Last updated on June 14th, 2023 at 12:32 pm
There are just a handful of ways to reduce your risk of cancer— one of the most important is to get the HPV vaccine to prevent HPV-associated cancers with the HPV vaccine (see Note 1).
Too many people who discuss the HPV vaccine, especially among the anti-vaccine religion, tend to focus on HPV-related cervical cancer. But HPV is linked to several dangerous and deadly cancers, and a new report examines the details of those cancers.
What are HPV and the HPV vaccine?
I know I cut and paste this section to every article I write about HPV vaccines, but it’s the first step to HPV vaccine myth debunking. Some readers may be coming here for the first time, and they ought to know just how the HPV vaccine prevents cancer.
However, I try to update this section when necessary with new information about either the disease or the vaccine. If you’ve read this section 47 times, just skip down to the next section where I discuss the key point of this article.
Genital and oral human papillomavirus (HPV) infections are the most common sexually transmitted infections (STI) in the USA. HPV is generally transmitted from personal contact during vaginal, anal, or oral sex.
It’s important to note that there are more than 150 strains or subtypes of HPV that can infect humans – however, only 40 of these strains are linked to one or more different cancers. Of those 40 strains, most are fairly rare.
Although the early symptoms of HPV infections aren’t serious and many HPV infections resolve themselves without long-term harm, HPV infections are causally linked to many types of cancers in men and women. According to current medical research, here are some of the cancers that are linked to HPV:
In addition, there is some evidence that HPV infections are causally linked to skin and prostate cancers. The link to skin cancer is still preliminary, but there is much stronger evidence that HPV is linked to many prostate cancers.
HPV is believed to cause nearly 5% of all new cancers across the world, making it almost as dangerous as tobacco in that respect. According to the CDC, roughly 79 million Americans are infected with HPV – approximately 14 million Americans contract a new HPV every year. Most individuals don’t even know they have the infection until the onset of cancer. The CDC also states that over 46,000 HPV-related cancers are diagnosed in the USA every year. It may be several times that amount worldwide.
There were two HPV vaccines on the world market before 2014. GSK, also known as GlaxoSmithKline, produced Cervarix, a bivalent (protects against two HPV strains) vaccine. It has been withdrawn from the US market (although available in many other markets), because of the competition from the quadrivalent (immunizes against four different HPV strains) and 9-valent (against nine HPV strains) Gardasil vaccines.
Merck manufactures Gardasil, probably the most popular HPV vaccine in the world. The first version of the vaccine, quadrivalent Gardasil, targets the two HPV genotypes known to cause about 70% of cervical cancer and two other HPV genotypes that cause genital warts. In Europe and other markets, Gardasil is known as Silgard.
The newer Gardasil 9, approved by the FDA in 2014, is a 9-valent vaccine that protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. It targets the four HPV strains found in the quadrivalent version, along with five additional ones that are linked to cervical and other HPV-related cancers. Both versions of Gardasil are prophylactic, meant to be given to females or males before they become exposed to possible HPV infection through intimate contact.
Gardasil is one of the easiest and best ways to prevent a few dangerous and, to abuse the definition slightly, common cancers that afflict men and women. Without a doubt, the HPV vaccine prevents cancer.
Currently, in the United States, the Advisory Committee on Immunization Practices (ACIP) recommends that preteen girls and boys aged 11 or 12 are vaccinated against HPV. Immunization is also recommended for teenage girls and young women up to the age of 26 who did not receive it when they were younger, and teenage boys and young men up to the age of 21.
Let me sum this all up so that if you come away from this section with nothing else, you get this summary. HPV is a sexually transmitted disease. HPV causes 46,000 cancers a year in the USA alone. The HPV vaccine prevents becoming infected by HPV, which means you are protected from these cancers.
USA statistics of HPV-associated cancers
In a 2018 article published in the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report, CDC researcher Elizabeth A Van Dyne, MD et al. examined the incidence of HPV-associated cancers in the USA from 1999 to 2015. Their results are surprising and should make us redouble our efforts to increase the uptake of the HPV vaccine.
The researchers found that oropharyngeal squamous cell carcinoma (SCC) (see Note 2) is now the most common of the various HPV-associated cancers in the USA. SCC incidence rates, from 1999 through 2015, increased by 2.7% per year for men and 0.8% per year among women.
Oropharyngeal cancer has now replaced cervical cancer as number 1 on the list of HPV-associated cancers. In 2015, there were a total of 11.788 cervical cancers compared to 18,917 oropharyngeal SCCs.
According to the report, the decline in cervical cancer is part of a long-term trend, since the 1950s, which has resulted from better guidelines and attention to cervical screening. On the other hand, the increase in oropharyngeal SCC may be due to changing sexual behaviors over the past 15-20 years, including unprotected oral sex, especially among white men, who report having the highest number of sexual partners and performing oral sex at a younger age.
The study also stated that in 1999, there were a total of 30,115 new cases of HPV-associated cancers. However, in 2015, there were 43,371 cases. The rate of HPV-associated cancers dropped by 0.4% annually during the study period, whereas it increased by 2.4% annually among men.
To obtain this data, the CDC analyzed data from their own National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program for all years from 1999 to 2015.
There is a limitation to these registries – they track the incidence of invasive cancers, but they do not track the HPV status of individual cases of cancer. The researchers adjusted the data using published statistics on the percentage of each cancer that is linked to HPV. In the United States, HPV DNA was found in 91% of cervical, 91% of anal, 75% of vaginal, 70% of oropharyngeal, 69% of vulvar, and 63% of penile cancers.
