers and facilitators in the outer setting (the health

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107 Background: Human papillomavirus is a causative agent of many human cancers. This study aims to determine the incidence and trends of HPV-related cancers in the United States. Methods: HPV-associated cancers as classified by the CDC were included: oropharyngeal squamous cell carcinoma (SCC), anal & rectal SCC, vulvar SCC, vaginal SCC, cervical carcinoma, and penile SCC. Data were obtained from the United States Cancer Statistics program from 2001-2017. SEER*Stat 8.3.8 and Joinpoint regression program 4.8.0.1 were used to calculate incidence trends of HPV-associated cancers per 100,000. Results: The overall incidence of HPV related cancers for women was 13.68/100,000, more than half of which (52%) were cervical cancer, at 7.12/100,000 in the year 2017. Over the last 16 years, the incidence of cervical cancer has decreased at an annual percent change (APC) of 1.03% (p < 0.001). In contrast, oropharyngeal (APC = 0.77%, p < 0.001), anal & rectal (APC = 2.75%, p < 0.001), and vulvar SCC all increased significantly (APC = 1.27%, p < 0.001). For older women, the incidence of anal & rectal cancer approached that of cervical cancer. In those over 80, the incidence of cervical cancer was 6.95 (-2.90% APC, p < 0.001), compared to 6.36 for anal & rectal cancer (1.23% APC, p < 0.001). Using a projection model, incidence of anal & rectal cancer is expected to surpass that of cervical cancer by year 2025 for every age group over 55. For men, the incidence of all HPV-related cancers was 11.0/100,000 in the year 2017, 81% were associated with oropharyngeal cancer. Over the last 16 years, there was an overall annual increase in HPV related cancers at 2.36% per year (p < 0.001) with the highest increase in oropharyngeal (APC = 2.71%, p < 0.001) and anal & rectal SCC (APC = 1.71%, p < 0.001). Those at greatest risk of oropharyngeal cancer were older men aged 65-69 years with an incidence of 36.5/100,000 and annual percent increase of 4.24% (p < 0.001). The intersectionality of age and race showed that White men age 65-69 years had the highest incidence of oropharyngeal at 41.6/100,000. Conclusions: Overall, there was a decrease in cervical cancer incidence likely due to screening or vaccination. However, over 80% of men with HPV related cancers had oropharyngeal cancer, a nearly fivefold higher incidence compared to women. In contrast, there was a significant increase in non-screenable HPV-related cancers and anal & rectal SCC incidence is projected to surpass that of cervical cancer within 5 years for certain at-risk groups. Further resources and research should be conducted to address the lack of screening or vaccination in these preventable cancers.