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Objectives: In 2009, there were 48,010 new cases of head and neck cancer in the United States. A decade later, it is projected that there will be 65,410 new cases in 2019, a 36% increase in new cases of the disease. While this number represents the general head and neck cancer population in the United States, only a few studies have described incidence and trends in head and neck cancer in the pediatric, adolescent, and young adult population—individuals who may have to live with the effects of cancer treatment due to a younger than average age of diagnosis. This study aimed to estimate head and neck cancer incidence and trends in the United States’ pediatric, adolescent, and young adult population. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1975-2016, we analyzed age-adjusted head and neck cancer incidence rates for pediatric cases (aged 0 to 14 years) and young adult cases (aged 15-39 years). We used Joinpoint regression analyses to examine incidence trends stratified by sex (male, female), race (white, blacks, and Others), and age groups (0-14, and 15-39 years). Results: There were 424 pediatric HNC cases and 6,936 adolescent and young adult cases in the study. Whites accounted for 70.6% of cancers, and 57.6% of cancers occurred in males. Overall, there was a 14.7% decrease in the incidence of HNC (1.32 per 100,000 in 1975 vs. 1.12 per 100,000 in 2016). For pediatric cases, there was a 51.2% decrease in incidence of HNC (0.18 per 100,000 in 1975 vs. 0.09 per 100,000 in 2016); in young adults, there was a 12.8% decrease in incidence of HNC (2.01 per 100,000 in 1975 vs. 1.75 per 100,000 in 2016). While there was overall decrease in incidence, we found differences based on sex. Among young adult males, the annual percent change (APC) from 1975 to 2016 was -0.46 (p < 0.05) while among young adult females, it significantly increased by 0.50 (p < 0.05). This difference in young adult male vs. female head and neck cancer incidence may have been driven by race: as stratified by race, the APC for white young adult males was -0.29 (ns) while white females had an APC of 0.55 (p < 0.05); and among black young adults, APC for males was -2.24 (p < 0.05) and APC for females was -0.82 (p < 0.05). Conclusions: Among pediatric, adolescent, and young adults in the United States, head and neck cancer has decreased markedly in all groups in the last four decades, except among white female adolescents and young adults where there has been a significant increase in the time period of the study. As this trend differs from the adult head and neck cancer population, it is critical that further investigations provide more insight into the epidemiology of head and neck cancer among white adolescent and young adult females. Note: This abstract was not presented at the conference. Citation Format: Nosayaba Osazuwa-Peters, Kara M. Christopher, Matthew C. Simpson, Premal B. Desai, Rebecca L. Rohde, Sai D. Challapalli, Adnan S. Hussaini, Neelima Panth, Eric Adjei Boakye. Incidence and trends in head and neck cancer among United States’ pediatric, adolescent, and young adult population [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A05.

Purpose: An estimated 8,200 cases of anal cancer will be diagnosed in 2017, accounting for nearly 1,100 deaths. Though anal cancer is a relatively rare malignancy, its increasing incidence has coincided with the increase in prevalence of risky sexual practices associated with anal human papillomavirus (HPV) infection, especially among men. At least 9 in 10 anal cancers are associated with HPV. Due to the rarity of anal cancer, little is known about factors affecting survivorship of anal cancer patients. The aim of this study was to evaluate clinical and nonclinical factors associated with anal squamous cell carcinoma (ASCC) survival in the United States. Methods: A retrospective cohort study of patients aged ≥18 years with ASCC in the National Cancer Institute Surveillance, Epidemiology, and End Results registry (2004-2014) was analyzed. ASCC (site codes C21.0-C21.9 and C20.9), were coded for invasive squamous cell carcinomas per the International Classification of Diseases for Oncology, third edition. The outcome was survival (alive or dead) and the exposures were clinical (stage of presentation and treatment modality), and nonclinical (marital status, age, sex, race/ethnicity). Fine and Gray proportional hazards regression model were used to assess differences in survival among sociodemographic and clinical factors. Results: There were 13,142 patients diagnosed with ASCC between 2004 and 2014. Mortality rate during the study period was 34.9% and median survival time was 113 months. In the adjusted model, a one-year increase in age was associated with 2% increased risk of death (adjusted hazard ratio (aHR) =1.02; 95% confidence interval (CI): 1.02-1.03). Compared with female patients, male patients (aHR=1.54; 95% CI: 1.40-1.70) had higher hazard of death, as did patients who were non-Hispanic black (aHR=1.40; 95% CI: 1.23-1.60) or non-Hispanic other (aHR=1.34; 95% CI: 1.09-1.65) versus non-Hispanic white. Patients who were never married (aHR=1.29; 95% CI: 1.15-1.44) or widowed (aHR=1.37; 95% CI: 1.18-1.59) had higher hazard of death compared to married patients. Patients had higher hazard of death if they were had stage II (aHR=2.01; 95% CI: 1.62-2.49), stage III (aHR=4.58; 95% CI: 3.70-5.67) or stage IV cancer (aHR=13.43; 95% CI: 10.74-16.78); and had not received surgery (aHR=1.41; 95% CI: 1.26-1.57). Conclusion: Besides the clinical factors known to impact survival, including stage and treatment modality, several nonclinical factors are associated with the survival of anal cancer in the United States: age, sex, race/ethnicity, and marital status. It is important that interventions considering these factors are developed to improve survivorship, especially among the unmarried, males, and minority patients. Citation Format: Eric Adjei Boakye, Matthew Simpson, Rebecca Rohde, Lauren Anderson, Betelihem B. Tobo, Thomas E. Burroughs, Nosayaba Osazuwa-Peters. Anal cancer survivorship: Clinical and nonclinical factors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4253.

