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Eight HPV types responsible for most cervical cancers worldwide
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Out of 118 known HPV types, almost all cervical cancer worldwide can be attributed to eight types, according to the results of a recent study, and the researchers said priority should be given to those types when assessing vaccines.
HPV types 16, 18 and 45 should be the focus of type-specific high-risk HPV-DNA-based screening tests and protocols, they added.
“Our results show which HPV types should be given priority when the cross-protective effects of current vaccines are assessed, and are useful for the formulation of recommendations about the use of second-generation polyvalent HPV vaccines,” Silvia de Sanjose, MD, and colleagues wrote. “These findings suggest that type-specific high risk HPV-DNA-based screening tests and protocols should focus on HPV types 16, 18 and 45.”
Researchers performed a retrospective cross-sectional study on paraffin-embedded specimens from patients with cervical cancer to estimate the prevalence of HPV DNA types in women diagnosed with invasive cervical cancer from 1949 to 2009. Samples of 10,575 cases of invasive cervical cancer from patients aged from 16 to 97 years in 38 countries were included in the study.
Sanjose and colleagues determined that all HPVs identified according to the regions of the world belong to nine of 15 species within the alpha-papillomavirus genus, and the most common types were 16, 18, 45, 33, 31, 52, 58 and 35 in descending order of prevalence.
Those eight types were responsible for 91% of all cervical cancers.
Types 16, 18 and 45 were the three most common types in each histological group — squamous cell carcinoma, adenocarcinoma and adenosquamous cell carcinoma. Those three types accounted for 75% of squamous cell carcinomas and 94% of adenocarcinomas.
Together, types 18 and 45 were significantly more common in cases of adenocarcinoma than in cases of squamous cell carcinoma, 44% vs. 14%.
Researchers detected HPV DNA in 81% of adenosquamous cell carcinomas and 72% of histologically rare cases of invasive cervical cancer. The most common types were again 16, 18 and 45.
Women with invasive cervical cancers associated with HPV 16, 18 or 45 were much younger than women with cancers caused by other HPV types. The mean age for women with cancer related to HPV 16 was 50 years compared with 48.2 years for HPV 18, and 46.8 years for HPV 45. The mean age for women with cancers caused by any other HPV type was 55.5 years.
These data are extremely important as they reveal that future HPV vaccine development should focus on fewer than 10 HPV types which are responsible for approximately 90% of cases of invasive cervical cancer. Such an effort will substantially expand the current HPV vaccine approach which is restricted to HPV 16 and 18, estimated to account for 70% of such cancers.
– Maurie Markman, MD
HemOnc Today Editorial Board member
For more information:
- Sanjose S. Lancet Oncology. 2010;doi:10.1016/S1470-2045(10)70230-8.