Cervical Cancer
“One woman dies of cervical cancer every 2 minutes…”
As of 2018, approximately 311,000 women died from cervical cancer worldwide. The WHO expect cases to rise from 570 000 to 700 000 between 2018 and 2030, with the annual number of deaths projected to increase to 400 000.More than 85% of these deaths occurred in low- and middle-income countries where cervical cancer represents the leading cancer-related death in women. Countries with effective access to screening programmes have much higher chances of early detection and allow earlier treatment. In high-income countries such screening and vaccination programmes have reduced cervical cancer incidence and mortality by more than half over the past 30 years. But the overall prognosis remains poor for women with metastatic or recurrent disease.
The World Health Assembly global strategy (WHA 73.2) to eliminate cervical cancer has set targets including
%
of women identified with cervical disease receive treatment
(90% of women with pre-cancer treated; 90% of women with invasive cancer managed).
In recent years the incorporation of the anti-VEGF agent bevacizumab has been ableble to extend overall survival beyond 12 months in responsive patinets (Cohen et al, 2019). But further improvments in traetment are urgently needed.
Other cancers
HPV is responsible for a substantial fraction of anogenital cancers and head and neck (oropharyngeal) cancers. A study by de Martel et al. 2018 estimated global incidence of other HPV‐attributable anogenital cancer includes 8,500 vulva; 12,000 vagina; 35,000 anus (half occurring in men) and 13,000 penis. In head and neck cancers, HPV‐attributable cancers represent 38,000 cases of which 21,000 are oropharyngeal cancers occurring in more developed countries. Prevention through universal access to affordable vaccination needs to be central to future public health preventative measures. But where cases of HPV attributable cancer exist then better treatments are urgently required. TIGER is contributing to this need for innovative clinical interventions to address these hard to treat diseases.
Anal cancer, is relatively rare, with about 27,000 new cases diagnosed worldwide in 2008 and age-adjusted incidence rates around 1 per 100,000 population. HPV DNA was identified in 88% of cases in one study. Research indicates rates have been increasing either in both sexes or in women, in many populations, especially in the Americas, Northern and Western Europe, and Australia. Data for other regions was more limited according to research (Islami et al 2017). The reasons for this are not clear but changes in sexual behaviour seems to be a risk factor that increases the incidence and persistence of anal HPV infections.
The majority of vaginal cancers and some vulvar cancers are associated with HPV. Both these cancers are relatively rare representing less than 1% of global cancer incidence in women. Recently rising incidence rates of vulvar cancer have been seen in younger women, this has been potentially linked to an increased prevalence of high-risk HPV types.
Research suggests half of the penile squamous cell carcinomas were most commonly associated with HPV type 16 , followed by HPV types 18 and 6, with little presence of other genotypes.