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Assessment of Head and Neck Squamous Cell Carcinomas in Minority Racial/Ethnic Groups in the US
thesisposted on 01.05.2020, 00:00 by Shaveta Khosla
Purpose- The goal of this study was to assess racial/ethnic differences among male head and neck squamous cell carcinoma (HNSCC) cases from minority racial/ethnic groups in the US, with special focus on the three largest Asian diasporas, namely, Chinese, South Asian Indians/Pakistanis (I/P), and Filipinos. The purpose of the first aim was to examine the site group, Human Papillomavirus (HPV) status and temporal trends in male HNSCC cases from minority racial/ethnic groups (i.e., Non-Hispanic Blacks, Hispanics, American Indians, Asians, and Pacific Islanders) and compare them to Non-Hispanic Whites (NHW). As HNSCCs represent the most common cancer in males in parts of Asia, and Asians are the fastest growing minority group in the US, the purpose of second and third aims were to examine differences in temporal trends, site group, late stage diagnosis, all-cause mortality and overall survival in male HNSCC cases from three largest Asian subgroups in the US and compare them to NHW. Methods- Secondary data from National Cancer Database were used. We used multinomial logistic and Cox proportional hazards models. Temporal trends were assessed by calculating annual percentage change. Kaplan Meier survival estimates and log rank tests were used to assess survival differences. Results- Diagnosis at a younger age was much more likely in minority racial/ethnic groups, especially among Asians (overall, and among the three largest Asian subgroups) and Pacific Islanders. In comparison to NHW who were more likely to develop oropharyngeal cancers (OPCs), minority groups were more likely to have HNSCCs of other site groups and had lower likelihood of HPV 16/18 positive OPC. Asians had the highest likelihood of having HNSCCs of other site groups with 11 times higher odds of non-oropharyngeal cancers (Non-OPC) and three times higher odds of oral cavity cancers (OCC). Among Asian diasporas, South Asians had a greater proportion of OCC, while Chinese and Filipinos had a far greater proportion of Non-OPC. South Asian I/P cases doubled from 2004 to 2013 largely due to increase in OCC. Only Chinese had significantly lower odds of late stage diagnosis, compared to NHW but all three Asian subgroups had lower hazards of dying. Conclusion- Significant racial/ethnic differences exist in site group, HPV 16/18 status and survival. Differences in risk factors are potentially contributing to some of these differences. Moreover, younger age at diagnosis among minority groups, in general, and among the Asian diasporas points towards an early initiation of risky habits. There is an urgent need to discourage the initiation and continuation of risky habits and restrict access to the risk factors, such as areca nut, through policy changes. There is a need to also promote screening among specific subpopulations who are at a higher risk of HNSCCs of certain specific sites, such as OCC in South Asians.