"Findings May Explain Gap in Cancer Survival"
New York Times (08.04.09)

University of Maryland researchers investigating throat cancer and squamous-cell cancers of the head and neck have made a discovery that may help explain why white cancer patients often outlive their black peers even when they have what appear to be the same cancers.

Cases of throat and head and neck cancers have spiked in recent years, with research suggesting a link to human papillomavirus, the same STD responsible for most cases of cervical cancer. HPV can be spread through oral sex, causing oropharyngeal cancer, or cancer of the throat and tonsils.

Dr. Kevin J. Cullen, director of the university's Greenebaum Cancer Center, and colleagues noticed that their white throat cancer patients survived an average 70 months, compared with 25 months for their black patients. "We were shocked to see this in our own institution, where more than half of the patients we treat are African-American," said Cullen.

Concurrently, the team was analyzing specimens of head and neck tumors collected from a treatment trial - the TAX 324 study - to determine how many tumors were linked to HPV. They found that patients with HPV-positive tumors responded much better to treatment with chemotherapy and radiation. And they were overwhelmingly white.

According to Cullen, one-half of white patients had HPV-positive tumors, compared to just one black patient. "There was no difference in the survival between black and white patients in the TAX 324 trials if you subtracted out the HPV-positive patients," he said.

The racial gap has often been explained as a result of late diagnosis among blacks, lack of access to care and less aggressive treatment. In the case of oropharyngeal cancer, however, the team's research suggests distinct biologic differences. It also suggests the racial gap in survival for this type of cancer could reflect cultural differences between blacks and whites, including different sexual practices.

In an accompanying editorial, Dr. Otis Brawley, medical director of the American Cancer Society, noted that changing sexual practices were driving up rates of head and neck cancers, and possibly others as well. "There is a huge public health message here," he wrote.

The study, "Racial Survival Disparity in Head and Neck Cancer Results from Low Prevalence of Human Papillomavirus Infection in Black Oropharyngeal Cancer Patients," and the editorial, "Oropharyngeal Cancer, Race, and the Human Papillomavirus," were published in Cancer Prevention Research (2009;2(9):776-781 and 769-772, respectively).