EUROGIN 2011 roadmap on prevention and treatment of HPV-related disease
1Unit of Cancer Epidemiology, Scientific Institute of Public Health Brussels, Belgium
2Unit of Infections and Cancer & Cancer Epidemiology Research Programme, IDIBELL, Institut Català d’Oncologia, Spain and CIBER Epidemiologia y Salut Púbñica, Spain
3Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Atlanta, USA
4Preventive Gynecology Unit, Gynecology Division, European Institute of Oncology, Milan, Italy
5Department of Medicine, University of California, San Francisco, San Francisco, California USA
6Hull York Medical School, University of York, Heslington, York, UK
7Division of Viral Oncology, Johns Hopkins, Kimmel Cancer Center, Baltimore, Maryland, USA
8Unit of Cancer Epidemiology, Centro per la prevenzione Oncologica, Turin, Italy
9Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
10Victorian Cytology Service Registries, Victorian Cytology Service, East Melbourne, Victoria, Australia
11Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, Beijing, China
12Department of Obstetrics and Gynaecology, University of Cape Town and Groote Schuur Hospital, Observatory, Cape Town, South Africa
13Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya and Bar-Ilan University Faculty of Medicine, Israel
14Department of Gastroenterology and Proctology, Bichat University Hospital, Paris, France
15Department of Cancer Epidemiology, Moffitt Cancer Centre, Tampa, Florida, USA
16International Agency for Research on Cancer, Lyon, France
17Institute of the Cervix, Paris, France
The EUROGIN 2011 roadmap reviews the current burden of HPV (human papillomavirus)-related morbidity, as well as the evidence and potential practice recommendations regarding primary and secondary prevention and treatment of cancers and other disease associated with HPV infection.
HPV infection causes approximately 600,000 cases of cancer of the cervix, vulva, vagina, anus and oropharynx annually, as well as benign diseases such as genital warts and recurrent respiratory papillomatosis. Whereas the incidence of cervical cancer has been decreasing over recent decades, the incidence of anal and oropharyngeal carcinoma, for which there are no effective screening programs, has been rising over the last couple of decades.
Randomised trials have demonstrated improved efficacy of HPV-based compared to cytology-based cervical cancer screening. Defining the best algorithms to triage HPV-positive women, age ranges and screening intervals are priorities for pooled analyses and further research, whereas feasibility questions can be addressed through screening programmes.
HPV vaccination will reduce the burden of cervical precancer and probably also of invasive cervical and other HPV-related disease in women. Recent trials demonstrated that prophylactic vaccination also protects against anogenital HPV infection, ano-genital intraepithelial lesions and warts associated with vaccine types, in males; and anal HPV infection and anal intraepithelial neoplasia in MSM. HPV-related oropharyngeal cancer could be treated less aggressively because of better survival compared to cancers of the oropharynx unrelated to HPV.
Key findings in the field of cervical cancer prevention should now be translated in cost-effective strategies, following an organised approach integrating primary and secondary prevention, according to scientific evidence but adapted to the local situation with particular attention to regions with the highest burden of disease.
Keywords: cervical cancer, vulvar cancer, anal cancer, penile cancer, head & neck cancer, genital warts, incidence, mortality, human papillomavirus, HPV, screening, vaccination
The EUROGIN roadmaps represent a continuing effort to update and interpret information on primary and secondary prevention of cervical cancer. This year the roadmap widened its focus and also addressed the burden and prevention, diagnosis and treatment of other HPV-related disease.
HPV infection causes approximately 600,000 cases of cancer of the cervix, vulva, vagina, penis, anus and oropharynx annually, as well as benign diseases such as genital warts and RRP. Whereas the incidence of cervical cancer has been decreasing over recent decades, the incidence of other HPV-related cancer for which there are no effective screening programs has been rising over the last decades.
Cervical cancer screening effectiveness may be improved by replacing frequent cytology with HPV screening of women aged 30-35 years or older every 5 to 8 years, using validated assays. Defining the best triage algorithms, age ranges and screening intervals are priorities for research. The specificity of HPV-based screening could be improved by using more specific tests or by applying more specific triage strategies (for instance higher viral load cutoffs, mRNA testing, genotyping, p16 and other biomarkers).
HPV vaccination will reduce the burden of cervical precancer and probably also of invasive cervical and other HPV-related disease in women. In the future, the decreased prevalence of HPV16/18-related precancer resulting from prophylactic vaccination will warrant less frequent and more specific screening.
These promising findings should now be translated in cost-effective strategies, by preference following an organised approach integrating primary and secondary prevention, according to scientific evidence and adapted to the local situation with particular attention for regions with the highest burden of disease.