High-risk human papillomavirus (hrHPV) causes squamous cell carcinoma (SCC) at a variety of sites, including cervix, head and neck, anus, vulva, vagina, and penis. The 9-valent HPV vaccine is highly effective at preventing carcinomas at these sites related to the specific HPV types it covers. Among women with hrHPV detected in routine cervical swabs, however, the distribution of hrHPV types is known to differ by racial/ethnic group, with East and West Africans 1 and North Americans of African ancestry 2,3 showing overrepresentation of hrHPV types that are not covered by the current 9-valent HPV vaccine. Corresponding studies of HPV type distribution by ethnicity in advanced-stage hrHPV-related cancers are limited. In this investigation, we performed a retrospective analysis of a large multiethnic study of advanced-stage carcinoma samples to test the hypothesis that patients of African vs non-African ancestry may show dissimilar distributions of nonvaccine hrHPV types.
MethodsOur archive of 290 311 tumor samples, each from a different patient, underwent comprehensive genomic profiling using a hybrid-capture-based DNA sequencing platform. 4 The samples were sent from medical care facilities across North America from January 2014 to June 2020 for detection of targetable genetic alterations during routine clinical care. Western Institutional Review Board approved this study, including issuing an informed consent waiver and a HIPAA waiver of authorization. This report follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies. We detected hrHPV genomic sequences in 3793 cervical, anogenital, and head and neck SCCs by de novo assembly of nonhuman reads, followed by alignment to the RefSeq database, which distinguishes hrHPV types. 5 Patient ancestry was determined by classifying specific single-nucleotide variations by genomic profiling based on their known variation among populations in the 1000 Genomes Project. 6 The comparator groups were individuals of African vs non-African ancestry. Categorical data were analyzed by Fisher exact test using Prism version 8.3.1 (GraphPad Software). Data were analyzed in July 2020. A 2-tailed P value of <.05 was considered statistically significant; the Bonferroni correction was applied for multiple simultaneous comparisons. Statistical analysis was performed for hrHPV types with 10 or more cancer cases total in individuals of African ancestry.
ResultsWe identified 5 hrHPV types each with 10 or more SCC cases in individuals of African ancestry: HPV-16 (193 cases), HPV-18 (56 cases), HPV-35 (17 cases), HPV-45 (27 cases), and HPV-59 (16 cases).Compared with non-African groups, individuals of African ancestry showed significant, several-fold enrichments for HPV types 35 (5.3% vs 1.6%; P < .001), 45 (8.4% vs 3.4%; P < .001), and 59 (5.0% vs 0.5%; P < .001) (Figure ), with significant enrichments in cervical (HPV-35, 5.2% vs 1.3%; P = .003; HPV-59, 9.0% vs 0.9%; P < .001) and anal (HPV-45, 7.0% vs 1.0%; P = .0...