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J Low Genit Tract Dis. 2013 Oct;17(4):397-403. doi: 10.1097/LGT.0b013e31827ed372.

Human papillomavirus prevalence in invasive anal cancers in the United States before vaccine introduction.

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1Chronic Viral Diseases Branch, Centers for Disease Control and Prevention, Atlanta GA; 2University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI; 3Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA; 4Michigan Cancer Surveillance Program, Michigan Department of Community Health, Lansing, MI; 5Department of Epidemiology, University of Kentucky, Lexington, KY; 6Los Angeles Cancer Registry, Los Angeles, CA; 7Florida Department of Health, Tallahassee, FL; 8Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA; 9Department of Epidemiology, University of Iowa, Iowa City, IA; 10College of Medicine, University of Florida, Gainesville, FL; 11Battelle Memorial Institute, Durham, NC; and 12Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta GA.



This study aimed to conduct a representative survey of human papillomavirus (HPV) prevalence and its genotype distribution in invasive anal cancer specimens in the United States.


Population-based archival anal cancer specimens were identified from Florida, Kentucky, Louisiana, and Michigan cancer registries and Surveillance, Epidemiology, and End Results (SEER) tissue repositories in Hawaii, Iowa, and Los Angeles. Sections from 1 representative block per case were used for DNA extraction. All extracts were assayed first by linear array and retested with INNO-LiPA if inadequate or HPV negative.


Among 146 unique invasive anal cancer cases, 93 (63.7%) were from women, and 53 (36.3%) were from men. Human papillomavirus (any type) was detected in 133 cases (91.1%) and 129 (88.4%) contained at least 1 high risk-type, most (80.1%) as a single genotype. Human papillomavirus type 16 had the highest prevalence (113 cases, 77.4%); HPV types 6, 11, 18, and 33 were also found multiple times. Among HPV-16-positive cases, 37% were identified as prototype variant Ep, and 63% were nonprototypes: 33% Em, 12% E-G131G, 5% Af1, 4% AA/NA-1, 3% E-C109G, 3% E-G131T, 2% As, and 1% Af2. No significant differences in the distributions of HPV (any), high-risk types, or HPV-16/18 were seen between sex, race, or age group.


The establishment of prevaccine HPV prevalence in the United States is critical to the surveillance of vaccine efficacy. Almost 80% of anal cancers were positive for the vaccine types HPV-16 or HPV-18, and in 70%, these were the only types detected, suggesting that a high proportion might be preventable by current vaccines.

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