HPV-Related Cancer Trends in South Africa 2011-2021

This overview summarizes a study that analyzed data from the South African National Cancer Registry from 2011 to 2021. It focused on HPV-related cancer trends among adults aged 15 and older. Cervical cancer remained highly prevalent and stable until 2016. After that, incidence began to decline. Most other anogenital cancers (vulvar, vaginal, penile, and anal squamous cell carcinoma) showed significant annual increases. These increases were particularly high among younger Black individuals. Oropharyngeal squamous cell carcinoma incidence was stable. HPV-unrelated oral cancers among men declined due to tobacco control laws.

Key Insights

• Cervical cancer was most prevalent (30.4 per 100,000 person-years). It was highest among women aged 55–64 (58.5 per 100,000) and Black women. However, it began declining after 2016.
• Non-cervical anogenital cancers increased rapidly (up to 10% annually). Vulvar and anal squamous cell carcinoma saw the highest rises. Young and middle-aged Black women were most affected.
• Racial differences were prominent. Black individuals had the highest incidence of most HPV-related cancers. Exceptions were oropharyngeal and some anal cancers, which were higher among White and mixed-race individuals.
• HIV-HPV coinfection and structural inequalities likely drove these trends. Young Black women were disproportionately affected by both infections.
• HPV vaccination impact may be delayed. Cancer rates may not drop until vaccinated cohorts reach middle age.

Background Context

South Africa has one of the highest HPV and HIV burdens globally. Cervical cancer is the second most common cancer and leading cause of cancer mortality among women. HPV prevalence among South African women ranges widely (18–75%). It is influenced by age, province, and HIV status. HIV infection raises the risk of persistent HPV infection and progression to cancer. The WHO and IARC note that HPV types 16 and 18 cause about 70% of cervical cancers worldwide. HPV is also linked to other anogenital and head/neck cancers. HPV vaccination and screening programs face implementation challenges, especially in rural and low-income areas. For more insights, refer to the original article.

Understanding the HPV-related Cancer Trends

The reported HPV-related cancer trends in South Africa from 2011 to 2021 highlights a significant rise in anogenital cancers (vulvar, vaginal, anal, and penile) with annual increases of 3.2% to 9.3%, while cervical cancer incidence remained stable but began declining in 2016. Black females, especially younger ones, face the highest burden of cervical and vulvar cancers due to high HPV-HIV co-infection rates, rooted in systemic inequities, limited healthcare access, and sociocultural factors. Penile and vaginal cancer trends have shifted from declines or stability to increases, possibly due to better (mandatory) case reporting after 2011. Despite free cervical cancer screening, barriers like low uptake (56% in 2020), lack of follow-up, and long wait times persist, necessitating same-day screening and treatment solutions. HPV vaccination, introduced in 2014, has faced challenges from pandemic disruptions and supply shortages, but a new single-dose program aims to improve coverage. Declines in HPV-unrelated oral cancers among males reflect effective tobacco control, though smoking remains a concern. The study calls for strengthened cervical cancer prevention, decentralized cancer care, and targeted HIV prevention to reduce disparities, particularly among Black South Africans.

Implications for Health Economics and Outcomes Research

• Prevention and Screening: High and rising HPV-related cancer rates call for stronger, equitable prevention. This includes HPV vaccination, screening, and timely treatment of precancerous lesions.
• Health System Strengthening: Decentralizing cancer care and improving access in rural and low-income areas is critical.
• Integration of Services: Combining HPV-related cancer prevention with sexual and reproductive health services could improve coverage. Home-based self-sampling may also help.
• Economic Impact: Rising non-cervical anogenital cancers will likely increase demand for cancer care. Sustained investment in prevention and early detection is needed.
• Policy Adaptation: Single-dose HPV vaccination may boost coverage and cost-effectiveness. Continued monitoring and public education are essential to address barriers.
• Research Needs: More studies linking cancer registry data to HIV and treatment status are needed. This will clarify HIV and antiretroviral therapy’s roles in HPV-related cancer trends.

The findings show progress in cervical cancer control. However, South Africa faces growing challenges from other HPV-related cancers. These are driven by viral, immunological, and social factors. Addressing them requires comprehensive, integrated, and equity-focused public health strategies.