689. California Female Human Papillomavirus Related Anogenital Malignancies
Session: Abstracts: Virology
Friday, October 22, 2010
Background:   Human Papillomavirus (HPV) is the most common sexually transmitted disease worldwide. Persistence of HPV infection is the known precursor to anogenital cancers, although anal and vulvar cancers are rare. Recent studies have demonstrated equal carriage of oncogenic HPV types in cervical and anal compartments suggesting that they may serve as common reservoirs. The natural history of these rare cancers is poorly understood. Large population based studies evaluating trends over time along with co-existent risks may help us understand HPV associated cancers.

Methods:   A cohort of women was identified via the State of California OSHPD Discharge database, a record of all acute care California hospital discharges from 1985-2007. This cohort was searched for ICD9 codes representative of cervical, vulvar, and anal cancer and precursors to HPV-related malignancy. Demographic data including age, race/ethnicity, county of residence, and insurance type was collected along with ICD9 codes for human immunodeficiency virus (HIV) and HPV. Data was analyzed with EpiInfo 6.

Results: A total of 212,930 female patient records with HPV-related cancers were identified, of whom 51.8% had private insurance, 59% were white, 24% Hispanic, 8% black, 7% Asian, and  2% other, with a mean age of 48 years.  The majority of diagnoses of cervical, anal, and vulvar cancers were from Southern California. Cervical cancer was the discharge diagnosis among 92% followed by vulvar and anal cancer in 5% and 3% respectively. Concurrent discharge diagnoses of HPV and HIV were rare (<1%).  Overall numbers of discharges for cervical cancer declined over time while anal and vulvar cancer discharges increased (p<0.0001). Few women had concurrent cervical, anal, and vulvar cancer discharge diagnoses.


Conclusion:  In California over the last 22 years discharge diagnosis of cervical cancer decreased over time, while vulvar and anal cancer increased. Moreover, despite studies that suggest concurrent carriage of anal and cervical high-risk types, co-existent diagnosis of anogenital cancers was uncommon.  Further studies are needed to elucidate risk factors for HPV malignancies in women.


Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Candice J. McNeil, MD, MPH , Infectious Diseases, Stanford University, Stanford, CA
Meira Halpern, PhD , Pediatric Infectious Diseases, Stanford University School of Medicine, Stanford, CA
Yvonne Maldonado, MD , Pediatric Infectious Diseases, Stanford University School of Medicine, Stanford, CA


C. J. McNeil, None

M. Halpern, None

Y. Maldonado, None

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