Human papillomavirus

HPV is the cause of over 4.5% of cancers worldwide including cervical, vulvar, vaginal, anal, penile and oropharyngeal. In developing countries, cervical cancer remains a leading cause of morbidity and mortality. In developed countries, cervical cancer has experienced a significant decrease due to cervical cancer screening and treatment whereas HPV associated oropharyngeal cancers continue to rise, specifically in men. In many developed countries including the United States, these cancers will outnumber cervical cancers. The majority of HPV infections are transient. The key to the development of cervical cancer is successful persistent infection of squamo-columnar junctional stem cells and functional expression of oncogenes E6 and E7. Less is understood about cancer development in other anogenital and oropharyngeal cancers. Although cervical cancer screening with cytology for precancers has been critical to the observed decline in cervical cancer, rates have plateaued. New screening guidelines include more sensitive tests including HPV genotyping. Currently, there are no screening guidelines for other anogenital and oropharyngeal cancers. Some experts recommend anal cancer screening using cytology in high risk population which include men who have sex with men living with HIV. Most importantly, prevention of the majority of these cancers is within reach with the administration of the HPV vaccine. However, high rates of coverage among children aged less than 15 years of age is needed.