Purpose

Populations with high cancer risk that are targeted for screening, education, and vaccination have been shown to increase rates of screening, which ultimately may improve timing of diagnosis and overall outcome for certain cancers. Spatial scan analysis provides a visual representation of areas with higher rates of disease. Limited research has used this methodology to assess HPV-associated cancers. Using, spatial scan statistics, our goal was to identify regions within Kentucky having significantly higher rates of HPV-associated tumors. These regions can be targeted for public health efforts in the form of education, vaccination, screening, and physician recruitment.

Methods

The Kentucky Cancer Registry data from 1995 to 2016 and spatial scan statistics were used to identify county-level clusters with high-incidence of HPV-associated cancers after adjustment for age and sex. Anatomic sites included in this analysis were oropharynx, cervix, anus, penis, and vulva.

Results

There was one high-rate cluster of oropharyngeal cancer, which was observed in the Louisville metropolitan region (Relative Risk [RR] = 1.24, p < 0.001). One high-rate cluster of anal and penile cancer incidence in men was identified that partially overlapped with the oropharyngeal cluster. There were five clusters of higher cervical, vulvar, and anal cancer incidence in females, one of which overlapped with the oropharyngeal cluster.

Conclusion

Overlapping clusters of HPV-associated cancers were identified at the county-level and included both urban and rural counties of Kentucky. Findings can assist in the design of public health interventions to increase screenings, promote vaccination, and recruit physicians in these regions to improve prevention, diagnosis, and early treatment of HPV-associated cancers.

中文翻译：

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使用空间扫描统计数据显示肯塔基州 HPV 相关癌症发病率的地理差异

目的

事实证明，针对癌症高风险人群进行筛查、教育和疫苗接种可以提高筛查率，最终可能会改善某些癌症的诊断时机和总体结果。空间扫描分析提供了疾病发生率较高的区域的视觉表示。使用这种方法来评估 HPV 相关癌症的研究有限。使用空间扫描统计数据，我们的目标是确定肯塔基州内 HPV 相关肿瘤发生率明显较高的区域。这些地区可以成为教育、疫苗接种、筛查和医生招募等形式的公共卫生工作的目标。

方法

肯塔基州癌症登记处 1995 年至 2016 年的数据和空间扫描统计数据用于确定在调整年龄和性别后 HPV 相关癌症高发的县级集群。该分析中包括的解剖部位包括口咽、子宫颈、肛门、阴茎和外阴。

结果

在路易斯维尔大都市区观察到一个口咽癌高发群（相对风险 [RR] = 1.24，p  < 0.001）。确定了男性肛门和阴茎癌发病率较高的一组，该组与口咽癌组部分重叠。女性宫颈癌、外阴癌和肛门癌发病率较高的五个集群，其中一个与口咽癌集群重叠。

结论

在县级确定了 HPV 相关癌症的重叠集群，包括肯塔基州的城市和农村县。研究结果可以帮助设计公共卫生干预措施，以增加筛查、促进疫苗接种，并招募这些地区的医生来改善 HPV 相关癌症的预防、诊断和早期治疗。