Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, 22 Esselen Street, Hillbrow, Johannesburg, 2001, South Africa.
Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, 22 Esselen Street, Hillbrow, Johannesburg, 2001, South Africa.
Cancer Epidemiol. 2019 Feb;58:121-129. doi: 10.1016/j.canep.2018.12.004. Epub 2018 Dec 15.
HPV infection causes several cancers which include cervical, vaginal, vulval, penile and oropharyngeal cancer (OPC). Understanding the burden of HPV-related cancers is important for guiding cancer prevention and treatment interventions.
To inform policy, we analysed trends of age-standardised incidence (ASIR) and mortality (ASMR) rates for HPV-related head and neck (HNC) and anogenital cancers (AGC) in South Africa between 1994 and 2013.
A total of 1 028 330 incident cancers and 617 044 cancer-related deaths were reported during the study period. The overall ASIR (-5.5%) and ASMR (-2.2%) for HNC declined, in part related to the anti-smoking legislation. In contrast, incidence (2.9%) and mortality (0.8%) rates for AGC increased with the rising HIV prevalence. ASIR for oral cavity cancer (OCC: -6.3%) and laryngeal cancer (LC: -11.3%) declined, including mortality associated with these cancers (OCC:-1.9%, and LC:-2.6%). However, oropharyngeal cancer showed a slower rate of decline in ASIR (-4.4%) and ASMR did not change. Compared to women, ASIR and ASMR for HNC were 3-fold higher among men. ASIR for both anal (7.5%) and vulval cancer (16.1%) increased. Median age at diagnosis of vulval cancer declined by 18 years (p-value = 0.01). Mortality rates for anal (3.9%) and vulval (2.6%) cancer increased. ASIR (-3.2%) and ASMR (-2.0%) for penile cancer declined. Rates for vaginal cancer did not change.
Anal and vulval cancers have increased over the reporting period. There is need to continuously monitor trends of these cancers. Implementation of HPV vaccination could significantly reduce the burden of HPV-related cancers.
HPV 感染可导致多种癌症，包括宫颈癌、阴道癌、外阴癌、阴茎癌和口咽癌。了解 HPV 相关癌症的负担对于指导癌症预防和治疗干预措施非常重要。
为了为政策提供信息，我们分析了 1994 年至 2013 年期间南非 HPV 相关头颈部（HNC）和肛门生殖器（AGC）癌症的年龄标准化发病率（ASIR）和死亡率（ASMR）趋势。
在研究期间共报告了 1028330 例癌症新发病例和 617044 例癌症相关死亡。HNC 的总体 ASIR（-5.5%）和 ASMR（-2.2%）下降，部分原因与反吸烟立法有关。相比之下，AGC 的发病率（2.9%）和死亡率（0.8%）随着 HIV 流行率的上升而增加。口腔癌（OCC：-6.3%）和喉癌（LC：-11.3%）的发病率下降，包括与这些癌症相关的死亡率（OCC：-1.9%，LC：-2.6%）。然而，口咽癌的 ASIR 下降速度较慢（-4.4%），ASMR 没有变化。与女性相比，男性的 HNC 的 ASIR 和 ASMR 高 3 倍。肛门癌（7.5%）和外阴癌（16.1%）的发病率增加。外阴癌的中位诊断年龄下降了 18 岁（p 值=0.01）。肛门癌（3.9%）和外阴癌（2.6%）的死亡率增加。阴茎癌的 ASIR（-3.2%）和 ASMR（-2.0%）下降。阴道癌的发病率没有变化。
在报告期间，肛门癌和外阴癌有所增加。需要持续监测这些癌症的趋势。HPV 疫苗的实施可以显著降低 HPV 相关癌症的负担。
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