Human papillomavirus (HPV) is involved in the pathogenesis of anogenital cancers and oropharyngeal cancer (OPC) in both women and men. HPV-vaccination is approved for prophylactic use in both genders. HPV-related cancer is increasing in men, but in most countries, including Denmark, HPV-vaccination is recommended for girls only. The objective of this study was to estimate the burden of cancers caused by HPV in women and men and the potential of HPV-vaccination in cancer control.
We retrieved data on the prevalence of HPV and the genotype distribution in HPV-related cancer types from the existing literature. Data on cancer incidences as well as frequency of procedures related to cervical screening was searched from the NORDCAN database and Danish National Health Registers.
Every year, 376 Danish women are diagnosed with cervical cancer and 99 women die from the disease. The incidence of cervical cancer has declined from 44.4 per 100,000 before cervical screening was introduced in Denmark in the 1960’s to 14.5 per 100,000 today. In Denmark, 700 women and 384 men are diagnosed with an HPV-related cancer each year. The annual burden of HPV-caused cancer was estimated to 548 new cases in women compared to 234 cases in men. The Danish cervical screening program is estimated to prevent 800-1300 cervical cancer cases each year. If these preventable cases are included in the estimate, the burden of HPV-caused cancer is 6-8 times higher in women than in men.
The burden of cancer caused by HPV and the preventive potential of HPV-vaccination is twice as high in women compared to men. However, what we see today is only the tip of the iceberg. When the cervical cancer cases prevented by screening are taken into account, the burden of HPV-caused cancer and the preventive potential of HPV-vaccination is considerably higher in women than in men. In Denmark, the coverage of HPV-vaccination has declined dramatically due to public concern about possible side-effects. Gender-neutral HPV-vaccination potentially would benefit girls more than boys, and the coverage in boys would have to be very high if coverage in girls is low.