Epidemiology and Burden of Disease Associated with HPV Infection

Human papillomavirus (HPV) infection is a carcinogen for the following human sites: cervix, vulva, vagina, penis, anus and oropharynx. Approximately 4.8 % of the global cancer incidence (in 2008) was attributable to HPV infections, although substantial differences were found by geographical region. The large majority (85 %) of the cancers attributed to HPV are cancers of the cervix, which were the fourth most common cancers worldwide among women in 2012. There is a clear correlation between the incidence (and mortality) of cervical cancer and the average level of development. Approximately 84 % (445,000 cases) of the total number of cervical cancer cases occur in the less developed regions (particularly, sub-Saharan Africa, Asia and South/Central America). Uniform declines in cervical cancer incidence rates have been observed in countries where effective screening programmes have been put in place. However, increasing trends in cervical cancer incidence have been observed, e.g., in Eastern Europe, most likely as a consequence of an increased exposure to HPV infection and limited screening. A similar pattern of rising rates emerges in low-resource regions including sub-Saharan African countries (Uganda, Zimbabwe) where high-quality incidence data series are available. Incidence and mortality rates for HPV-related cancers other than cervix are low, but recent increases in anal and oropharyngeal cancers have been observed in some populations. The combined use of HPV vaccination and HPV-based testing in screening programmes should accelerate the decline of cervical cancer to reduce the burden of HPV-related diseases.