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Habbous S, Chu KP, Lau H, Schorr M, Belayneh M, Ha MN, Murray S, O'Sullivan B, Huang SH, Snow S, Parliament M, Hao D, Cheung WY, Xu W, Liu G. Human papillomavirus in oropharyngeal cancer in Canada: analysis of 5 comprehensive cancer centres using multiple imputation. CMAJ 2017; 189:E1030-E1040. [PMID: 28808115 DOI: 10.1503/cmaj.161379] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The incidence of oropharyngeal cancer has risen over the past 2 decades. This rise has been attributed to human papillomavirus (HPV), but information on temporal trends in incidence of HPV-associated cancers across Canada is limited. METHODS We collected social, clinical and demographic characteristics and p16 protein status (p16-positive or p16-negative, using this immunohistochemistry variable as a surrogate marker of HPV status) for 3643 patients with oropharyngeal cancer diagnosed between 2000 and 2012 at comprehensive cancer centres in British Columbia (6 centres), Edmonton, Calgary, Toronto and Halifax. We used receiver operating characteristic curves and multiple imputation to estimate the p16 status for missing values. We chose a best-imputation probability cut point on the basis of accuracy in samples with known p16 status and through an independent relation between p16 status and overall survival. We used logistic and Cox proportional hazard regression. RESULTS We found no temporal changes in p16-positive status initially, but there was significant selection bias, with p16 testing significantly more likely to be performed in males, lifetime never-smokers, patients with tonsillar or base-of-tongue tumours and those with nodal involvement (p < 0.05 for each variable). We used the following variables associated with p16-positive status for multiple imputation: male sex, tonsillar or base-of-tongue tumours, smaller tumours, nodal involvement, less smoking and lower alcohol consumption (p < 0.05 for each variable). Using sensitivity analyses, we showed that different imputation probability cut points for p16-positive status each identified a rise from 2000 to 2012, with the best-probability cut point identifying an increase from 47.3% in 2000 to 73.7% in 2012 (p < 0.001). INTERPRETATION Across multiple centres in Canada, there was a steady rise in the proportion of oropharyngeal cancers attributable to HPV from 2000 to 2012.
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Affiliation(s)
- Steven Habbous
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Karen P Chu
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Harold Lau
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Melissa Schorr
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Mathieos Belayneh
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Michael N Ha
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Scott Murray
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Brian O'Sullivan
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Shao Hui Huang
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Stephanie Snow
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Matthew Parliament
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Desiree Hao
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Winson Y Cheung
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Wei Xu
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Geoffrey Liu
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
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