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. 2019 Jan 7;2(4):pky045.
doi: 10.1093/jncics/pky045. eCollection 2018 Oct.

Burden of Human Papillomavirus (HPV)-Related Cancers Attributable to HPVs 6/11/16/18/31/33/45/52 and 58

Silvia de Sanjosé  1   2   3 , Beatriz Serrano  1   4 , Sara Tous  1   4 , Maria Alejo  5 , Belén Lloveras  6 , Beatriz Quirós  1   4 , Omar Clavero  1   4 , August Vidal  7 , Carla Ferrándiz-Pulido  8 , Miquel Ángel Pavón  1   4 , Dana Holzinger  9 , Gordana Halec  9   10 , Massimo Tommasino  11 , Wim Quint  12 , Michael Pawlita  9 , Nubia Muñoz  13 , Francesc Xavier Bosch  1   4 , Laia Alemany  1   2 ; RIS HPV TT, VVAP and Head and Neck study groups
Affiliations

Burden of Human Papillomavirus (HPV)-Related Cancers Attributable to HPVs 6/11/16/18/31/33/45/52 and 58

Silvia de Sanjosé et al. JNCI Cancer Spectr. .

Abstract

Background: Many countries, mainly high- and upper-middle income, have implemented human papillomavirus (HPV) vaccination programs, with 47 million women receiving the full course of vaccine (three doses) in 2014. To evaluate the potential impact of HPV vaccines in the reduction of HPV-related disease, we aimed to estimate the HPV type distribution and burden of anogenital and head and neck cancers attributable to HPV types (HPVs 16/18/31/33/45/52/58/6/11) included in currently licensed HPV vaccines.

Methods: In all, 18 247 formalin-fixed paraffin-embedded specimens were retrieved from 50 countries. HPV DNA detection and typing were performed with the SPF-10 PCR/DEIA/LiPA25 system. With the exception of cervical cancer, HPV DNA-positive samples were additionally subjected to HPV E6*I mRNA detection and/or p16INK4a immunohistochemistry. For cervical cancer, estimates were based on HPV DNA, whereas for other sites, estimates were based on HPV DNA, E6*I mRNA, and p16INK4a biomarkers.

Results: The addition of HPVs 31/33/45/52/58 to HPVs 16/18/6/11 in the nonavalent HPV vaccine could prevent almost 90% of cervical cancer cases worldwide. For other sites, the nonavalent HPV vaccine could prevent 22.8% of vulvar, 24.5% of penile, 60.7% of vaginal, 79.0% of anal cancers, 21.3% of oropharyngeal, 4.0% of oral cavity, and 2.7% of laryngeal cancer cases.

Conclusions: Our estimations suggest a potential impact of the nonavalent HPV vaccine in reducing around 90% of cervical cancer cases and a global reduction of 50% of all the cases at HPV-related cancer sites.

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Figures

Figure 1.
Figure 1.
Anatomical sites included from each country. The number of cancer samples included at each anatomical site varies among countries.
Figure 2.
Figure 2.
Overall HPV positivity for HPV DNA and HPV DNA + (E6*I mRNA or p16INK4a) by anatomical site. 95% CI = 95% confidence interval (one-sided, 97.5% CI calculated when appropriate; HPV = human papillomavirus. For more details, please see the methodological section from Castellsagué et al. 2016; de Sanjose et al. 2010; de Sanjosé et al. 2013; Alemany et al. 2014, Alemany et al. 2015, and Alemany et al. 2016 (5,16–20).
Figure 3.
Figure 3.
Worldwide HPV prevalence and relative contribution in HPV-related cancers, by sex. 95% CI = 95% confidence interval (one-sided, 97.5% CI calculated when appropriate); Cervix = based on HPV DNA; HPV = human papillomavirus; Other locations = based on information on three markers (HPV DNA + (E6*I mRNA or p16INK4a)); Prev = prevalence and type-specific relative contribution estimations. For more details, please see the methodological section from Castellsagué et al. 2016; de Sanjose et al. 2010; de Sanjosé et al. 2013; Alemany et al. 2014, Alemany et al. 2015, and Alemany et al. 2016 (5, 16–20).
Figure 4.
Figure 4.
HPV relative contribution of types included in licensed HPV vaccines in HPV-related cancers, by region. 95% CI = 95% confidence interval (one-sided, 97.5% CI calculated when appropriate); HPV = human papillomavirus; n = number of cancer cases represented in the region. Type-specific relative contribution estimations: Cervix = based on HPV DNA positive; Other locations = based on information on three markers (HPV DNA positive + (E6*I mRNA or p16INK4a)). For more details, please see the methodological section from Castellsagué et al. 2016; de Sanjose et al. 2010; de Sanjosé et al. 2013; Alemany et al. 2014, Alemany et al. 2015, and Alemany et al. 2016 (5, 16–20).
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