CDC reports a rise in Human papillomavirus(HPV) associated cancers in recent years.

Clinical Pearls:

• HPV associated cancers are on the rise.
• Out of 38,793 HPV-associated cancers diagnosed each year in U.S, nearly 79 % were preventable cancer caused due to HPV strains for which vaccine coverage is available across population.
• Out of all the HPV associated cancer, only cervical cancer is preventable by good screening strategies. No population based screening strategy exist for other HPV associated cancer.

The CDC reported a rise in Human papillomavirus(HPV) associated cancers in recent years’ in its Morbidity and Mortality Weekly Report published on line on July 7, 2016.[1] It is known that HPV is a cause of cervical cancers as well as vulvar, vaginal, oropharyngeal, rectal and anal cancers. 13 known strains of HPV are carcinogenic and persistent infection with these can progress to precancer and cancer.

CDC analyzed the high quality data obtained from population-based cancer registries of National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program from 2008–2012, covering approximately 99% of US population.

There was an overall increase in HPV-associated cancer from 10.8 per 100,000 persons during 2004–2008 to 11.7 per 100,000 persons during 2008–2012.

 An average of 38,793 HPV-associated cancers were diagnosed each year during the study span of 5 years. Out of which 23,000 were among females and 15,793 among males. Out of 38,793 at least 30,700(79%) can be attributed to HPV.

Notably, of these 24,600 cancers are attributable to HPV types 16 and 18, which are targeted by all current HPV vaccines, and 28,500 are attributable to high-risk HPV types 31, 33, 45, 52, and 58, all included in the 9-valent HPV vaccine. 

The most common HPV associated cancer was cervical cancer (11,771) in females and oropharyngeal squamous cell carcinomas (15,738) mostly in males.

Only cervical cancer can be prevented with regular screening and follow up, no population based screening strategy exist for other HPV associated cancer. The Healthy People 2020 target for cervical screening is 93%, and the2013 statistics report only 80.7% of women undergo complete screening with wide racial and ethnic disparity.

The authors led by Laura J. Viens, MD, of the Division of Cancer Prevention and Control said “HPV vaccination can prevent infection with HPV types that cause cancer at cervical and other sites," including the anus. "Vaccines are available for HPV types 16 and 18, which cause 63% of all HPV-associated cancers in the United States, and for HPV types 31, 33, 45, 52, and 58, which cause an additional 10%." 

The study has very important public health implication that extending coverage to full US population could prevent future HPV-attributable cancers bringing down the incidence dramatically.

The CDC advisory committee recommends routine HPV vaccination (bivalent, quadrivalent, or 9-valent) for females aged 11-12 through 26 years and quadrivalent or 9-valent for males at ages 11 to 12 through 21 for males if they were not previously vaccinated.

"In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer," said Electra Paskett. She is co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer in Columbus.

"Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes -- and we would have a dramatic decrease in HPV-related cancers across the globe," Paskett added.

"Ongoing surveillance for HPV-associated cancers using high-quality population-based registries is needed to monitor trends in cancer incidence that might result from increasing use of HPV vaccines and changes in cervical cancer screening practices," the CDC report concluded.

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[1] https://www.cdc.gov/mmwr/volumes/65/wr/mm6526a1.htm?s_cid=mm6526a1_w