The researchers observed these annual changes in HPV-associated cancers over the 1999-2015 study period:
| Cancer Type | Average Annual Change (%) |
|---|---|
| Cervical | – 1.6 |
| Vaginal | – 0.6 |
| Oropharyngeal in men | + 2.7 |
| Oropharyngeal in women | + 0.8 |
| Anal in men | + 2.1 |
| Anal in women | + 2.9 |
| Vulvar | + 1.3 |
Another analysis of HPV-related cancers
In a 1 March 2022 paper published in JAMA Network Open by John K Chan, MD, Division of Gynecologic Oncology, California Pacific/Palo Alto/Sutter Health Research Institute, San Francisco, and colleagues examined over 657,000 HPV-associated (oropharyngeal squamous cell carcinoma [SCC], anal/rectal SCC, vulvar SCC, vaginal SCC, cervical carcinoma, and penile SCC) cancers using data from the US Cancer Statistics Public Use Database, representing 99% of the US population, between January 1, 2001, and December 31, 2017. They also obtained HPV vaccination and screening data from the Behavioral Risk Factor Surveillance between January 1, 2001, and December 31, 2016; and TeenVaxView between January 1, 2008, and December 31, 2018.
Here are some of the results from this analysis:
- A total of 657 317 HPV-associated cancers were analyzed over the period stated above — 264,019 (40.2%) developed in men and 393,298 (59.8%) in women. This dismisses the myth that HPV-related cancers are only an issue in women
- More than half (206,075 [52.4%]) of cancers in women were cervical,
- The vast majority (211,421 [80.1%]) of HPV-associated cancers in men were oropharyngeal.
- In female adolescents (aged 13-17 years), the vaccination rate increased from 37.2% to 69.9% from 2008 to 2018. I wish it were higher, but it is a surprisingly good uptake.
- Before vaccination approval in 2006, cervical cancer rates in the 20- to 24-year age group were decreasing by 2.29% annually.
- Since vaccine approval, this rate has been decreasing by 9.50% annually. This shows that the increase in vaccination is correlated closely with a decrease in cervical cancer rates.
Summary
Based on CDC data from 2014 to 2018, about 46,143 HPV-associated cancers occur in the United States each year: 25,719 among women and 20,424 among men. Not all of these cancers can be prevented by the HPV vaccine, but Gardasil9 protects against the vast majority of HPV types that are linked to cancer.
Let’s be clear about a couple of things. First, the HPV vaccine is extremely safe, shown over and over again in large clinical trials and epidemiological studies. Second, the HPV vaccine is extremely effective in reducing the rate of HPV-related cancers.
There are so few ways to actually prevent cancer. Why would any parent not take their children to the pediatrician to get the vaccine that could protect against 46,000 HPV-associated cancers every year? Why is this even a question?
Notes
- Although this article focuses on the HPV vaccine, the hepatitis B vaccine is also important for the prevention of some cancers. The vaccine prevents hepatitis B viral infections, and chronic hepatitis B infections can lead to liver cirrhosis or cancer. Liver cancer is actually one of the few cancers in the USA where the incidence has increased over the past few years. And if you follow the anti-vaccine rhetoric, you know the hepatitis B vaccine is almost as controversial as the HPV vaccine.)
- Oropharyngeal squamous cell carcinoma is sometimes called “throat cancer,” but it actually includes cancers at the base of the tongue, pharyngeal tonsils, anterior and posterior tonsillar pillars, glossotonsillar sulci, the anterior surface of the soft palate, and uvula, and lateral and posterior pharyngeal walls. So it’s a broad name for a number of closely related cancers.
Citations
- Bzhalava D, Guan P, Franceschi S, Dillner J, Clifford G. A systematic review of the prevalence of mucosal and cutaneous human papillomavirus types. Virology. 2013 Oct;445(1-2):224-31. doi: 10.1016/j.virol.2013.07.015. Epub 2013 Aug 5. Review. PubMed PMID: 23928291.
- Liao CI, Francoeur AA, Kapp DS, Caesar MAP, Huh WK, Chan JK. Trends in Human Papillomavirus-Associated Cancers, Demographic Characteristics, and Vaccinations in the US, 2001-2017. JAMA Netw Open. 2022 Mar 1;5(3):e222530. doi: 10.1001/jamanetworkopen.2022.2530. PMID: 35294540; PMCID: PMC8928005.
- Ljubojevic S, Skerlev M. HPV-associated diseases. Clin Dermatol. 2014 Mar-Apr;32(2):227-34. doi: 10.1016/j.clindermatol.2013.08.007. Review. PubMed PMID: 24559558.
- Saraiya M, Unger ER, Thompson TD, Lynch CF, Hernandez BY, Lyu CW, Steinau M, Watson M, Wilkinson EJ, Hopenhayn C, Copeland G, Cozen W, Peters ES, Huang Y, Saber MS, Altekruse S, Goodman MT; HPV Typing of Cancers Workgroup. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst. 2015 Apr 29;107(6):djv086. doi: 10.1093/jnci/djv086. Print 2015 Jun. PubMed PMID: 25925419; PubMed Central PMCID: PMC4838063.
- Van Dyne EA, Henley SJ, Saraiya M, Thomas CC, Markowitz LE, Benard VB. Trends in Human Papillomavirus-Associated Cancers – United States, 1999-2015. MMWR Morb Mortal Wkly Rep. 2018 Aug 24;67(33):918-924. doi: 10.15585/mmwr.mm6733a2. PubMed PMID: 30138307.
