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Cancer Prevention Research
Cancer Prevention Research
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Commentary

Reducing HPV-Associated Cancer Globally

Douglas R. Lowy and John T. Schiller
Douglas R. Lowy
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John T. Schiller
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DOI: 10.1158/1940-6207.CAPR-11-0542 Published January 2012
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    Figure 1.

    A, worldwide incidence and distribution of HPV-associated cancers (data from ref. 1). Red, HPV-positive cancer; white, HPV-negative cancer. B, incidence and distribution of HPV-associated cancers in the United States (data from refs. 3 and 4). The approximate percentage of HPV-associated cancer attributable to HPV16 and -18 is also shown. Red, HPV-positive cancer; white, HPV-negative cancer.

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  • Table 1.

    HPV-related disease and roles for screening and vaccination in the developing versus industrialized world

    Existing interventionPotential for intervention
    Disease burdenaScreeningHPV vaccineScreeningHPV vaccine
    Developing world
     CervicalHighLimitedLimitedHighHighb
     Noncervicalc
      OropharyngealLowNoneLimiteddNoneLowe
      OtherLowNoneLimitedNoneLowe
     Noncervical (male)
      OropharyngealLowNoneLimiteddNoneLowe
      OtherLowNoneLimitedNoneLowe
    Industrialized world
     CervicalHighExtensiveExtensivefHighHigh
     Noncervicalc
      OropharyngealHighNonegExtensivedNonegHighd
      OtherModerateLimitedExtensiveUnknownhModeratei
     Noncervical (male)
      OropharyngealHighNonegLimiteddNonegHighd
      OtherModerateLimitedLimitedUnknownhModeratei

    iAlthough the vaccine should be highly effective against the HPV types associated with these diseases, the relative population-wide impact of reducing them would be “moderate.”

    • ↵aThough high worldwide, the incidence of cervical cancer is substantially higher in the developing than industrialized world. Noncervical disease burdens are relative to cervical cancer in the developing or industrialized world.

    • ↵bCurrently being developed by the GAVI Alliance and other potential donors.

    • ↵cIncludes males and females.

    • ↵dAlthough the vaccine should be highly effective against the HPV types associated with this disease, there are no vaccine data on oral/oropharyngeal infection or disease.

    • ↵eAlthough the vaccine may be effective against these diseases, their currently low prevalence would limit the potential population-wide impact of vaccine.

    • ↵fThe extent of vaccine uptake in the U.S. lags behind other industrialized countries. Therefore, in October 2011 the U.S. CDC ACIP upgraded its male vaccine recommendation to “routine.” For countries with high HPV vaccine uptake among females, herd immunity from female vaccination should protect most males from HPV-associated disease.

    • ↵gNo established screening for oropharyngeal HPV or its related neoplasia is currently available.

    • ↵hNo established screening for anal cancer, but it is under consideration for high-risk populations.

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    The following article is available for this Commentary:
    The Effect of HIV and HPV Coinfection on Cervical COX-2 Expression and Systemic Prostaglandin E2 Levels
    Daniel W. Fitzgerald, Karl Bezak, Oksana Ocheretina, Cynthia Riviere, Thomas C. Wright, Ginger L. Milne, Xi Kathy Zhou, Baoheng Du, Kotha Subbaramaiah, Erin Byrt, Matthew L. Goodwin, Arash Rafii, and Andrew J. Dannenberg

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    Cancer Prevention Research: 5 (1)
    January 2012
    Volume 5, Issue 1
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    Reducing HPV-Associated Cancer Globally
    Douglas R. Lowy and John T. Schiller
    Cancer Prev Res January 1 2012 (5) (1) 18-23; DOI: 10.1158/1940-6207.CAPR-11-0542

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    Reducing HPV-Associated Cancer Globally
    Douglas R. Lowy and John T. Schiller
    Cancer Prev Res January 1 2012 (5) (1) 18-23; DOI: 10.1158/1940-6207.CAPR-11-0542
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    • Article
      • Abstract
      • The Burden of HPV-Associated Cancer in the Developing Versus Industrialized World
      • The Current HPV Vaccines
      • Reducing Cervical Cancer in the Developing World: The Nonoverlapping Roles of Vaccination and Screening
      • Reducing HPV-Associated Cancer in the Industrialized World
      • A Glimpse of the Future: Potential Utility of Second-Generation Vaccines
      • Summary
      • Disclosure of Potential Conflicts of Interest
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      • Acknowledgments
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