Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread-optimally universal-implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph '. Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters.
Bibliographical noteFunding Information:
MLG: Has had scientific collaborations and has received research funding from Merck. She has acted as a consultant for Merck and GlaxoSmithKline.
JC: Is on advisory Boards for Abbott, Becton Dickinson, Gen-Probe, Qiagen and Roche and his institution receives research funding from these companies as well as Genera Biosystems and Oncohealth.
WAF: Has received speaker fees, and educational and unrestricted research grants from Merck Canada.
The work was partially supported by public grants from the European Commission (7th Framework Programme grants HEALTH-F3-2010-242061, PREHDICT and HEALTH-F2-2011-282562, HPV AHEAD), from the Instituto de Salud Carlos III (Spanish Government) (grants FIS PI08/1535, FIS PI10/02995, FIS PI11/02090, FIS PI11/02096, FIS PI11/02104, RCESP C03/09, RTICESP C03/10, RTIC RD06/0020/0095, RD12/0036/0056 and CIBERESP) and from the Agència de Gestió d’Ajuts Universitaris i de Recerca – Generalitat de Catalunya (Catalonian Government) (grants AGAUR 2005SGR00695 and AGAUR 2009SGR126), who had no role in data collection, analysis or interpretation of results. Thomas R. Broker receives research support from the USPHS/NIH/National Cancer Institute (grants “Human Papillomavirus Gene Expression” CA36200 and “Mechanisms of Human Papillomavirus DNA Replication” CA83679). Anna-Barbara Moscicki's work is supported by US Public Health Service grant R37 CA51323 (National Cancer Institute, National Institutes of Health, Department of Health and Human Services) and National Institute of AIDS and Infectious Disease RC1 AI86051. John Doorbar is funded by the UK Medical Research Council through program grant MC_U117584278 (Molecular Biology of Human Papillomavirus Infection). Marc Arbyn received financial support from: (1) the 7th Framework Programme of DG Research of the European Commission through the PREHDICT project (grant No. 242061, coordinated by the Vrije Universiteit Amsterdam, the Netherlands) and through the HPV AHEAD Network (FP7-HEALTH-2011-282562); (2) the Belgian Foundation Against Cancer (Brussels, Belgium); and (3) the International Agency for Research on Cancer (Lyon, France). Jack Cuzick was supported in part by Cancer Research UK programme grant A10404. Karen Canfell is supported by grants from the National Health and Medical Research Council, Australia (CDF APP1007994 and Project Grant #1007518), by non-commercial government and academic consulting agreements in Australia, New Zealand and the UK, and by Cancer Council NSW, Australia. Lynette A. Denny was partially supported by Bill and Melinda Gates Foundation, USA (35537). The work of Chris J.L.M. Meijer received support via the 7 th Framework Programme of DG Research of the European commission through the PREHDICT project (grant 242061, coordinated via the Vrije Universiteit Amsterdam). Jane J. Kim is supported in part by grants from the U.S. National Cancer Institute (U54 CA164336, R01 CA160744-01A1) and the Bill and Melinda Gates Foundation (30505) for modeling of HPV and cervical cancer in developing countries.
JD: Is supported by the UK Medical Research Council, has recently acted as consultant for Sanofi Pasteur MSD, Merck and Roche, and has received research support from Sanofi Pasteur MSD, GlaxoSmithKline and the Wellcome Trust.
- Anal cancer
- Cervical cancer
- HPV testing
- HPV vaccination
- Oropharyngeal cancer
- Penile cancer
- Vaginal cancer
- Vulvar cancer