The study examined cervical cancer, HPV-associated cancers outside the cervix in females, and HPV-associated cancers in males. For females, researchers characterized relative burden patterns using country-specific ratios of age-standardised incidence rates and a quartile-based classification. They also evaluated associations between incidence rates and the Human Development Index, using data for 2022 to compare the geographic distribution of these cancers.

In 24 countries and territories, the age-standardised incidence rate of female non-cervical HPV-associated cancers exceeded that of cervical cancer. The analysis found contrasting development gradients: cervical cancer incidence was inversely associated with HDI, whereas female non-cervical and male HPV-associated cancer incidence showed positive associations with HDI. The relationships for cervical cancer and female non-cervical HPV-associated cancers were nonlinear, indicating that the association between national development and incidence was not uniform across all development levels.

Historical data from Cancer Incidence in Five Continents Plus were used to examine changes in 40 countries between 1998 and 2017. Joinpoint regression showed that cervical cancer age-standardised incidence decreased in 23 of the 40 countries. By contrast, incidence increased in 23 countries for female non-cervical HPV-associated cancers and in 13 countries for male HPV-associated cancers. These temporal results describe the study population of countries with available data, rather than every country worldwide.

The analysis also tested whether the time elapsed since HPV vaccine introduction into national immunisation programmes was associated with incidence rates in 2022. An inverse association was observed between years since vaccine introduction and cervical cancer incidence. That association was no longer statistically significant after adjustment for cervical screening coverage, with an adjusted coefficient of β = −0.19 and P = 0.537.

The positive association between years since HPV vaccine introduction and female non-cervical HPV-associated cancer incidence was attenuated after adjustment for HDI, but remained statistically significant, with β = 0.11 and P = 0.022. These analyses were ecological, so the results identify population-level associations between vaccination timing and incidence rather than demonstrating a causal effect of vaccination on an individual or establishing benefits from the vaccine itself.

Taken together, the findings show that the global burden of HPV-associated cancer does not follow one geographic pattern. Cervical cancer remained a major burden in low-HDI countries, while non-cervical HPV-associated cancers were increasingly prominent in many higher-HDI settings. The historical analysis also documented declines in cervical cancer in most of the 40 countries with usable time-series data, alongside increases in female non-cervical HPV-associated cancers in the same number of countries and male HPV-associated cancers in 13.

The authors concluded that future strategies should be tailored to local epidemiological contexts, with gender-neutral HPV vaccination considered where appropriate alongside integrated management of shared behavioural risk factors. Their conclusions are based on modelled global estimates for 2022, historical incidence data from a limited group of countries, and observational associations. As a result, the study supports context-specific planning rather than a single universal interpretation of HPV-associated cancer trends.

Subject of Research: Global epidemiology of cervical and non-cervical HPV-associated cancers

Article Title: The global landscape of HPV-associated cancers beyond the cervix: a comparative epidemiological analysis

Article References: Zhong, P., Zhang, X., Hu, S., Zhao, X., Xia, C., Yang, H., Stafford, R. S., Zhao, F., & Zhang, L. (2026). The global landscape of HPV-associated cancers beyond the cervix: a comparative epidemiological analysis. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14563-1

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14563-1

Keywords: HPV, cervical cancer, global epidemiology, cancer incidence, HPV vaccination, human development, cervical screening, anal cancer, oropharyngeal cancer, health inequality, global, landscape