Chapter 2: The burden of HPV-related cancers
Section snippets
Cancer of the cervix
Cancer of the cervix uteri is the second most common cancer among women worldwide, with an estimated 493,000 new cases and 274,000 deaths in 2002 [2]. Some 83% of the cases occur in developing countries, where cervical cancer accounts for 15% of female cancers, with a risk before age 65 of 1.5%, while in developed countries it accounts for only 3.6% of new cancers, with a cumulative risk (ages 0–64) of 0.8% [2]. The highest incidence rates are observed in sub-Saharan Africa, Melanesia, Latin
Quantification of the role of HPV in human cancer
Oncogenic HPV can be detected by PCR in virtually all cases of cervical cancer, and it is generally accepted that the virus is necessary for the development of cancer, so that all cases of cancer can be “attributed” to infection [1].
With respect to SCCs of the vulva and vagina, penile cancer, and anal cancer, the relative risk associated with HPV infection is difficult to quantify, because of the small size of most studies, and the absence of comparable measurements of prevalence of infection
Time trends of cervical cancer
Time trend studies make use of published rates of mortality and incidence. Comparative studies of mortality, in particular, must take into account the deaths certified as “Uterus, part unspecified”. The proportion of uterine deaths ascribed to this category varies widely, both between countries, and over time, and it can be very high, for example, over 50% in France and Italy for women aged over 30 in 1995. Some form of “reallocation” of these deaths to more specific categories is generally
Quantifying the contributions of changes in HPV infection and screening on incidence of cancer
Although observed trends are the net result of changes in risk, as determined by infection and persistence of oncogenic HPV, and prevention of invasive disease via screening, quantifying their relative contributions is difficult. There is little information on changes in incidence or prevalence of HPV infection. Increases in HPV-16 have been reported in Finland in women aged in their twenties [39], while in Sweden, rises in HPV-16 during the 1970s and early-1980s in women aged under 35 have
Trends in other HPV-related cancers
There are few systematic studies of time trends of cancers of the external genitalia. In Norway, marked increases in the incidence of VIN were observed, but not of invasive cancer between 1973 and 1992 [42]; a similar observation was observed in the US [43]. Possibly early diagnosis and treatment of in situ carcinoma reduces increases in invasive vulvar carcinoma incidence. For anal cancers, there have been marked incidence increases for over 50 years [44]. Conversely, there have been recent
Projections of HPV-related cancers
Planning cancer services requires knowledge of the current and likely future patterns of occurrence. Predictions can be used to make decisions on future provision of services (or post hoc, to investigate why their expected impact was not achieved). Both screening and HPV infection will influence future rates, and accurate predictions will depend upon information on both changing levels of persistent infection with HR-HPVs and the relative impact of interventions in the population. The
Disclosed potential conflicts of interest
Authors have disclosed no potential conflicts of interests.
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