Head and Neck Cancer among American Indian and Alaska Native Populations in California, 2009-2018

Simple Summary: In the United States, it is estimated there will be 54,000 new cases of oral cavity and pharyngeal cancer in 2021. Tobacco exposure and drinking alcohol are the main causes of head and neck cancer (HNC). Human Papilloma Virus (HPV) is now increasing in prevalence and is the most common cause of oropharyngeal cancer in the United States. This study assessed the incidence of HNC and HPV status in American Indian/Alaska Native (AI/AN) populations in California and determined if incidence was higher among AI/ANs compared to other ethnicities. We found that AI/AN and White patients had the highest burden of late-stage HNC and HPV+ lip, oral cavity, and pharynx cancer compared to other ethnicities. In addition, AI/ANs had a decreased survival rate compared to White patients. These findings reveal ethnic or racial differences in incidence, presentation, and survival, and should inform future preventative care measures for the AI/AN population. The purpose of this study was to determine the incidence of HPV-positive (HPV+) and HPV-negative (HPV-) head and neck cancer (HNC) in the American Indian/Alaska Native (AI/AN) population in California to assess whether incidence is higher among AI/ANs compared to other ethnicities. We analyzed data from the California Cancer Registry, which contains data reported to the Cancer Surveillance Section of the Department of Public Health. A total of 51,289 HNC patients were identified for the years 2009-2018. Outcomes of interest included sex, stage at presentation, 5-year survival rate, tobacco use, and HPV status. AI/AN and White patients had the highest burden of late stage HNC (AI/AN 6.3:100,000; 95% CI 5.3-7.4, White 5.8:100,000; 95% CI 5.7-5.9) compared to all ethnicities or races (Black: 5.2; 95% CI 4.9-5.5; Asian/Pacific Islander: 3.2; 95% CI 3-3.3; and Hispanic: 3.1; 95% CI 3-3.2 per 100,000). Additionally, AI/AN and White patients had the highest burden of HPV+ lip, oral cavity, and pharynx HNC (AI/AN 0.9:100,000; 95% CI 0.6-1.4, White 1.1:100,000; 95% CI 1-1.1) compared to all ethnicities or races (Black: 0.8:100,000; 95% CI 0.7-0.9; Asian/Pacific Islander: 0.4; 95% CI 0.4-0.5; and Hispanic: 0.6; 95% CI 0.5-0.6). AI/ANs had a decreased 5-year survival rate compared to White patients (AI/AN 59.9%; 95% CI 51.9-67.0% and White 67.7%; 95% CI 67.00-68.50%) and a higher incidence of HNC in former and current tobacco users. These findings underscore the disparities that exist in HNC for California AI/AN populations. Future studies should aim to elucidate why the unequal burden of HNC outcomes exists, how to address increased tobacco usage, and HPV vaccination patterns to create culturally and community-based interventions.

Automated summary

This study in California found that American Indian/Alaska Native (AI/AN) and White patients had the highest burden of late-stage head and neck cancer (HNC) and HPV-positive lip, oral cavity, and pharynx cancer compared to other ethnicities. AI/ANs had a decreased 5-year survival rate compared to White patients. Future research should focus on understanding the inequalities in HNC outcomes, addressing increased tobacco usage, and implementing interventions tailored to the cultural and community needs of AI/AN populations.