There are wide variations in survival from the various cancers caused by HPV. A study of patient outcomes in the USA found that the 5-year age-standardised relative survival rate was 66% for vulval and anal cancers, 64% for cervical cancers, 53% for vaginal cancers, 51% for oropharyngeal cancers and 47% for penile cancers.74
There are also wide variations in survival from specific HPV-related cancers across Europe. Among women diagnosed with cervical cancer between 2010 and 2014, age-standardised five-year survival ranged from 80% in Iceland and 73% in Norway and Cyprus to 56% in Latvia and 55% in Poland and Bulgaria. The average among EU countries was 63%.75,76 Similar inequalities have been identified concerning other HPV-caused cancer types: age-standardised five-year survival among individuals diagnosed between 2000 and 2007 ranged from 47% to 81% for HPV-caused anal cancer,77 from 40% to 65% for vaginal and vulval cancer, from 30% to 60% for penile cancer and from 30% to 65% for oropharyngeal cancer,78 across European countries. Survival rates are significantly lower in many Central and Eastern European countries, in part reflecting variations in access to high-quality cancer treatment and care.
There are now consensus guidelines for the clinical treatment of the cancers caused by HPV which, if followed by practitioners, would help to achieve improved and more equitable outcomes across Europe. ESGO, the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) have developed guidelines for the management of patients with cervical cancer across Europe.79
A consensus statement on colposcopy, developed by ESGO and EFC will soon be published. It will recommend that women detected at risk of cervical disease in a cervical cancer screening programme should be referred to a trained colposcopist and provided with written information prior to their colposcopy. Furthermore, local treatment of CIN (cervical pre-cancer) should be performed under colposcopic guidance and whenever possible as an out-patient procedure under local anaesthetic.
Guidelines for the diagnosis, treatment and follow-up of anal cancer have been drawn up by the European Society for Medical Oncology (ESMO), the European Society for Surgical Oncology (ESSO) and ESTRO.80 Clinical practice in the field of head and neck cancers caused by HPV should follow best practice guidelines such as those developed by the National Cancer Institute in the USA81 or by a multi-disciplinary group in the UK.82 For penile cancer, clinical practice guidelines have been published by ESMO.83
There are, clearly, resource implications for the successful implementation of clinical guidelines in terms of timely patient access to appropriate secondary care facilities (such as multi-disciplinary specialist cancer treatment centres), the availability of medicines, clinical staff training and other factors including public awareness of symptoms. These will be easier to achieve in some countries than others. Medical audits on cancer cases in each country could help to identify gaps in prevention strategies and be a catalyst for action.
Attention must also be paid to quality of life issues for people undergoing treatment and in its aftermath. Cervical cancer survivors commonly experience bladder and bowel dysfunction, sexual problems, lymphedema (swelling in the limbs) and psychosocial issues.84 Survivors of oropharyngeal cancer frequently face particular problems with dry mouth, swallowing, chewing and concerns about speech and appearance.85 Anal cancer survivors also suffer serious long-term impacts on their quality of life, including bowel, urinary and sexual problems.86