Faculty, Staff and Student Publications
Publication Date
6-1-2025
Journal
Journal of the National Cancer Institute
DOI
10.1093/jnci/djaf033
PMID
39913364
PMCID
PMC12257938
PubMedCentral® Posted Date
2-6-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Background: We estimated the impact of screening on morbidity and mortality of human papillomavirus (HPV)16-positive oropharyngeal cancer among US men aged 45-79 years.
Methods: We developed an individual-level, state-transition natural history microsimulation model to estimate the impact of screening using oral HPV16 detection, HPV16-E6 antibody detection, and transcervical ultrasound of neck/oropharynx. We compared clinical detection to counterfactual screen detection for cancer stage, single- vs multiple-modality treatment, and survival. Screening scenarios encompassed 4 progression speeds across cancer stages (very slow, slow, fast, and very fast) and 4 screening frequencies.
Results: Among US men aged 45-79 years in 2021 (n = 54 881 311), 163 958 clinically diagnosed human papillomavirus (HPV)-positive oropharyngeal cancers and 32 009 deaths would occur through age 84 in the absence of screening. Assuming very-fast progression, 4%, 20%, 31%, and 60% of these cancers would be detected by one-off, 5-yearly, 3-yearly, and annual screening. Annual screening (very-fast progression) could reduce the number of cancers diagnosed at advanced stages (American Joint Committee on Cancer, 7th edition, stages III/IV: 90.0% with no screening vs 59.1%) and treated by multiple modalities (80.6% with no screening vs 50.6%). Cancer mortality would also be reduced by 36.2%, with a gain of 106 000 life-years. Annual screening would have a number needed to screen (NNS) of 561 per screen-detected cancer, 1118 per additional cancer treated by single modality, 4740 per death prevented, and 520 per life-year gained; such high NNS reflect potential inefficiency of population-level screening.
Conclusions: If proven efficacious in randomized trials and cost-effective, screening for HPV-positive oropharyngeal cancers could provide considerable population-level reductions in advanced stage cancers, treatment-related morbidities, and mortality.
Keywords
Humans, Oropharyngeal Neoplasms, Male, Middle Aged, Aged, Early Detection of Cancer, Papillomavirus Infections, Human papillomavirus 16, United States, Mass Screening, Oncogene Proteins, Viral, Computer Simulation, Disease Progression, Human Papillomavirus Viruses, Repressor Proteins
Published Open-Access
yes
Recommended Citation
Landy, Rebecca; Haber, Gregory W; Graubard, Barry I; et al., "Impact of Screening for Human Papillomavirus-Positive Oropharyngeal Cancers: A Microsimulation-Based Modeling Study" (2025). Faculty, Staff and Student Publications. 4438.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4438
Included in
Bioinformatics Commons, Biomedical Informatics Commons, Genetic Phenomena Commons, Medical Genetics Commons, Oncology Commons