Human Papillomavirus–Attributable Cancers — United States, 2012–2016

Virginia Senkomago, PhD; S. Jane Henley, MSPH; Cheryll C. Thomas, MSPH; Jacqueline M. Mix, PhD; Lauri E. Markowitz, MD; Mona Saraiya, MD

Disclosures

Morbidity and Mortality Weekly Report. 2019;68(33):724-728. 

In This Article

Abstract and Introduction

Introduction

Human papillomavirus (HPV) causes nearly all cervical cancers and some cancers of the vagina, vulva, penis, anus, and oropharynx.[1]* Most HPV infections are asymptomatic and clear spontaneously within 1 to 2 years; however, persistent infection with oncogenic HPV types can lead to development of precancer or cancer.[2] In the United States, the 9-valent HPV vaccine (9vHPV) is available to protect against oncogenic HPV types 16, 18, 31, 33, 45, 52, and 58 as well as nononcogenic types 6 and 11 that cause genital warts. CDC analyzed data from the U.S. Cancer Statistics (USCS) to assess the incidence of HPV-associated cancers and to estimate the annual number of cancers caused by HPV, overall and by state, during 2012–2016.[3,4] An average of 43,999 HPV-associated cancers were reported annually, and an estimated 34,800 (79%) of those cancers were attributable to HPV. Of these 34,800 cancers, an estimated 32,100 (92%) were attributable to the types targeted by 9vHPV, with 19,000 occurring among females and 13,100 among males. The most common were cervical (9,700) and oropharyngeal cancers (12,600). The number of cancers estimated to be attributable to the types targeted by 9vHPV ranged by state from 40 to 3,270 per year. HPV vaccination is an important strategy that could prevent these cancers, but during 2018, only half of adolescents were up to date on HPV vaccination.[5] These surveillance data from population-based cancer registries can be used to inform the planning for, and monitor the long-term impact of, HPV vaccination and cancer screening efforts nationally and within states.

CDC analyzed cancer incidence data from USCS, which includes cancer registry data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Data from the District of Columbia (DC) and all states met high-quality data criteria for 2012–2016, covering 100% of the U.S. population. Invasive cancer cases were classified by anatomic site using the International Classification of Diseases for Oncology, Third Edition (ICD-O–3)§ (Supplementary Table, https://stacks.cdc.gov/view/cdc/80649) and were histologically confirmed. Cancers are not tested for HPV in most cancer registries; therefore, HPV-associated cancers were defined as invasive cancers at anatomic sites with cell types in which HPV DNA frequently is found, including carcinomas of the cervix (i.e., squamous cell cancers [SCC], adenocarcinomas, and other carcinomas) and SCC of the vulva, vagina, penis, oropharynx, and anus (including rectal SCC).[4] Oropharyngeal SCC included squamous cell cancer types at the base of tongue, pharyngeal tonsils, anterior and posterior tonsillar pillars, glossotonsillar sulci, anterior surface of soft palate and uvula, and lateral and posterior pharyngeal walls. Anal SCC also included rectal SCCs because they are biologically similar and might be misclassified.

HPV-associated cancer incidence rates were calculated using reported cases as the numerator and modification of annual county population estimates as the denominator,** standardized to the 2000 U.S. standard population and expressed as cases per 100,000 persons. The USCS data, including the numbers and rates of HPV-associated cancers, are available to the public through the USCS Data Visualizations Tool.†† To estimate the number of HPV-attributable cancers (cancers that are probably caused by HPV), the average annual number of HPV-associated cancers was multiplied by the percentage of each cancer type found to be attributable to HPV in a large U.S. study using HPV genotyping.[3] Estimates of HPV-attributable cancers were rounded to the nearest 100 for national data and to the nearest 10 for state-level data. Cancers were grouped as those attributable to the types targeted by 9vHPV, to other HPV types, and HPV-negative cancers (those that occur at anatomic sites in which HPV-associated cancers are often found but do not have detectable HPV DNA). The percentage of HPV-negative cancers was calculated as the difference between the total HPV-associated cancers and the HPV-attributable estimates.

During 2012–2016, an average of 43,999 HPV-associated cancers (12.2 per 100,000 persons) were reported annually, and an estimated 79% (34,800) of these cancers were attributable to HPV (Table 1). Of these cancers, an estimated 32,100 (92%) were attributable to the types targeted by 9vHPV. The largest number were oropharyngeal cancer (12,600), followed by cervical (9,700), anal (6,000), vulvar (2,500), penile (700), and vaginal cancers (600). Among cancers estimated to be attributable to the types targeted by 9vHPV, 19,000 (59%) occurred among females, and 13,100 (41%) occurred among males.

The annual number of cancers estimated to be attributable to the types targeted by 9vHPV ranged by state from 40 (Wyoming) to 3,270 (California) (Table 2). Oropharyngeal cancer was the most common cancer estimated to be attributable to types targeted by 9vHPV in most states, except in Texas, where cervical cancer was most common and in Alaska, DC, New Mexico, and New York, where estimates of oropharyngeal and cervical cancers attributable to the types targeted by 9vHPV were the same.

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