Abstract
BackgroundData on the current burden of adenocarcinoma (ADC) and histology-specific human papillomavirus (HPV) type distribution are relevant to predict the future impact of prophylactic HPV vaccines.MethodsWe estimate the proportion of ADC in invasive cervical cancer, the global number of cases of cervical ADC in 2015, the effect of cervical screening on ADC, the number of ADC cases attributable to high-risk HPV types -16, -18, -45, -31 and -33, and the potential impact of HPV vaccination using a variety of data sources including: GLOBOCAN 2008, Cancer Incidence in Five Continents (CI5) Volume IX, cervical screening data from the World Health Organization/Institut Català d'Oncologia Information Centre on HPV and cervical cancer, and published literature.ResultsADC represents 9.4% of all ICC although its contribution varies greatly by country and region. The global crude incidence rate of cervical ADC in 2015 is estimated at 1.6 cases per 100,000 women, and the projected worldwide incidence of ADC in 2015 is 56,805 new cases. Current detection rates for HPV DNA in cervical ADC tend to range around 80–85%; the lower HPV detection rates in cervical ADC versus squamous cell carcinoma may be due to technical artefacts or to misdiagnosis of endometrial carcinoma as cervical ADC. Published data indicate that the five most common HPV types found in cervical ADC are HPV-16 (41.6%), -18 (38.7%), -45 (7.0%), -31 (2.2%) and -33 (2.1%), together comprising 92% of all HPV positive cases. Future projections using 2015 data, assuming 100% vaccine coverage and a true HPV causal relation of 100%, suggest that vaccines providing protection against HPV-16/18 may theoretically prevent 79% of new HPV-related ADC cases (44,702 cases annually) and vaccines additionally providing cross-protection against HPV-31/33/45 may prevent 89% of new HPV-related ADC cases (50,769 cases annually).ConclusionsIt is predicted that the currently available HPV vaccines will be highly effective in preventing HPV-related cervical ADC.
Highlights
Data on the current burden of adenocarcinoma (ADC) and histology-specific human papillomavirus (HPV) type distribution are relevant to predict the future impact of prophylactic HPV vaccines
The proportion of Invasive cervical cancer (ICC) cases that were histologically confirmed ADC cases was extracted from previously published registry-specific data from the International Agency for Research on Cancer (IARC) Cancer Incidence for Five Continents (CI5) volume IX [26]
Type distribution of HPV in ADC We summarized the global HPV type distribution in cervical ADC using data from two published sources [29,30]
Summary
Data on the current burden of adenocarcinoma (ADC) and histology-specific human papillomavirus (HPV) type distribution are relevant to predict the future impact of prophylactic HPV vaccines. Cervical cancer incidence and mortality has been reduced substantially in countries that have well-developed cervical screening programs [2]. This decline in incidence is mainly due to the increased. The natural history of cervical ADC is very different from that of SCC and this may explain the lower rates of detection of premalignancies during cytologic screening. The earliest precursor lesions of ADC are more difficult to define than those of SCC; lesions are more diverse, and invasive ADC is thought to develop from a small focus of adenocarcinoma in situ (AIS) [7,11,12]. As a result of these factors, ADC is often diagnosed at a more advanced disease stage than SCC, and is generally associated with a worse prognosis [14,15,16,17,18,19]
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