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Preface

Preface to the third edition

Since the first edition of the HPV Information Centre, GLOBOCAN, one of the landmark products ofthe International Agency for Research on Cancer (IARC), serves as the reference source of cancerstatistics. GLOBOCAN is a resource that provides on a regular basis the most accurate assessmentof global cancer burden in the world. On June 1st 2010, the new edition of GLOBOCAN, GLOBOCAN2008, was launched and new cancer estimates for 2008 are currently available.This third edition of the HPV Information Centre incorporates the new burden estimates for all HPV-related cancers. In addition to the publicly available GLOBOCAN 2008, IARC has kindly providedthe HPV Information Centre with age-specific estimates for HPV-related cancers which are also pre-sented in this report.

http://www.who.int/hpvcentre

http://www.who.int/hpvcentre

LIST OF TABLES - 1 -

List of Tables1 Key statistics in the World . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

1 INTRODUCTION - 3 -

sis such as the use of smoking, parity, oral contraceptive use and co-infection with HIV.

Section 6 presents sexual and reproductive behaviour indicators that may be used as proxy mea-sures of risk for HPV infection and anogenital cancers.

Section 7 presents preventive strategies that include basic characteristics and performance of cervi-cal cancer screening status, status of HPV vaccine licensure introduction, and recommendations innational immunization programs and the prevalence of male circumcision and condom use.

c WHO/ICO HPV Information Centre

2 DEMOGRAPHIC AND SOCIOECONOMIC FACTORS - 5 -

Figure 3: Estimated population trends of four selected age groupsin the World compared to developing and developed regions in

2 DEMOGRAPHIC AND SOCIOECONOMIC FACTORS - 7 -

Table 3: Sociodemographic indicators in the WorldIndicator Male Female TotalPopulation in 1000s1 3282865a 3229412a 6512276a

