ESMO E-Learning: HPV-Related Cancers: Prevention, Vaccines and Treatment

In this E-Learning module the authors present several aspects of human papilloma virus (HPV)-related cancers starting from the prevalence and natural history of HPV infection in various anatomical sites, matching high-risk HPV types with certain cancer types, HPV-related carcinogenesis, course of disease in HPV-related cancers, prevention strategies, specificities in terms of treatment and research efforts.

According to GLOBOCAN 2018 database, an estimated 2.2 million infection-attributable cancer cases were diagnosed worldwide with HPV-attributable cancers being in the second position with 690 000 cases. The cancer burden attributed to HPV showed the clearest relationship with country income level being higher in low-income than in high-income countries.

HPV is the most common sexually transmitted infection in the world. It is so common that nearly all sexually active men and women will get at least one type of HPV at some point in their lives​.

Cervical cancer represents the “historical” model of ​HPV-driven carcinogenesis and other organs affected are vulva, vagina, anus, penis and recently, high-risk HPVs have been recognised as a risk factor responsible for an increasing number of oropharyngeal cancers. The authors emphasise in their module that HPV-driven oropharyngeal cancers are an emerging disease which is distinct from traditional head and neck cancers caused by smoking and ​alcohol consumption. ​

​It is not possible to precisely date the time of infection and the vast majority of infection will spontaneously clear​. Persistent infection is very rare and depends on several factors related to the host, the virus and the environment. The authors underline that a prevalence and the natural history of HPV infection vary from an anatomical site to another. ​In particular, they emphasise that it is not about one but multiple HPVs, not one but multiple diseases, and not one but multiple cancers.

The authors also underline that there is a wide range of assays to identify HPV infection and HPV-driven cancers​. The choice will depend on several factors including the advantages and drawbacks of each test​, the population (healthy individuals versus pre/cancer patients) , and the anatomical location. There is a crucial need for resources directed towards HPV prevention.