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  • Review Article
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Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination

Nature Reviews Clinical Oncology (2024)Cite this article

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Abstract

Cervical cancer is the first cancer deemed amenable to elimination through prevention, and thus lessons from the epidemiology and prevention of this cancer type can provide information on strategies to manage other cancers. Infection with the human papillomavirus (HPV) causes virtually all cervical cancers, and an important proportion of oropharyngeal, anal and genital cancers. Whereas 20th century prevention efforts were dominated by cytology-based screening, the present and future of HPV-associated cancer prevention relies mostly on HPV vaccination and molecular screening tests. In this Review, we provide an overview of the epidemiology of HPV-associated cancers, their disease burden, how past and contemporary preventive interventions have shaped their incidence and mortality, and the potential for elimination. We particularly focus on the cofactors that could have the greatest effect on prevention efforts, such as parity and human immunodeficiency virus infection, as well as on social determinants of health. Given that the incidence of and mortality from HPV-associated cancers remain strongly associated with the socioeconomic status of individuals and the human development index of countries, elimination efforts are unlikely to succeed unless prevention efforts focus on health equity, with a commitment to both primary and secondary prevention.

Key points

  • Human papillomavirus (HPV) infection is a necessary cause for virtually all cervical cancers and an attributable cause for variable proportions of anal, oropharyngeal, vaginal, vulvar and penile cancers worldwide.

  • Cervical cancer screening led to substantial declines in cervical cancer incidence and mortality in many countries during the 20th century.

  • The advent of HPV vaccines and screening approaches has created the opportunity to eliminate cervical cancer, a recognized public health problem, by the end of the 21st century.

  • HPV vaccination programmes will probably prevent HPV-associated cancers other than cervical cancer, although research into the optimal screening approaches for these cancers is still ongoing.

  • Parity, tobacco use and human immunodeficiency virus infections are major cofactors that influence the epidemiology of HPV-associated cancers.

  • Cervical cancer elimination will require combined primary and secondary prevention approaches as well as a focus on reducing health inequities within and between countries.

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Fig. 1: Age-standardized incidence and mortality from cervical cancer in women.
Fig. 2: Incidence of oropharyngeal and anal cancer in Nordic countries.
Fig. 3: Age-standardized incidence of cervical cancer in 2020.
Fig. 4: Correlation between cervical cancer mortality and level of education attainment across European countries.

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Authors and Affiliations

  1. Department of Oncology, McGill University, Montréal, Quebec, Canada

    Talía Malagón, Eduardo L. Franco & Romina Tejada

  2. St Mary’s Research Centre, Montréal West Island CIUSSS, Montréal, Quebec, Canada

    Talía Malagón

  3. Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada

    Talía Malagón, Eduardo L. Franco & Romina Tejada

  4. International Agency for Research on Cancer, Lyon, France

    Salvatore Vaccarella

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R.T. and S.V. researched data for the article. T.M. and E.L.F. contributed substantially to discussion of the content. All authors wrote, reviewed and/or edited the manuscript before submission.

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Correspondence to Talía Malagón.

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Competing interests

T.M. is a board member of the International Papillomavirus Society. E.L.F. has received personal fees from Merck, and holds a patent related to the discovery of DNA methylation markers for the early detection of cervical cancer, which is registered at the Office of Innovation and Partnerships, McGill University, Montreal, Quebec, Canada. R.T. and S.V. declare no competing interests.

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Malagón, T., Franco, E.L., Tejada, R. et al. Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination. Nat Rev Clin Oncol (2024). https://doi.org/10.1038/s41571-024-00904-z

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