Population growth rate (%)1 - - 1.18b

Median age (years)1 - - 27.9a

Population living in urban areas (%)2 - - 50c

Crude birth rate (births per 1000 population)1 - - 20.3b

Crude death rate (deaths per 1000 population)1 - - 8.5b

651227/F30 5.9776 Tf 108.96 T109 Td [(c)]TJ0.89664 Tf 216.82792 cm[09 Td [(651229/F30 5.9776 Tf 108.96 T09 Td [(c)]TJ0.89664 Tf 216.82792 cm[09 Td [(651227/F30 5.9776 Tf 108.96 T09 Td [(c)]TJ0.84 0.82 0.62 rg 0.84 0.82 0.62 RGETq1 0 0 1 56.693 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.903 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 393.596 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 393.994 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.3 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 395.987 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 0.82 0.62 rg 0.84 0.82 0.62 RGq1 0 0 1 396.385 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.17 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 439.002 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 393.401 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.3 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 395.393 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 0.82 0.62 rg 0.84 0.82 0.62 RGq1 0 0 1 396.792 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.15 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 490.387 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 393.485 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.3 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 395.378 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 0.82 0.62 rg 0.84 0.82 0.62 RGq1 0 0 1 396.776 666.656 619[]0 d 0 J 0.398 w 0 0 m 336.17 0 l SQ0 g 0 GBT/F47 8.9664 Tf 56.693 657.243.7m[(c)]TAdult8(bir)mo0(th)-2aliy8(r)10(ate)-27:/F27 5.9776 Tf 184.75.01109 Td [(1)]T3/F47 8.9664 Tf 216.874 0 .809 Td [(-)-522J/F30 5.9776 Tf 34.814 05509 Td [(c)]TJ0.89664 Tf 216.82703 42.809 Td [(-)-5155/F30 5.9776 Tf 34.814 05609 Td [(c)]TJ0.89664 Tf 216.82703 42.809 Td [(-)-5191/F30 5.9776 Tf 34.814 05609 Td [(c)]TJ0.84 0.82 0.62 rg 0.84 0.82 0.62 RGETq1 0 0 1 56.693 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.903 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 393.596 680.201 5[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 393.994 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.3 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 395.987 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 0.82 0.62 rg 0.84 0.82 0.62 RGq1 0 0 1 396.385 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.17 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 439.002 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 393.401 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.3 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 395.393 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 0.82 0.62 rg 0.84 0.82 0.62 RGq1 0 0 1 396.792 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.15 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 490.387 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 393.485 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.3 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 395.378 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.8 0 l SQ0 g 0 G1 g 0.82 0.62 rg 0.84 0.82 0.62 RGq1 0 0 1 396.776 666.601 5[]0 d 0 J 0.398 w 0 0 m 336.1 0 G1 g 1 Gq1 0 0 1 393.485 666.601 5[]0 d 0Q0.708 0 l SQ0 g 0 G1 g 0.82 0.62 y8(aran0(ate)-27:/F27 5.97tys)-278(per)-278(1000)-27))]TJ/F27 5.9776liv)25(te)-278((bir)-424.7809 Td [(1)]T3/F47 8.698 8Tf 216.874 0 .809 Td [(-)-522J/F18(-)276 Tf 108.96 T519 Td [(c)]TJ0.89664 Tf 216.82792 cm[09 Td [(651229/F30 5.9776 Tf 108.96 T47 Td [(c)]TJ0.89664 Tf 216.82792 cm[09 Td [(651227/F30 5.9776 Tf 108.96 T49 Td [(c)]TJ0.84 0.82 0.62 rg 0.84 0.82 0.62 RGETq1 0 0 1 56.693 666.656 619[]0 d 0 J 0.398 w 026.02766.903 0 l SQ0 g 0 G1 g 1 Gq1 0 0 1 393.596 680.201 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1q1 0 0 1 393.994 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1q1 0 0 1 395.987 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1q1 0 0 1 393.994 666.62 RGq1 0 0 1 396.385 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1Gq1 0 0 1 439.002 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1q1 0 0 1 393.994 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1q1 0 0 1 395.987 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1q1 0 0 1 393.994 666.62 RGq1 0 0 1 396.385 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1Gq1 0 0 1 490.387 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1q1 0 0 1 393.994 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1q1 0 0 1 395.987 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1q1 0 0 1 393.994 666.62 RGq1 0 0 1 396.385 666.601 5[]0 d 0 J 0.398 w 0 26.02766.903 0 l SQ0 g 0 G1 g 1G3.485 666.601 5[]0 d 0Q0.708 0 l SQ0 g 0 G11g 01050y)20(-2751)]5(nal(ate)-27:/F27 5.97tys)-278(per)-2io8(1000)-27))]TJ/F27,27 5.9776livte (bir

65122761- 27.9

3 BURDEN OF HPV RELATED CANCERS - 10 -

Figure 7: Incidence of cervical cancer compared to other cancers in the World using crude andage-standardized rates (ASR) and by age

Data sources:IARC, Globocan 2008. Age-specific data from GLOBOCAN 2008 were obtained from IARC, personal communication.



Figure 15: Ranking of cervical cancer to others cancers among all women and women ages 15-44years according to mortality rates

All women

Women ages 15-44 years

*Highest incidence rate rank 1st. Ranking is based on crude mortality rates (actual number of cervical cancer deaths) in the country/region. Ranking using ASR may differ.Data sources:


Figure 18: Global estimated number of deaths of cervical cancer by age group compared to regions,in 2008 and projected in 2025

Ann

ual n

umbe

r of

cer

vica

l can

cer

deat

hs

●

●

●

●

●

●

●

●

●

●

Age group

0−64 yrs 65+ yrs

2008 20250

100000

200000

300000

400000

274883

394699

+34%

+64%

Year

WORLD

2008 20250

100000

200000

300000

400000

33159 38291+1%

+34%

Year

DEVELOPED REGIONS

2008 20250

100000

200000

300000

400000

241724

380212

+46%

+84%

Year

DEVELOPING REGIONS

Projected burden in 2025 is estimated by applying current population forecasts for the country and assuming that current mortality rates of cervical cancer are constant over time.Data sources:IARC, Globocan 2008.



