Shing Jaimie Z, Mashele Sizeka, Tsegaye Adino T, Da Costa Dias Bianca, Engels Eric A, Chikandiwa Admire, Shiels Meredith S, Mwansa-Kambafwile Judith, Stephens Erica S, Metekoua Carole, Liu Danping, Carvajal Loretto J, Kreimer Aimée R, Muchengeti Mazvita
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
Lancet Glob Health. 2025 Jun;13(6):e1101-e1110. doi: 10.1016/S2214-109X(25)00065-8.
Understanding human papillomavirus (HPV)-related cancer epidemiology in South Africa is crucial for informing cancer prevention in this high-burden country. We aimed to describe HPV-related cancer incidence in South Africa between 2011 and 2021.
For this cross-sectional study, we obtained data on cancer incidence from the South African National Cancer Registry and population estimates from Statistics South Africa. We calculated age-standardised incidence per 100 000 person-years for cervical carcinoma, and vulvar, vaginal, penile, oropharyngeal, and anal squamous cell carcinoma among people aged 15 years and older by sex, year, age, and race. Average annual percentage changes (AAPCs) were calculated using the Joinpoint Regression Program.
Between Jan 1, 2011 and Dec 31, 2021, the overall cervical carcinoma incidence was 30·4 cases per 100 000 person-years (95% CI 30·2 to 30·6), which was highest in females aged 55-64 years (58·5 cases per 100 000 person-years [57·5 to 59·5]); incidence was stable between 2011 and 2016 and began to decline in 2016 (AAPC -2·7% [95% CI -10·8 to -0·2]). The incidence of vulvar squamous cell carcinoma (2·3 cases per 100 000 person-years [2·2 to 2·4]), vaginal squamous cell carcinoma (0·7 cases per 100 000 person-years [0·7 to 0·7]), and female-anal squamous cell carcinoma (0·6 cases per 100 000 person-years [0·6 to 0·7]) increased between 2011 and 2021 (AAPC 8·0% [95% CI 5·3 to 13·9] for vulvar squamous cell carcinoma; 3·2% [0·5 to 6·6] for vaginal squamous cell carcinoma; and 8·5% [2·0 to 23·2] for anal squamous cell carcinoma). The largest increase in vulvar squamous cell carcinoma between 2011 and 2021 was observed among females aged 15-44 years (AAPC 10·0% [8·2 to 13·4]) and 45-54 years (AAPC 10·7% [8·2 to 14·1]). The incidence of penile squamous cell carcinoma (1·4 cases per 10 000 person-years [1·3 to 1·4]) and anal squamous cell carcinoma in males (0·4 cases per 100 000 person-years [0·4 to 0·5]) increased between 2011 and 2021 (AAPC 6·9% [3·8 to 10·7] for penile squamous cell carcinoma; 9·3% [6·7 to 12·7] for anal squamous cell carcinoma). For both sexes, oropharyngeal squamous cell carcinoma trends were stable. The incidence of cervical carcinoma, vulvar squamous cell carcinoma, and vaginal squamous cell carcinoma was highest among Black females; penile squamous cell carcinoma was highest among Black males; anal squamous cell carcinoma in males was similar by race; and oropharyngeal squamous cell carcinoma was highest among White and Coloured individuals.
The incidence of non-cervical anogenital cancers is rapidly increasing in South Africa. The incidence of most HPV-related cancers is high among Black individuals, especially for cervical and vulvar cancers, potentially due to disproportionately high HPV-HIV co-infection prevalence among young Black females. HIV prevention and continued HPV vaccination efforts are crucial for reducing HPV-driven cancers in the future.
South African National Health Laboratory Services and US National Cancer Institute Intramural Research Program.
了解南非人乳头瘤病毒（HPV）相关癌症的流行病学情况对于在这个高负担国家开展癌症预防工作至关重要。我们旨在描述2011年至2021年间南非HPV相关癌症的发病率。
在这项横断面研究中，我们从南非国家癌症登记处获取了癌症发病率数据，并从南非统计局获取了人口估计数。我们按性别、年份、年龄和种族计算了15岁及以上人群中子宫颈癌、外阴癌、阴道癌、阴茎癌、口咽癌和肛门鳞状细胞癌每10万人年的年龄标准化发病率。使用Joinpoint回归程序计算平均年度百分比变化（AAPC）。
在2011年1月1日至2021年12月31日期间，子宫颈癌的总体发病率为每10万人年30.4例（95%CI 30.2至30.6），在55-64岁女性中最高（每10万人年58.5例[57.5至59.5]）；2011年至2016年发病率稳定，2016年开始下降（AAPC -2.7%[95%CI -10.8至-0.2]）。2011年至2021年间，外阴鳞状细胞癌（每10万人年2.3例[2.2至2.4]）、阴道鳞状细胞癌（每10万人年0.7例[0.7至0.7]）和女性肛门鳞状细胞癌（每10万人年0.6例[0.6至0.7]）的发病率有所上升（外阴鳞状细胞癌的AAPC为8.0%[95%CI 5.3至13.9]；阴道鳞状细胞癌为3.2%[0.5至6.6]；肛门鳞状细胞癌为8.5%[2.0至23.2]）。2011年至2021年间，15-44岁女性（AAPC 10.0%[8.2至13.4]）和45-54岁女性（AAPC 10.7%[8.2至14.1]）的外阴鳞状细胞癌增幅最大。2011年至2021年间，阴茎鳞状细胞癌（每10000人年1.4例[1.3至1.4]）和男性肛门鳞状细胞癌（每10万人年0.4例[0.4至0.5]）的发病率有所上升（阴茎鳞状细胞癌的AAPC为6.9%[3.8至10.7]；肛门鳞状细胞癌为9.3%[6.7至12.7]）。男女口咽鳞状细胞癌的发病趋势均稳定。子宫颈癌、外阴鳞状细胞癌和阴道鳞状细胞癌的发病率在黑人女性中最高；阴茎鳞状细胞癌在黑人男性中最高；男性肛门鳞状细胞癌的发病率在不同种族间相似；口咽鳞状细胞癌在白人和有色人种中最高。
南非非子宫颈肛门生殖器癌症的发病率正在迅速上升。大多数HPV相关癌症在黑人个体中的发病率较高，尤其是宫颈癌和外阴癌，这可能是由于年轻黑人女性中HPV-HIV合并感染率过高。预防艾滋病毒和持续开展HPV疫苗接种工作对于未来减少HPV驱动的癌症至关重要。
南非国家卫生实验室服务局和美国国立癌症研究所内部研究项目。
