TABLE 1. Incidence* and percent distribution of human papillomavirus (HPV)-associated cancers,† by sex, cancer type, region, and race/ethnicity§ — Indian Health Service (IHS) Purchased/Referred Care Delivery Area (PRCDA) counties,¶ United States, 2013–2017.
| Characteristic | AI/AN, rate (%) |
All regions combined |
|||||||
|---|---|---|---|---|---|---|---|---|---|
| Northern Plains | Alaska | Southern Plains | Pacific Coast | East | Southwest | AI/AN, rate (%) | White, non-Hispanic rate (%) | RR | |
|
Sex, cancer type
| |||||||||
|
Female
| |||||||||
| All HPV-associated cancers |
20.0 (100) |
21.6 (100) |
21.1 (100) |
18.5 (100) |
11.1 (100) |
8.9 (100) |
15.9 (100) |
13.7 (100) |
1.16** |
| Cervix |
11.2 (57) |
12.8 (59) |
13.8 (65) |
12.6 (63) |
6.5 (57) |
6.6 (73) |
10.3 (63) |
6.5 (39) |
1.58** |
| Vagina |
—†† |
— |
— |
— |
— |
— |
0.4 (2) |
0.4 (3) |
1.11 |
| Vulva |
3.6 (16) |
3.1 (12) |
3.3 (16) |
1.1 (8) |
1.9 (17) |
0.8 (8) |
2.0 (13) |
2.2 (18) |
0.93 |
| Oropharynx |
2.3 (11) |
3.1 (14) |
1.8 (9) |
2.1 (14) |
— |
0.4 (5) |
1.5 (10) |
1.9 (16) |
0.80 |
| Anus |
2.6 (13) |
2.0 (12) |
1.7 (9) |
2.5 (15) |
— |
0.7 (9) |
1.7 (11) |
2.7 (23) |
0.61** |
|
Male
| |||||||||
| All HPV-associated cancers |
10.6 (100) |
11.4 (100) |
14.9 (100) |
12.7 (100) |
10.0 (100) |
4.1 (100) |
10.2 (100) |
11.8 (100) |
0.86** |
| Oropharynx |
9.0 (86) |
6.3 (67) |
12.2 (83) |
10.3 (81) |
8.6 (84) |
3.3 (78) |
8.2 (82) |
9.7 (83) |
0.84** |
| Anus |
— |
— |
1.7 (10) |
1.3 (11) |
— |
— |
1.1 (11) |
1.4 (11) |
0.78 |
| Penis | — | — | 1.1 (7) | 1.1 (7) | — | 0.5 (13) | 0.9 (8) | 0.7 (6) | 1.26 |
Abbreviations: AI/AN = American Indians and Alaska Natives; ICD-O-3 = International Classification of Diseases for Oncology, Third Edition; RR = rate ratio.
* Cases per 100,000 persons; age-adjusted to the 2000 U.S. standard population.
† HPV-associated cancers were defined as invasive cancers at anatomic sites with cell types in which HPV DNA frequently is found. All cancers were histologically confirmed. Cervical cancers (ICD-O-3 site codes C53.0–C53.9) are limited to carcinomas (ICD-O-3 histology codes 8010–8671, 8940–8941). Vaginal (ICD-O-3 site code C52.9), vulvar (ICD-O-3 site codes C51.0–C51.9), penile (ICD-O-3 site codes C60.0–60.9), anal (ICD-O-3 site codes C20.9, C21.0–C21.9) and oropharyngeal cancers are limited to squamous cell carcinomas (ICD-O-3 histology codes 8050–8084, 8120–8131).
§ AI/AN race was reported by cancer registries or identified through linkage with the IHS patient registration database. To minimize racial/ethnic misclassification, analyses were restricted to AI/AN of non-Hispanic origin.
¶ Compiled from data for 2013–2017 from 50 states and the District of Columbia in cancer registries that met data quality criteria and linked with the IHS patient registration database; based on patients who resided in a PRCDA-designated county. States that have at least one PRCDA-designated county, by region and percentage of total AI/AN population residing in PRCDA counties, include Alaska (100%) (Alaska), Pacific Coast (60.3%) (California, Idaho, Oregon, and Washington), Southwest (83.9%) (Arizona, Colorado, Nevada, New Mexico, and Utah), Northern Plains (54.3%) (Indiana, Iowa, Michigan, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wisconsin, and Wyoming), Southern Plains (56.7%) (Kansas, Oklahoma, and Texas), and East (16.8%) (Alabama, Connecticut, Florida, Louisiana, Maine, Massachusetts, Mississippi, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, and Virginia). In the United States, 53.3% of the AI/AN population reside in PRCDA counties.
** For all regions combined, the rate among AI/AN was significantly (p<0.05) different from the rate among non-Hispanic Whites.
†† Dash indicates that data were suppressed when fewer than six cases were reported.