US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines.
BACKGROUND
This study sought to determine the prevaccine type-specific prevalence of human papillomavirus (HPV)-associated cancers in the United States to evaluate the potential impact of the HPV types in the current and newly approved 9-valent HPV vaccines.


METHODS
The Centers for Disease Control and Prevention partnered with seven US population-based cancer registries to obtain archival tissue for cancers diagnosed from 1993 to 2005. HPV testing was performed on 2670 case patients that were fairly representative of all participating cancer registry cases by age and sex. Demographic and clinical data were evaluated by anatomic site and HPV status. Current US cancer registry data and the detection of HPV types were used to estimate the number of cancers potentially preventable through vaccination.


RESULTS
HPV DNA was detected in 90.6% of cervical, 91.1% of anal, 75.0% of vaginal, 70.1% of oropharyngeal, 68.8% of vulvar, 63.3% of penile, 32.0% of oral cavity, and 20.9% of laryngeal cancers, as well as in 98.8% of cervical cancer in situ (CCIS). A vaccine targeting HPV 16/18 potentially prevents the majority of invasive cervical (66.2%), anal (79.4%), oropharyngeal (60.2%), and vaginal (55.1%) cancers, as well as many penile (47.9%), vulvar (48.6%) cancers: 24 858 cases annually. The 9-valent vaccine also targeting HPV 31/33/45/52/58 may prevent an additional 4.2% to 18.3% of cancers: 3944 cases annually. For most cancers, younger age at diagnosis was associated with higher HPV 16/18 prevalence. With the exception of oropharyngeal cancers and CCIS, HPV 16/18 prevalence was similar across racial/ethnic groups.


CONCLUSIONS
In the United States, current vaccines will reduce most HPV-associated cancers; a smaller additional reduction would be contributed by the new 9-valent vaccine.
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA). msaraiya@cdc.gov.
Mona
M
Saraiya
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Elizabeth R
ER
Unger
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Trevor D
TD
Thompson
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Charles F
CF
Lynch
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Brenda Y
BY
Hernandez
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Christopher W
CW
Lyu
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Martin
M
Steinau
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Meg
M
Watson
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Edward J
EJ
Wilkinson
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Claudia
C
Hopenhayn
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Glenn
G
Copeland
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Wendy
W
Cozen
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Edward S
ES
Peters
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Youjie
Y
Huang
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Maria Sibug
MS
Saber
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Sean
S
Altekruse
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (MSa, TDT, MW) and Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (ERU, MSt), Centers for Disease Control and Prevention, Atlanta, GA; University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI (MTG, BYH); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (CFL); Departments of Preventive Medicine (WC) and Pathology (WC, MSS), University of Southern California, Los Angeles, CA; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA (ESP); Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL (EJW); Michigan Department of Community Health, Lansing, MI (GC); Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY (CH); Florida Department of Health, Tallahassee, FL (YH); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (SFA); Battelle Memorial Institute, Durham, NC (CWL); National Cancer Institute (SA).
Marc T
MT
Goodman
D000328:Adult; D000368:Aged; D052685:Alphapapillomavirus / Q000235:genetics / Q000302:isolation & purification*; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D052161:Human papillomavirus 18 / Q000302:isolation & purification; D006801:Humans; D007822:Laryngeal Neoplasms / Q000517:prevention & control / Q000821:virology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control* / Q000821:virology*; D009959:Oropharyngeal Neoplasms / Q000517:prevention & control / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications* / Q000517:prevention & control / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000276:immunology*; D010412:Penile Neoplasms / Q000517:prevention & control / Q000821:virology; D012042:Registries; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control / Q000821:virology; D014846:Vulvar Neoplasms / Q000517:prevention & control / Q000821:virology
D004279:DNA, Viral; D053918:Papillomavirus Vaccines