HPV (human papillomavirus) is a very common sexually transmitted infection that causes 4.5% of all cancers in women and men worldwide.5 In the European continent, about 2.5% of cancers are attributable to HPV. The virus causes more than cervical cancer; it is also responsible for a high proportion of anal, penile, vaginal, vulval and oropharyngeal cancers. The virus is also responsible for genital warts and recurrent respiratory papillomatosis (RRP).
Almost all (85-90%) of sexually active women and men will acquire HPV at some point in their lives.6 There are around 200 different types of HPV. 12 of these HPV types are associated with a high risk of cancer7, the most significant being types 16 and 18. HPV types 6 and 11 are not carcinogenic but can cause warts on or around the genital area. They are also implicated in recurrent respiratory papillomatosis (RRP), a relatively rare but very disabling condition that adversely affects breathing in children and adults of both sexes.
In some European countries, the prevalence of high-risk HPV infection exceeds 15% in women.8 One study of oncogenic HPV types in men found a prevalence rate of 12%.9 In men who have sex with men specifically, the prevalence rate of HPV types 16 or 18 could be as high as 20%.10 High-risk oral HPV infection specifically has been found to be much more prevalent in men than women.11
Most people exposed to HPV suffer no ill-effects. But some, particularly those who are repeatedly exposed to high-risk HPV types or who are already immunocompromised (e.g. because they are HIV+), may go on to be diagnosed with a cancer caused by HPV.
HPV is implicated in virtually all cases of cervical cancer and around 90% of anal cancers. Estimates vary concerning the role of HPV in other cancers but one global analysis suggested that it causes 12%–63% of oropharyngeal cancers, 36%–40% of penile cancers, 40%–64% of vaginal cancers, and 40%–51% of vulvar cancers.12 There is some greater uncertainty about the proportion of oropharyngeal cancers caused by HPV. A 2018 global study concluded that HPV was responsible for 30% of oropharyngeal cancers13 while the CDC (Centers for Disease Control and Prevention) in the USA suggests 70%.14
For the other cancers, the CDC estimates that 91% of anal cancers are caused by HPV, 63% of penile, 75% of vaginal and 69% of vulval. For all the cancers that can be caused by HPV combined, including cervical cancer, the CDC considers that HPV is implicated in 79% of cases. The CDC estimate does not include a small proportion of other head and neck cancers, affecting the sino-nasal tract, the oral cavity and the larynx, that can also be caused by HPV.
If 2.5% of cancers in Europe are HPV-related, this suggests that about 67,500 cancer cases out of a total of 2.7 million15 across the 27 EU states will be caused by HPV in 2020. More specific studies have estimated that HPV is responsible for about 53,000 new cases of cancer annually across 31 European countries,16 and 87,000 across the wider WHO European region.17 About 20% of cases occur in men, although one study suggests the proportion could be closer to 30%.18 In recent years, there has been a marked increase in the incidence of oropharyngeal cancers, mainly caused by HPV type 16, particularly in men.19 In the USA, HPV-positive oropharyngeal cancer has overtaken cervical cancer as the most common HPV-associated cancer type.20
No data is available on the total number of cancer deaths in Europe caused specifically by HPV. However, data is available for cervical cancer specifically. In Europe, in 2018, there were almost 26,000 deaths attributable to cervical cancer, of which about 16,000 were in Central-Eastern Europe, 2,100 in Northern Europe, 3,500 in Southern Europe, and 4,250 in Western Europe.21 The cervical cancer mortality rate was significantly higher, almost threefold, in Central-Eastern Europe.
Every case of genital warts is caused by HPV. There are between 379,000 and 510,000 new cases of genital warts in women and between 377,000 and 428,000 new cases in men annually across 31 European countries. There is no Europe-wide data on RRP but the prevalence in the United Kingdom has been estimated at about 1.5 per 100,000.22 Both genital warts and RRP can have a significant impact on quality of life and treatments are costly.23,24