Long-term incidence trends of HPV-related cancers, and cases preventable by HPV vaccination: a registry-based study in Norway

BMJ Open. 2018 Feb 23;8(2):e019005. doi: 10.1136/bmjopen-2017-019005.


Objectives: Examine long-term incidence trends of human papillomavirus (HPV)-related cancer in Norway, and estimate the number of cancer cases preventable by vaccines against HPV 16/18 or HPV 16/18/31/33/45/52/58.

Design: Observational registry-based study. We extracted incident cases of HPV-related cancer during 1953-2015 from the Cancer Registry of Norway. Tumour HPV prevalence estimates from large international meta-analyses or from Norway were used to estimate the protective potential of HPV vaccines.

Participants and setting: The Norwegian population.

Primary outcome measures: Incidence trend analyses during 1953-2015 for squamous cell carcinoma (SCC) of the cervix, vulva, vagina, oropharynx, anus and penis, and adenocarcinoma of the cervix. Additionally, the number of cancer cases preventable by HPV vaccination.

Results: Among women, incidences of SCC of the anus, oropharynx, vulva and cervical adenocarcinoma increased, while vaginal SCC showed no trend. For these cancers combined, the average annual percentage change (AAPC) during 1953-2015 was 1.2 (95% CI 0.7 to 1.6). The incidence of cervical SCC generally decreased during 1976-2004 and remained stable thereafter. Among men, incidences of SCC of the anus, oropharynx and penis increased. The AAPC during 1953-2015 combined for all male HPV-related cancer was 1.9 (95% CI 1.3 to 2.5). A vaccine against HPV 16/18 might yearly prevent 402 (95% CI 382 to 420) cancers. A vaccine against HPV 16/18/31/33/45/52/58 might yearly prevent 478 (95% CI 464 to 490) cancers, of which 206 (95% CI 202 to 209) occur in non-cervical organs, and 113 (95% CI 110 to 115) occur among men.

Conclusions: The incidences of HPV-related cancers that are not effectively prevented by screening have generally increased during 1953-2015. HPV vaccination can prevent a substantial number of cancers in Norway, in cervical and non-cervical organs, among women and men.

Keywords: epidemiology; preventive medicine; public health.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Squamous Cell / epidemiology*
  • Carcinoma, Squamous Cell / prevention & control
  • Carcinoma, Squamous Cell / virology
  • Female
  • Humans
  • Incidence
  • Linear Models
  • Male
  • Middle Aged
  • Neoplasms / epidemiology*
  • Neoplasms / prevention & control
  • Neoplasms / virology
  • Norway / epidemiology
  • Papillomaviridae / classification
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Vaccines / therapeutic use
  • Registries
  • Tumor Virus Infections / prevention & control*


  • Papillomavirus Vaccines