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HPV-Associated Diseases

HPV infections are responsible for nearly 26,000 new cancer cases each year in the United States. Of these, 18,000 occur in women and 8,000 occur in men (Figure 2).[1] (See How HPV Infections Cause Cancers for more information on the progression from HPV infection to cancer.) HPV also causes more than 300,000 cases of genital warts and approximately 820 cases of juvenile-onset RRP in the U.S. each year.[2,3]* The combined cost of HPV-associated cancers and other conditions is estimated to be $8 billion per year in the United States. A large majority of cancers caused by HPV are brought about by one of two types: HPV16 or HPV18 (Table 2). Together, these types cause about 22,000 cases of cancer in the United States each year.

Cervical cancer is the most common cancer caused by HPV. Almost all cases of cervical cancer—which kills 4,000 U.S. women each year [4]—are caused by HPV infections. Although cervical cancer is the cancer most commonly associated with HPV, the virus plays a significant role in other anogenital cancers in both men and women. These include cancers of the vulva, vagina, and anus in women and cancers of the anus and penis in men.[1,5]

HPV-associated cancers of the oropharynx (the part of the throat just behind the mouth) are a growing problem in the United States and many other high-income countries.[6] The incidence of these cancers more than tripled in the U.S. between 1988 and 2004.[7] At this rate, the number of new oropharyngeal cancer cases caused by HPV likely will exceed the number of cervical cancer cases by 2020. This shift has important public health implications, in part because oropharyngeal cancers are four times more common among men than among women (Figure 2). Thus, efforts to prevent HPV-associated diseases must focus on both females and males.[6]

Figure 2

Figure 2. Numbers of U.S. Cancers and Genital Warts Attributed to HPV Infections

Sources: Centers for Disease Control and Prevention. Human papillomavirus-associated cancers—United States, 2004-2008. MMWR. 2012 Apr 20;61(15):258-61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22513527; Hoy T, Singhal PK, Willey VJ, Insinga RP. Assessing incidence and economic burden of genital warts with data from a US commercially insured population. Curr Med Res Opin. 2009;25(10):2343-51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19650749; Chesson HW, Ekwueme DU, Saraiya M, Watson M, Lowy DR, Markowitz LE. Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States. Vaccine. 2012;30(42):6016-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22867718



Table 2

U.S. Cancers Attributed to HPV

Cancer Site Average # Cancers Per Year at Site (a) Percent Probably Caused by HPV (a) Number Probably Caused by HPV (a) Percent HPV Cancers Probably Caused by HPV16 or 18 (b) Number Probably Caused by HPV16 or 18
Anus 4,767 93 4,500 93 4,200
Cervix 11,967 96 11,500 76 8,700
Oropharynx 11,726 63 7,400 95 7,000
Penis 1,046 36 400 87 300
Vagina 729 64 500 88 400
Vulva 3,136 51 1,600 86 1,400
TOTAL 33,371   25,900   22,000

(a) Centers for Disease Control and Prevention. Human papillomavirus-associated cancers—United States, 2004-2008. MMWR. 2012 Apr 20;61(15):258-61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22513527

(b) Gillison ML, Chaturvedi AK, Lowy DR. HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer. 2008;113(10 Suppl):3036-46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18980286

Footnotes

* Data on incidence of adult-onset RRP are not available.

Includes costs of cervical cancer screening and follow-up and the treatment costs of cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers, as well as genital warts and RRP.

References

  1. Centers for Disease Control and Prevention. Human papillomavirus-associated cancers—United States, 2004-2008. MMWR. 2012 Apr 20;61(15):258-61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22513527
  2. Hoy T, Singhal PK, Willey VJ, Insinga RP. Assessing incidence and economic burden of genital warts with data from a U.S. commercially insured population. Curr Med Res Opin. 2009;25(10):2343-51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19650749
  3. Chesson HW, Ekwueme DU, Saraiya M, Watson M, Lowy DR, Markowitz LE. Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States. Vaccine. 2012;30(42):6016-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22867718
  4. American Cancer Society. Cancer facts & figures 2013. Atlanta (GA): ACS; 2013. Available from: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf
  5. National Cancer Institute. HPV and cancer [Internet]. Bethesda (MD): NCI; [updated 2012 Mar 15; cited 2013 Jan 28]. Available from: http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
  6. Gillison ML, Alemany L, Snijders PJ, Chaturvedi A, Steinberg BM, Schwartz S, et al. Human papillomavirus and diseases of the upper airway: head and neck cancer and respiratory papillomatosis. Vaccine. 2012;30(5 Suppl):F34-54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23199965
  7. Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011;29(32):4294-301. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21969503