3.1.3 Comparison of incidence and mortality

Figure 19: Global age-specific incidence and mortality rates ofcervical cancer compared to developing and developed regions

Rates per 100,000 women per year.Data sources:IARC, Globocan 2008. Age-specific data from GLOBOCAN 2008 were obtained from IARC, personal communication.For specific estimation methodology refer to http://globocan.iarc.fr/DataSource_and_methods.asp.


4 HPV RELATED STATISTICS - 31 -

Figure 23: Ten most frequent HPV types among women with invasive cervical cancer in the World


Table 11: Pooled estimate of HPV prevalence among anal cancer cases, by sex

Sex


4.2.2 Vulvar cancer


4.2.3 Vaginal cancer

Vaginal and cervical cancers share similar risk factors and it is generally accepted that both carcino-mas share the same aetiology of HPV infection although there is limited evidence available. Womenwith vaginal cancer are more likely to have a history of other ano-genital cancers, particularly of thecervix, and these two carcinomas are frequently diagnosed simultaneously. HPV DNA is detectedamong 91% of invasive vaginal carcinomas and 82% of high-g 0 -rade vaginalasneoplasias (VAIN3).In acase series of vaginal cancers, HPV-16 is the most common type in at least 70% of HPV-positivecarcinomas.(Vaccine 2006, Vol. 24, Supl 3; Vaccine 2008, Vol. 26, Supl 10; IARC Monog 0 -raphs 2007, Vol. 90)

In this section, the HPV burden among cases of vaginal cancers in the World is presented.

Table 13: Studies on HPV prevalence among cases of vaginal cancer in the WorldNo. HPV prevalence

Study HPV detection method Histology tested %


Figure 28: Ten most frequent HPV types among vaginal cancercases in the World


Figure 30: Ten most frequent HPV types among penile cancercases in the World

Data sources:See references in Section 8.


8 REFERENCES - 51 -

8 REFERENCES - 52 -

Region/Country ReferenceCôte d’I La Ruche G, Int J Cancer 1998; 76: 480 ¶ • ‚

Gambia Wall SR, Br J Cancer 2005; 93: 1068 ¶

Guinea Bosch FX, J Natl Cancer Inst 1995; 87: 796 „

Keita N, Br J Cancer (Accepted) ; : ¶

8 REFERENCES - 53 -

Region/Country ReferenceBaken LA, J Infect Dis 1995; 171: 429 ¾

Baldwin SB, J Infect Dis 2003; 187: 1064 ¾

Bell MC, Gynecol Oncol 2007; 107: 236 • ‚

Bloss JD, Hum Pathol 1991; 22: 711 »

Bosch FX, J Natl Cancer Inst 1995; 87: 796 „

Brown DR, Sex Transm Dis 2002; 29: 763 •

Bryan JT, J Med Virol 2006; 78: 117 „

Burger RA, J Natl Cancer Inst 1996; 88: 1361 „

Burnett AF, Gynecol Oncol 1992; 47: 343 „

8 REFERENCES - 55 -

Region/Country ReferenceBosch FX, J Natl Cancer Inst 1995; 87: 796 „

Franceschi S, Br J Cancer 2002; 86: 705 ¾

Leon S, Sex Transm Dis 2009; 36: 290 ¶

8 REFERENCES - 56 -

Region/Country ReferenceYang Y-80, Gynecol Oncol 1997; 64: 59 „

Yang YY, J Microbiol Immunol Inf80ect 2004; 37: 282 „

Yeoh GP, Acta Cytol 2006; 50: 627 ¶

8 REFERENCES - 61 -

Region/Country ReferenceKagie MJ, Gynecol Oncol 1997; 67: 178 »

Lont A, Int J Cancer 2006; 119: 1078 ‰

Madsen BS, Int J Cancer 2008; 122: 2827 »

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