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Vaccine. 2013 Dec 31;31 Suppl 7:H1-31. doi: 10.1016/j.vaccine.2013.10.003.

Comprehensive control of human papillomavirus infections and related diseases.

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Cancer Epidemiology Research Program (CERP), Institut Català d'Oncologia - Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain. Electronic address:
University of Alabama at Birmingham, Biochemistry and Molecular Genetics, Birmingham, Alabama, USA.
Section of Cancer Information, International Agency for Research on Cancer, Lyon, France.
Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
Viral Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Division of Virology, National Institute for Medical Research, London, UK.
Paterson Institute for Cancer Research, University of Manchester, Manchester, UK.
Department of Pathology, Tennis Court Road, Cambridge, UK.
Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium; Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium.
Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Global Cancer Initiative, Chestertown, MD, USA.
Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Department of Psychology and Department of Obstetrics and Gynaecology, University of Western Ontario, Social Sciences Centre 7428, London, Ontario, Canada.
Lowy Cancer Research Centre, Prince of Wales Clinical School, The University of NSW, Australia and Cancer Epidemiology Research Unit, Cancer Council NSW, Sydney, Australia (past affiliation).
Department Obstetrics and Gynaecology and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa.
Division of Cancer Epidemiology, McGill University, Montreal, Canada.
Institut National de Santé Publique du Québec, Montréal, Québec, Canada.
Consultant on Immunization Policy, Mercer Island, WA, USA.
National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA.
Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.
Screening Group, International Agency for Research on Cancer, Lyon, France.
Cancer Epidemiology Research Program (CERP), Institut Català d'Oncologia - Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
Cancer Epidemiology Research Program (CERP), Institut Català d'Oncologia - Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain.


Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread-optimally universal-implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph 'Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters.


Anal cancer; Cervical cancer; HPV; HPV testing; HPV vaccination; Oropharyngeal cancer; Penile cancer; Prevention; Screening; Vaginal cancer; Vulvar cancer

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