HPV is the cause of almost all cervical cancer and is responsible for a substantial fraction of other anogenital cancer and oropharyngeal cancer. Understanding the HPV-attributable cancer burden can boost programs of HPV vaccination and HPV-based cervical screening.
Attributable fractions (AF) and the relative contributions of different HPV types were derived from published studies reporting on the prevalence of transforming HPV infection in cancer tissue1. Maps of age-standardized incidence rates of HPV-attributable cancers by country from GLOBOCAN 2012 data are shown separately for the cervix, other anogenital tract, and head and neck cancers.
4.5% of all cancers worldwide (630,000 new cancer cases per year of which 570,000 cases in women and 60,000 cases in men) are attributable to HPV. The HPV AF is 8.6% in women, with vast variations by region, and 0.8% in men. AF in women ranges from <3% in Australia/New Zealand and the USA to >20% in India and sub-Saharan Africa. Cervix accounts for 83% of HPV-attributable cancer, two-thirds of which occur in less developed countries. Other HPV-attributable anogenital cancer includes 8,500 vulva; 12,000 vagina; 35,000 anus (half occurring in men); and 13,000 penis. In the head and neck, HPV-attributable cancers represent 38,000 cases of which 21,000 are oropharyngeal cancers occurring in more developed countries. Contrary to the other cancer sites, the majority of HPV-attributable cancer of the head and neck occur in men (80%) and incidence rates are larger in high- income than low/middle-income countries.
Economic development is not sufficient to reduce the burden of sexual transmission of HPV and the related cancer burden unless population-based interventions are prioritized and made cost-effective in low/middle income countries. Universal access to vaccination is logistically less demanding than cervical screening and is therefore the key to avoiding most cases of HPV-attributable cancer in both sexes. The preponderant burden of HPV16/18 and the possibility of cross-protection emphasize the importance of the introduction of cheaper vaccines in less developed countries, even if only HPV16/18 vaccines are affordable.
1. de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer 2017;In Press.