Human papillomavirus-associated carcinomas in Hawaii and the mainland U.S.

BACKGROUND To the authors' knowledge, human papillomavirus (HPV)-associated carcinomas in Hawaii have not been studied in detail. METHODS Surveillance, Epidemiology, and End Results data (from 1973-1996) were used to study rate of incidence patterns of squamous cell carcinomas (SCCs) of the uterine cervix, vulva/vagina, anus, penis, and palatine tonsils among Asian/Pacific Islanders and whites in Hawaii and among whites in the U.S. in general. RESULTS With the exception of invasive cervical SCC, male and female Asian/Pacific Islanders in Hawaii had considerably lower incidence rates of HPV-associated SCCs than Hawaii whites and U.S. whites. Among women, Hawaii whites and U.S. whites had rather similar rates of invasive anogenital and tonsillar SCCs, but in situ SCC of the cervix or vulva/vagina was diagnosed less often among Asian/Pacific Islanders and whites in Hawaii than among whites in the general U.S. Among men, Hawaii whites had higher rates than U.S. whites of both anal and tonsillar, but not penile, SCCs. Among Hawaiian men with anal carcinoma, 43% (15 of 35) had remained unmarried versus 3% (2 of 65) of Hawaiian women with anal carcinoma. CONCLUSIONS Asian/Pacific Islanders in Hawaii generally have lower incidence rates of HPV-associated SCCs than whites. However, low ratios of in situ to invasive cervical SCCs suggest that many Hawaii women, notably Asian/Pacific Islanders, are not diagnosed and treated for cervical neoplasias at a preinvasive stage. The high rate of incidence of anal SCC in male Hawaiian whites and the high proportions of unmarried men among patients with this disease suggest the transmission of HPV through homosexual contact. These men may be targeted in future screening programs for anal carcinoma.