Incidence, Trends and Ethnic Differences of Oropharyngeal, Anal and Cervical Cancers: Singapore, 1968-2012

Abstract

In recent decades, several Western countries have reported an increase in oropharyngeal and anal cancers caused by human papillomavirus (HPV). Trends in HPV-associated cancers in Asia have not been as well described. We describe the epidemiology of potentially HPV-related cancers reported to the Singapore Cancer Registry from 1968–2012. Analysis included 998 oropharyngeal squamous cell carcinoma (OPSCC), 183 anal squamous cell carcinoma (ASCC) and 8,019 invasive cervical cancer (ICC) cases. Additionally, 368 anal non-squamous cell carcinoma (ANSCC) and 2,018 non-oropharyngeal head and neck carcinoma (non-OP HNC) cases were included as comparators. Age-standardized incidence rates (ASR) were determined by gender and ethnicity (Chinese, Malay and Indian). Joinpoint regression was used to evaluate annual percentage change (APC) in incidence. OPSCC incidence increased in both genders (men 1993–2012, APC = 1.9%, p<0.001; women 1968–2012, APC = 2.0%, p = 0.01) and was 5 times higher in men than women. In contrast, non-OP HNC incidence declined between 1968–2012 among men (APC = -1.6%, p<0.001) and women (APC = -0.4%, p = 0.06). ASCC and ANSCC were rare (ASR = 0.2 and 0.7 per 100,000 person-years, respectively) and did not change significantly over time except for increasing ANSCCs in men (APC = 2.8%, p<0.001). ICC was the most common HPV-associated cancer (ASR = 19.9 per 100,000 person-years) but declined significantly between 1968–2012 (APC = -2.4%). Incidence of each cancer varied across ethnicities. Similar to trends in Western countries, OPSCC incidence increased in recent years, while non-OP HNC decreased. ICC remains the most common HPV-related cancer in Singapore, but Pap screening programs have led to consistently decreasing incidence.

Incidence, cost and gender differences of oropharyngeal and noncervical anogenital cancers in South Korea

“…Additionally, the incidence of male oropharyngeal cancer increased from 2.7 in 2013 to 3.1 in 2016, whereas that of female and other cancers was stable during the study period. The incidence rate of oropharyngeal cancer associated with HPV is increasing in Asian countries such as Singapore, Taiwan and developed countries such as Northern Europe, Australia, and the United States, and the incidence rate is 2-3 times higher in males than in females [25][26][27][28], which is consistent with our study. (49%), respectively).…”

“…Therefore, appropriate prevention should be considered to prevent the increase in the incidence rate of HPV-associated disease in Korea. The incidence of oropharyngeal disease was estimated in Singapore, and the incidence per 100,000 persons of oropharyngeal squamous cell carcinoma was 2.66 for males and 0.72 for females in 2008-2012 [27]. In comparison with the results of our study, the incidence per 100,000 persons of oropharyngeal cancer in 2013 was 2.7 for males and 0.7 for females, similar to that of the Singaporean study.…”

The emerging risk of oropharyngeal and oral cavity cancer in HPV-related subsites in young people in Brazil

“…In the mid-2000s, there was a striking rise, from 40.5% to 72.2%, in the overall HPV prevalence of oropharyngeal tumors [4]. Likewise, oropharyngeal and oral cavity subsites strongly associated with HPV infection (hereafter referred to as HPV-related subsites) have increased in both sexes in Asia [8], Oceania [9,10], and North America [11][12][13], whereas HPV-unrelated subsites have decreased, similar to the prevalence of smoking [14] and lung cancer incidence [15]. There is a global concern regarding the changing epidemiology of OPC/OCC.…”

Humán papillomavírus asszociált méhnyak-megbetegedések Magyarországon: epidemiológia és a HPV-típusok összefüggése a párhuzamosan végzett citológiai diagnózissal

“…Az alkoholt nem vagy kismértékben fogyasztók között figyelhető meg az a trend, hogy az ilyen betegek rendszerint nők, medián életkoruk alacsonyabb, mint a HPVnegatív betegeké, és a daganatok gyakorlatilag az oropharyngealis régióra lokalizáltak [10,12,13]. Ebben a régióban HPV-fertőzés és ezzel párhuzamosan laphámrákok előfordulási gyakoriságának emelkedése nők-nél figyelhető meg, amely a szexuális szokások megválto-zásával függhet össze [14][15][16]. Összesen 136 fej-nyaki laphámrákot felölelő korábbi munkánkban az oropharingealis rákok 48,5%-a, a gégerákok 35,7%-a volt HPVpozitív, és Magyarországon is az alkoholt nem fogyasztó HPV-betegek körében a nők voltak túlsúlyban [3].…”

“…Ennek oka még nem tisztázott, lehet, hogy az adatok véletlen szórásáról van szó, az is elképzelhető, hogy az utóbbi években nőtt a női lakosság HPV-fertő-zöttsége, de a később ismertetendő kevésbé hatékony citológiai szűrés következtében a megbetegedések későn kerülnek felismerésre. A perianalis rákok előfordulási gyakorisága egyes adatok szerint általában csökken [15], Magyarországon nem változik. Ezek a daganatok relatí-ve ritkák és halálozási arányuk legalább négyszer alacsonyabb, mint a többi, HPV-vel összefüggő daganaté.…”