Human Papillomavirus-Associated Subsequent Malignancies among Long-Term Survivors of Pediatric and Young Adult Cancers

Abstract

Long-term survivors of pediatric and young adult (PAYA) cancers have a high incidence of subsequent neoplasms, but few risk factors other than cancer treatment have been identified. We aimed to describe the burden of human papillomavirus (HPV)-associated malignancies among survivors of PAYA cancers to assess whether HPV infections might be a reasonable area of future etiologic research on subsequent malignancies in this population. We used longitudinal data from 9 population-based registries of the Surveillance, Epidemiology, and End Results program collected between 1973 and 2010 to assemble a cohort of individuals who were diagnosed with any cancer between the ages of 0 and 29 years and survived at least 5 years post-diagnosis. We estimated sex-specific standardized incidence ratios (SIRs) with corresponding 95% confidence limits (CL) of HPV-associated subsequent malignancies (cervical, vaginal, vulvar, penile, anal, tongue, tonsillar, and oropharyngeal). Our study population comprised 64,547 long-term survivors of PAYA cancers diagnosed between 1973 and 2010. Compared with females in the general US population, female PAYA cancer survivors had a 40% relative excess of HPV-associated malignancies overall (SIR = 1.4, 95% CL: 1.2, 1.8). Compared with males in the general US population, male PAYA cancer survivors had a 150% relative excess of HPV-associated malignancies overall (SIR = 2.5, 95% CL: 1.9, 3.4). Our findings suggest an excess of HPV-associated malignancies among PAYA cancer survivors compared with the general US population. We hypothesize that a portion of subsequent malignancies among PAYA cancer survivors may be directly attributable to HPV infection. This hypothesis warrants exploration in future studies.

Intimacy, Substance Use, and Communication Needs During Cancer Therapy: A Report From the “Resilience in Adolescents and Young Adults” Study

“…The real or perceived risks of these activities, however, may be different among cancer survivors. For example, U.S. epidemiologic data suggest childhood cancer survivors have a 2.5-fold higher standardized incidence ratio of human papilloma virus–associated malignancies [26]. And, although they report sexual dysfunction, dissatisfaction, and impaired sexual identity development compared to population norms, childhood cancer survivors are also twice as likely to report high risk sexual behaviors such as receiving money in exchange for sex or engaging in unprotected anal sex [8,9,13].…”

Prevalence and predictors of human papillomavirus (HPV) vaccination among young women surviving childhood cancer

“…Relative to those without a history of childhood cancer, female survivors have an overall 40% increased risk of developing a late HPV-associated cancer [10]. This risk increases among those previously treated with radiation therapy; the standardized incidence ratio for developing a late vaginal cancer in this group, for example, is 11.0 (95% confidence interval, 3.5 - 27.0).…”

“…Survivors of pediatric cancer are at an increased risk for HPV-related cancers and complication, and later associated malignancies [10, 24]. Despite this increased susceptibility, rates of HPV vaccination initiation and completion for adolescent survivors of childhood cancer are slightly lower when compared to controls [25].…”

Medical and sociodemographic factors associated with human papillomavirus (HPV) vaccination adherence among female survivors of childhood cancer

“…Female survivors, for example, experience an excess risk of 40% overall, but this escalates to 760% for tonsillar cancers among those treated with radiation therapy [13]. Survivors at highest risk for cervical dysplasia and/or HPV-associated cancers post-treatment include those treated with allogeneic or autologous transplant, pelvic radiation, or those diagnosed with Hodgkin's lymphoma [14-17].…”