Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health



First Committee Member

Abraham Mengist, PhD

Second Committee Member

Shinobu Watanabe-Galloway, PhD

Third Committee Member

David Brett-Major, MD, MPH



Approximately 46,143 human papillomaviruses (HPV) related cancers are diagnosed annually in the United States. Although the HPV vaccine has been available in the United States since 2006, more than half of adolescents have not completed the HPV vaccine series. In Nebraska, the incidence rates of HPV-related cancers have increased from 2006 (5.7%) to 2018 (6.3%). Although cervical cancer has been highly studied, there is limited research and surveillance on head and neck, vaginal, vulvar, anal, and penile cancers in a state such as Nebraska, which experiences limited access to healthcare in its rural areas. Clarity about these aspects could enhance more preventive measures. Moreover, disparities related to HPV vaccination are unclear in Nebraska.


To examine the trends and sociodemographic related disparities in the incidence of HPV-related cancers and HPV vaccination in Nebraska from 2010 to 2018 and 2009 to 2019, respectively.


A retrospective study (from 2010 to 2018) was conducted using the Nebraska Cancer Registry's aggregate data of HPV vaccination rate and incidence of HPV infection-related cancers (cervix, vaginal, vulvar, anal, penile, oropharyngeal). The HPV vaccination database came from Nebraska State Immunization Information System. Variations in the rate of HPV vaccination and in the incidence of HPV- related cancer was examined across demographic characteristics, including age, sex and ethnic groups. All the analyses were performed with Joinpoint Regression Program


From 2010 to 2018, the incidence of cervical cancer has increased with an Average Annual Percent Change (AAPC) of 2.9%. The highest increase in the trend was observed in the age group of 45-54, followed by 65 and older. A significant increase in the incidence of Head and Neck cancer was seen from 2012 to 2018 (APC:3.6). Another statistical significance was found in the age group of <35 of Head and Neck cancer (AAPC: 14.6). There was a slight increase in the incidence trend of vulvar cancer over the years from 2010 to 2018 (AAPC:1.4). Vulvar cancer's age group of 35-44 presented the highest increase with an AAPC at 9.0. On the other hand, the age group of 65 years and older trend showed a decrease (AAPC: -1.5). Penile cancer has also shown an uptrend with an AAPC of 6.5 from 2010 to 2018. The age group of 65 and older followed the same trend (AAPC: 12.4). Regarding the trend of anal cancer, an overall increase (AAPC: 5.6) was seen during the study period with a statistical significance in the age group 55-64 years.

From 2009 to 2019, vaccination showed a similar pattern in all the sociodemographic factors (sex, race, ethnicity). Specifically, a significant increase in the HPV vaccination rate were observed in sexes, races, and ethnicities. The trend was higher in females, Black or African Americans, and Hispanics.

Conclusion :

In conclusion, the trend of the incidence of HPV infection-related cancers, particularly head and neck cancer, increased from 2010 to 2018. The HPV vaccination rate showed a significant increase and then a slight decrease over the years from 2010 through 2018. Our findings highlight the importance of screening guidelines for the booming head and neck cancers. Targeted actions for vaccination improvements in white race and non-Hispanics are crucial.

More research is needed to investigate the burden of HPV- related cancers on a population level and HPV vaccination in rural areas.

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