title: The burden of HPV associated cancers in two regions in Nigeria 2012-2014.
abstract: HPV attributable cancers are the second most common infection-related cancers worldwide, with much higher burden in less developed regions. There are currently no country-specific estimates of the burden of these cancers in Nigeria just like many other low and middle income countries.
  
  
  
  In this study, we quantified the proportion of the cancer burden in Nigeria that is attributable to HPV infection from 2012 to 2014 using HPV prevalence estimated from previous studies and data from two population based cancer registries (PBCR) in Nigeria. We considered cancer sites for which there is strong evidence of an association with HPV infection based on the International Agency for Research on Cancer (IARC) classification. We obtained age and sex-specific estimates of incident cancers and using the World Standard Population, we derived age standardized incidence (ASR) rates for each cancer type by categories of sex, and estimated the population attributable fractions (PAF).
  
  
  
  The two PBCR reported 4336 new cancer cases from 2012 to 2014. Of these, 1627 (37.5%) were in males and 2709 (62.5%) in females. Some 11% (488/4336) of these cancers were HPV associated; 2% (38/1627) in men and 17% (450/2709) in women. Of the HPV associated cancers, 7.8% occurred in men and 92.2% in women. The ASRs for HPV associated cancers was 33.5 per 100,000; 2.3 and 31.2 per 100,000 in men and women respectively. The proportion of all cancers attributable to HPV infection ranged from 10.2 to 10.4% (442-453 of 4336) while the proportion of HPV associated cancers attributable to HPV infection ranged from 90.6% to 92.8% (442-453 of the 488 cases). In men, 55.3% to 68.4% of HPV associated cancers were attributable to HPV infection compared to 93.6% to 94.8% in women. The combined ASR for HPV attributable cancers ranged from 31.0 to 31.7 per 100,000. This was 1.4 to 1.7 per 100,000 in men and 29.6 to 30.0 per 100,000 in women. In women, cervical cancer (n=392, ASR 28.3 per 100,000) was the commonest HPV attributable cancer, while anal cancer (n=21, ASR 1.2 per 100,000) was the commonest in men.
  
  
  
  HPV attributable cancers constitute a substantial cancer burden in Nigerian women, much less so in men. A significant proportion of cancers in Nigerian women would be prevented if strategies such as HPV DNA based screening and HPV vaccination are implemented.
authors: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: elima.jedyagba@gmail.com.
authors: E E
authors: EE
authors: Jedy-Agba
authors: Center for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, United Kingdom.
authors: E O
authors: EO
authors: Dareng
authors: Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD, USA.
authors: S N
authors: SN
authors: Adebamowo
authors: Institute of Human Virology, Abuja, Nigeria.
authors: M
authors: M
authors: Odutola
authors: Department of Epidemiology and Public Health, University of Maryland, Baltimore, USA.
authors: E A
authors: EA
authors: Oga
authors: National Hospital Abuja, Nigeria.
authors: F
authors: F
authors: Igbinoba
authors: University of Abuja Teaching Hospital Gwagwalada, Nigeria.
authors: T
authors: T
authors: Otu
authors: University of Nigeria Teaching Hospital Enugu, Nigeria.
authors: E
authors: E
authors: Ezeome
authors: International Agency for Research on Cancer, Lyon, France.
authors: F
authors: F
authors: Bray
authors: Federal Ministry of Health, Abuja, Nigeria.
authors: R
authors: R
authors: Hassan
authors: Institute of Human Virology, Abuja, Nigeria; Department of Epidemiology and Public Health, University of Maryland, Baltimore, USA; Marlene and Stewart Greenbaum Comprehensive Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors: C A
authors: CA
authors: Adebamowo
mesh_terms: D001005:Anus Neoplasms / Q000453:epidemiology / Q000821:virology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000821:virology*; D015995:Prevalence; D012372:ROC Curve; D012042:Registries / Q000706:statistics & numerical data*; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000821:virology*
keywords: Cancer incidence; Cancer registries; HPV; HPV associated cancers; Nigeria