Carlson, Katie
(2024)
Disparities and trends in human papillomavirus (HPV) pathologic testing among oropharyngeal cancer patients in the National Cancer Database.
Master Essay, University of Pittsburgh.
Abstract
Background: Oropharyngeal squamous cell carcinoma (OPSCC), a type of cancer that affects the mouth and throat, has an infectious disease etiology, with most cases caused by human
papillomavirus (HPV). Clinical recommendations advise that all new cases of OPSCC be tested for the presence of the virus, but this guideline is not always followed. Knowledge of HPV status of OPSCC is important for guiding treatment and prognosis. With rising incidence rates of HPV-associated OPSCC, HPV testing disparities represent a critical public health concern. This study aimed to examine sociodemographic disparities and temporal trends in HPV testing for oropharyngeal cancer patients in the National Cancer Database.
Methods: Our analysis included 3,116 patients in the National Cancer Database diagnosed with oropharyngeal squamous cell carcinoma between 2013 and 2016. Exposure variables were
year of diagnosis, facility type, race/ethnicity, insurance status, educational attainment, urban/rural, and median income. The outcome variable was HPV testing status. Descriptive statistics showed the distribution of HPV testing statuses across exposure variables, and chi-square
testing was used to assess statistical significance. For each exposure variable, trends in HPV testing between 2013 and 2016 were examined, and Fisher’s exact test was performed for each year.
Results: Across all exposure variables except urban/rural, there was a significant difference in the proportion of patients who received HPV testing. Between 2013 and 2016, the
proportion of patients who were HPV tested increased incrementally and significantly (2013 = 73.6% and 2016 = 82.4%, p<0.001). HPV testing rates differed significantly by year of diagnosis and insurance status in 2014 (p=0.0003165) and 2016 (0.0349); by year of diagnosis and educational attainment in 2013 (p=0.009294); by year of diagnosis and urban/rural in 2016 (p=0.04234); by year of diagnosis and median income in 2014 (p=0.02003); by year of diagnosis
and facility type in 2015 (p=0.002088); and by year of diagnosis and race/ethnicity in 2015 (p=0.03602).
Conclusions: Significant HPV testing disparities exist across time and by exposure variable for oropharyngeal squamous cell carcinoma patients in the National Cancer Database. Our
findings underscore the need for increased scrutiny of HPV testing practices to ensure that every OPSCC patient receives testing.
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