Background The HPV vaccine prevents HPV-associated cancers and genital warts, which cause significant morbidity and mortality in the US. While the vaccine is targeted toward 11-12-year-old boys and girls, there is a catch-up vaccination range up to 26 years. However, vaccination rates are very low among eligible young adults, aged 18-26 years, and besides college-related studies, not a lot is known about factors associated with the HPV vaccine uptake in this population. The aim of this study was to assess sociodemographic factors associated with HPV vaccination uptake in a nationally representative sample of 18-26-year-old adults. Methods The National Health Interview Survey 2014-2015 was examined for young adults, aged 18-26 years (n = 7588). HPV vaccine initiation was defined as receipt of at least one dose of the vaccine and completion as receipt of the three doses. Sociodemographic factors included age, gender, race, marital status, education, health insurance, regular provider, number of doctor visits, and geographic region. Survey-weighted multivariable logistic regression models were used to examine the socio-demographic factors that were associated with HPV vaccine uptake. Results Approximately 27% of respondents had initiated the HPV vaccine and 16% had completed the HPV vaccine. After adjusting for covariates, compared to females, males were 81% less likely to initiate HPV vaccine [(adjusted odds ratio) 0.19; (95 % confidence interval) 0.16-0.23]. Other factors associated with HPV vaccine initiation included having health insurance (1.70; 1.32-2.18), visiting the doctor’s office 6+ times (1.86; 1.48-2.34) and 1-5 times (2.09; 1.56-2.81) vs. no doctor’s office within the last 12 months, and having no high school diploma (0.46; 0.32-0.64) and having high school diploma (0.40; 0.31-0.52) vs. college degree or higher. The same factors were associated with HPV vaccine completion; but, being black (0.60; 0.44-0.83) vs. white and having no usual place of care (0.74; 0.57-0.96) were also associated with lower odds of completing the vaccine series. Conclusions Our study shows that there are sociodemographic factors associated with HPV vaccine uptake among young adults in the United States, and males, individuals with a lower education, and those without adequate healthcare access are less likely to initiate and complete the HPV vaccination. Our findings suggest it is necessary to develop targeted interventions to promote HPV vaccination among those in the catch-up age range. Citation Format: Eric Adjei Boakye, Betelihem B. Tobo, Daphne Lew, Meera Muthukrishnan, Vy T. Pham, Rebecca Rohde, Thomas Burroughs, Mark A. Varvares, Nosayaba Osazuwa-Peters. Factors associated with HPV vaccination initiation and completion among 18-26 year olds in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4221. doi:10.1158/1538-7445.AM2017-4221

Purpose To assess racial and gender differences, among a drag racing population, as predictors of sexual risk factors associated with HPV infection, including number of oral sexual partners, age of first vaginal sex, and age of first oral sex. Methods A cross-sectional study was conducted at a drag racing event on September 12-13, 2015 in Madison, Illinois. Independent variables were gender and race. Outcome variables were number of oral sexual partners (high vs. low), age of first vaginal sex, and age at first oral sex. Multivariable logistic regression was used to examine the association between race and gender, and number of sexual partners. Multivariable linear regression analysis assessed the association between race and gender, and age of first vaginal sex, and age at first oral sex. Results Three hundred and one individuals took our survey. Of these respondents, 63% were male, and 65% identified as African Americans. Mean age for this population was 48 ± 13 years. Approximately 45% of participants reported they have had four or more oral sexual partners. Mean age for first vaginal sex was 17 ± 3 years, 20 ± 6 years for first oral sex. Multivariate logistic regression revealed that gender was a significant predictor of number of oral sexual partners, but race was not significant. Men compared to women were more likely to have a high number of oral sexual partners (OR = 2.08; 95% CI: 1.23, 3.57). In multivariable linear regression, gender and race were significant predictors of age of first vaginal sex, and age at first oral sex. Men were more likely to have earlier vaginal sexual debut as compared to women (β = -1.13; 95% CI: -1.82, -0.43) as were African Americans compared to Caucasians (β = -1.14; 95% CI: -1.82, -0.46). Men were also more likely to have earlier oral sexual debut as compared to women (β = -2.51; 95% CI: -3.98, -1.04). Caucasians were more likely to have earlier oral sexual debut as compared to African Americans (β = 2.44; 95% CI: 1.02, 3.87). Conclusions Race and gender were independent predictors of HPV risk factors. Males were more likely to initiate earlier and engage in both oral and vaginal sexual behaviors that are high risk for developing HPV. Caucasians were more likely to initiate earlier, and engage in oral sexual behaviors that are high risk for developing HPV. These findings provide impetus for the development of targeted educational interventions aimed at improving knowledge of these sexual risk factors among Caucasians and males, in the community. Citation Format: Rebecca L. Rohde, Nosayaba Osazuwa-Peters, Eric Adjei Boakye, Rajan Ganesh, Ammar Moiyadi, Adnan S. Hussaini, Mark A. Varvares. Do race and gender independently predict risk factors associated with the Human papillomavirus. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1430.