Abstract
Background: Subsequent malignant neoplasms (SMN; new cancers that arise after an original diagnosis) contribute to premature mortality among adolescent and young adult (AYA) cancer survivors. Because of the high population prevalence of human papillomavirus (HPV) infection, we identify demographic and clinical risk factors for HPV-associated SMNs (HPV-SMN) among AYA cancer survivors in the SEER-9 registries diagnosed from 1976 to 2015. Methods: Outcomes included any HPV-SMN, oropharyngeal-SMN, and cervical-SMN. Follow-up started 2 months after their original diagnosis. Standardized incidence ratios (SIR) compared risk between AYA survivors and general population. Age-period-cohort (APC) models examined trends over time. Fine and Gray’s models identified therapy effects controlling for cancer and demographic confounders. Results: Of 374,408 survivors, 1,369 had an HPV-SMN, occurring on average 5 years after first cancer. Compared with the general population, AYA survivors had 70% increased risk for any HPV-SMN [95% confidence interval (CI), 1.61–1.79] and 117% for oropharyngeal-SMN (95% CI, 2.00–2.35); cervical-SMN risk was generally lower in survivors (SIR, 0.85; 95% CI, 0.76–0.95), but Hispanic AYA survivors had a 8.4 significant increase in cervical-SMN (SIR, 1.46; 95% CI, 1.01–2.06). AYAs first diagnosed with Kaposi sarcoma, leukemia, Hodgkin, and non-Hodgkin lymphoma had increased HPV-SMN risks compared with the general population. Oropharyngeal-SMN incidence declined over time in APC models. Chemotherapy and radiation were associated with any HPV-SMN among survivors with first HPV-related cancers, but not associated among survivors whose first cancers were not HPV-related. Conclusions: HPV-SMN in AYA survivors are driven by oropharyngeal cancers despite temporal declines in oropharyngeal-SMN. Hispanic survivors are at risk for cervical-SMN relative to the general population. Impact: Encouraging HPV vaccination and cervical and oral cancer screenings may reduce HPV-SMN burden among AYA survivors.
| Original language | English |
|---|---|
| Pages (from-to) | 625-633 |
| Number of pages | 9 |
| Journal | Cancer Epidemiology Biomarkers and Prevention |
| Volume | 32 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2023 |
Funding
This manuscript has been authored by UT-Battelle, LLC, under contract DE-AC05–00OR22725 with the US Department of Energy (DOE). The US government retains and the publisher, by accepting the article for publication, acknowledges that the US government retains a nonexclusive, paid-up, irrevocable, worldwide license to publish or reproduce the published form of this manuscript, or allow others to do so, for US government purposes. DOE will provide public access to these results of federally sponsored research in accordance with the DOE Public Access Plan (http://energy.gov/downloads/doe-public-access-plan). J.Y. Ou reports grants from Huntsman Cancer Institute during the conduct of the study. K. Parker reports grants from NCI Cancer Center during the conduct of the study. D. Kepka reports grants from American Cancer Society/Merck outside the submitted work. J.M. Ramsay reports grants from P30CA042014 during the conduct of the study. A.C. Kirchhoff reports grants from Huntsman Cancer Institute during the conduct of the study. No disclosures were reported by the other authors. grant 5P30CA042014 awarded to Dr. Cornelia Ulrich. The authors declare no conflict of interest. NCI grant 5P30CA042014 (PI: Cornelia Ulrich) The publication costs of this article were defrayed in part by the payment of publication fees. Therefore, and solely to indicate this fact,