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Epidemiology and burden of HPV-related disease

https://doi.org/10.1016/j.bpobgyn.2017.08.006Get rights and content

Highlights

  • HPV is responsible of 4.5% (630,000) of all new cancer cases worldwide.

  • Cervical cancer is the fourth most frequent cancer among women and the fourth leading cause of cancer deaths worldwide.

  • HPV16 is consistently the most frequent genotype in all HPV-related cancer sites.

  • Universal HPV vaccination could prevent between 70% and 90% of HPV-related disease.

  • Increasing trends in HPV-related anal and head and neck cancers have been observed in the last decade.

Abstract

Human papillomavirus (HPV) infection is recognized as one of the major causes of infection-related cancer in both men and women. High-risk HPV types are not only responsible for virtually all cervical cancer cases but also for a fraction of cancers of the vulva, vagina, penis, anus, and head and neck cancers. Furthermore, HPV is also the cause of anogenital warts and recurrent respiratory papillomatosis. Despite the availability of multiple preventative strategies, HPV-related cancer remains a leading cause of morbi-mortality in many parts of the world, particularly in less developed countries. Thus, in this review, we summarize the latest estimates of the global burden of HPV-related diseases, trends, the attributable fraction by HPV types, and the potential preventative fraction.

Introduction

Although most human papillomavirus (HPV) infections do not cause symptoms and resolve spontaneously, persistent infection with oncogenic HPV types, also known as high-risk (HR) HPVs, may lead to precancerous lesions and cancer. HR HPVs are not only responsible for virtually all cervical cancer cases, but are also causally related with a variable fraction of other anogenital cancers (vulvar, vaginal, penile, and anal cancers) and a subset of head and neck cancers, particularly base of tongue cancer, tonsil cancer, and other oropharyngeal cancer sites [1], [2], [3].

Among the more than 200 genotypes of HPVs identified to date, only a few are responsible for most of the burden of disease. The last International Agency for Research on Cancer (IARC) classification defined 12 HPV types as carcinogenic to humans, namely HPVs 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 (Group 1) [4]. Within them, HPV16 and HPV18 stand out for their highest carcinogenic capacity [5].

In the last decade, cervical cancer screening based on HPV testing and prophylactic HPV vaccination have radically changed the perspective of diagnosis and prevention of cervical neoplasia and the rest of HPV-related diseases. However, HPV infection remains one of the major causes of infection-related cancer in both men and women, particularly in less developed countries [6].

The aim of this paper is therefore to provide an overview of the global prevalence of HPV infection and HPV-related disease by geographical region and cancer site. Special emphasis is given to cervical cancer as it accounts for more than 80% of cancers attributable to HPV infection [7]. Consideration is also given to genital warts, a major cause of morbidity worldwide, caused mainly by low-risk (LR) HPV6 and HPV11.

Section snippets

HPV infection in women with normal cytological findings

The most updated data estimating HPV infection among women with normal cervical cytology is based on systematic reviews and meta-analysis performed by the Institut Català d’Oncologia (ICO)/IARC Information Centre on HPV and Cancer [8], ∗[9]. The global prevalence of HPV infection is estimated as 11.7% (95% confidence interval: 11.6–11.7), although there are considerable regional differences and substantial variations from study to study. Particularly high prevalence of HPV infection is seen in

Burden of cancers attributable to HPV infection

In 2012, approximately 4.5% (640,000 cases) of new cancer cases were attributable to HPV infection. HPV represented 29.5% of infection-related cancers worldwide in 2012 and caused more than half of all infection-attributable cancers in women (570,000 cases), in which cervical cancer accounts for more than 80% of cases ∗[6], ∗[7], [16].

Conclusions

Continuous monitoring and quantification of cancer burden is critical for cancer control. Differences in cervical cancer burden among populations are mainly the result of historical disparities on cervical cancer prevention.

Cervical cancer has been effectively controlled by cytological screening and treatment in many high-income countries, while they are not feasible at scale in low-resource settings. The elevated rates of cervical cancer reported in less developed regions result from poor

Summary

Overall, 630,000 cancer cases (4.5% of all cancer cases) are attributable to HPV every year, representing a major threat to public health worldwide. HPV-related cancers account for 8.6% (570,000 cases) of all cancer cases in women and 0.8% (60,000 cases) of all cancer cases in men and caused more than half of all infection-attributable cancers in women in 2012. The vast majority (83.0%) of cancer cases attributable to HPV are cervical cancer cases (528,000 cases), followed by head and neck

Conflict of interest

Authors declare no competing interests. The Unit of Infections and Cancer has received unrestricted research grants from GlaxoSmithKline, Merck, and Sanofi Pasteur MSD. Xavier F. Bosch has acted as a consultant for Merck and receives honorarium for lectures or travel support from Merck, Qiagen, Roche, Sanofi Pasteur MSD, and GlaxoSmithKline.

Acknowledgments

This work was partially supported by grants from the Instituto de Salud Carlos III-ISCII (Spanish Government) co-funded by FEDER funds/European Regional Development Fund (ERDF) – A WAY TO BUILD Europe (References: Redes temáticas de investigación cooperative en salud (RETICS) RD12/0036/0056, Centro de Investigación Médica en Red Ciber-Cancer: CB16/12/00401), Agencia de Gestión de Ayudas Universitarias y de Investigación (AGAUR) de la Generalitat de Catalunya (2014SGR1077) and Recercaixa 2015 (

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