Survival Disparities in Smoking Status and HPV-Associated Oropharyngeal and Cervical Cancers: An Analysis of Population-Based Florida Cancer Registry (1981-2009)

Background:Smoking and Human Papillomaviruses (HPV) have been implicated in various cancers. Notably, both smoking and persistent oncogenic HPV infection can result in oropharyngeal and cervical cancers.

Methods:Using the Florida Cancer Registry (1981-2009) that was linked with US census we examined median survival, survival rates, and the prevalence of  HPV-associated oropharyngeal (tongue, tonsil) and cervical cancers by smoking status (never, former, current) in Floridian adults (≥18yrs). A multivariable Cox regression for overall survival is used to calculate adjusted hazard ratio (AHR) and 95% confidence interval (95%CI) for smoking status.  

Results:Of 186,631 patients, 6.9% had tongue cancer, 3.8% tonsil, and 21% cervical (30%). Except cervical (30% current-smokers), current-smokers consisted of the majority of tonsil (42%), tongue (37%) cancers. For tongue cancer, current (AHR=[1.3];95%CI:1.2- 1.4) and former (1.1];1.0-1.2) smokers had worse survival than non-smokers. Median survival time was 1.6yrs (1.5-1.7) in current, 2.3yrs (2.1-2.5) in former and 2.7yrs (2.4-3.0) in non-smokers. Among males, current ([1.4];1.3-1.5) and former ([1.1];1.0-1.2) smokers had worse survival than non-smokers. Among females, current ([1.2];1.1-1.4) and former ([1.1];1.0-1.3) smokers had worse survival than non-smokers. For tonsil cancer, current ([1.5];1.3-1.6) and former ([1.2];1.1-1.4) smokers had worse survival than non-smokers. Median survival was the shortest in current-smokers (1.9;1.7-2.0), then in former (2.6;2.3-2.8) and non-smokers (3.2;2.9-3.9). Among males, current ([1.4];1.2-1.6) and former ([1.2];1.0-1.3) smokers had worse survival than non-smokers. Among females, current ([1.5];1.3-1.9) and former ([1.3];1.1-1.6) smokers had worse survival than non-smokers. For cervical cancer, median survival was slightly longer for current-smokers (3.8;3.6-4.1) and similar for former (3.5;3.1-4.0) and non-smokers (3.4;3.2-3.5).

Conclusions:Overall, both current and former male and female smokers had worse survival in HPV-associated tongue/tonsil/cervical cancers. Such survival disparities highlight the importance of anti-smoking and HPV prevention campaigns. These results may provide a foundation for targeted and gender specific cancer screening and prevention programs and added smoking cessation and HPV vaccination efforts.