Reducing HPV-Associated Cancer Globally

Douglas R. Lowy; John T. Schiller

doi:10.1158/1940-6207.CAPR-11-0542

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.

Table 1.

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

		Existing intervention		Potential for intervention
	Disease burden^a	Screening	HPV vaccine	Screening	HPV vaccine
Developing world
Cervical	High	Limited	Limited	High	High^b
Noncervical^c
Oropharyngeal	Low	None	Limited^d	None	Low^e
Other	Low	None	Limited	None	Low^e
Noncervical (male)
Oropharyngeal	Low	None	Limited^d	None	Low^e
Other	Low	None	Limited	None	Low^e
Industrialized world
Cervical	High	Extensive	Extensive^f	High	High
Noncervical^c
Oropharyngeal	High	None^g	Extensive^d	None^g	High^d
Other	Moderate	Limited	Extensive	Unknown^h	Moderateⁱ
Noncervical (male)
Oropharyngeal	High	None^g	Limited^d	None^g	High^d
Other	Moderate	Limited	Limited	Unknown^h	Moderateⁱ

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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