The study drew on two administrative databases maintained by Ecuador's National Institute of Statistics and Censuses: the registry of hospital beds and discharges, which captures admissions reported by public and private facilities nationwide, and the registry of general deaths, part of the country's civil registration and vital statistics system. The researchers deliberately restricted the analysis to the years 2015 through 2019 to establish a pre-pandemic baseline, since the COVID-19 pandemic disrupted healthcare utilization, diagnostic activity, and death registration in ways that could distort comparisons with later years. Hospitalizations were identified using International Classification of Diseases codes for anal, penile, oral cavity, oropharyngeal, and laryngeal cancers recorded as the principal discharge diagnosis, while deaths were identified using the same cancer sites as the underlying cause of death.

The numbers reveal a burden concentrated in cancers of the head and neck. These cancers, which combine the oral cavity, oropharynx, and larynx into a single category, accounted for 66.4 percent of all HPV-associated cancer hospitalizations among men, followed by penile cancer at 24.0 percent and anal cancer at 9.6 percent. Within the head and neck group, laryngeal cancer alone drove 44.3 percent of admissions, with oropharyngeal cancer contributing 36.6 percent and oral cavity cancer 19.2 percent.

Averaged over the five-year window, the tally amounts to roughly 688 hospitalizations per year. The overall crude hospitalization rate was 8.2 per 100,000 men, rising to an age-standardized rate of 9.7 per 100,000 when adjusted to the World Health Organization's World Standard Population, a statistical reference that allows fair comparison across countries with different age structures. Age emerged as a defining feature of the burden.

Men aged 60 and older accounted for 54.3 percent of all hospitalizations and recorded an age-specific rate of 47.6 per 100,000 men, more than five times the rate of 9.5 seen among men aged 30 to 59. The skew toward older ages was most pronounced for laryngeal cancer, with 69.4 percent of those admissions occurring in the oldest group, and for oral cavity cancer at 63.0 percent. Yet the pattern was far from uniform across cancer types.

More than half of hospitalizations for oropharyngeal, penile, and anal cancers occurred in men younger than 60, and admissions among men under 30 made up 6.9 percent of the overall total, with the youngest group representing a disproportionate 14.3 percent of anal cancer and 13.2 percent of oral cavity cancer hospitalizations. Mortality followed a similar but steeper age gradient. Of the 575 deaths recorded over the study period, an average of about 115 per year, 72.7 percent occurred among men aged 60 and older, where the age-specific mortality rate reached 10.7 per 100,000 men.

Head and neck cancers dominated the death toll at 71.1 percent of deaths, again led by laryngeal cancer, which alone accounted for 63.6 percent of deaths within that category. The crude mortality rate was 1.4 per 100,000 men, with an age-standardized rate of 1.7. Even so, the researchers documented a meaningful toll among younger men: 37.2 percent of oropharyngeal cancer deaths and 34.3 percent of penile cancer deaths occurred before age 60, and 2.1 percent of all deaths were recorded in men under 30.

Taken together, roughly one-third of deaths from oropharyngeal, penile, and anal cancers struck men still in the prime of working life. To separate the share of disease truly driven by the virus, the team applied site-specific attributable fractions drawn from published studies, prioritizing estimates derived from Latin American tumor samples where available. These fractions reflect the proportion of cancers at each site that molecular studies have found to contain HPV DNA or its surrogate markers.

Anal cancer was assigned a fraction of 100 percent, penile cancer 51 percent, oropharyngeal cancer 21.2 percent, oral cavity cancer 6.3 percent, and laryngeal cancer 4.5 percent. Applying these figures, the researchers estimated that 1,002 hospitalizations, or 29.1 percent of the total, and 134 deaths, or 23.3 percent, were attributable to HPV. The resulting age-standardized rates were 2.8 hospitalizations and 0.4 deaths per 100,000 men.

This attribution exercise reshuffled the hierarchy of burden. While head and neck cancers dominated the raw counts, penile cancer emerged as the leading contributor to the estimated HPV-attributable toll, accounting for 42.1 percent of attributable hospitalizations and 50.7 percent of attributable deaths. Anal cancer contributed 32.8 percent of attributable hospitalizations and 23.9 percent of attributable deaths, while head and neck cancers accounted for the remaining 25.0 percent and 25.4 percent respectively.

Within the head and neck category, oropharyngeal cancer represented 70.5 percent of estimated virus-attributable admissions. The pattern reflects the multifactorial nature of head and neck cancers, in which tobacco and alcohol remain dominant causes at many sites, whereas anal and penile cancers are far more tightly linked to HPV. The Ecuadorian figures also invite regional comparison.

The country's age-standardized hospitalization rate for HPV-associated cancers, 9.7 per 100,000 men, exceeded the rates reported for Peru at 1.6 and Mexico at 7.8, but fell below Brazil's 24.5. For penile cancer specifically, Ecuador's age-standardized hospitalization rate of 2.3 per 100,000 men surpassed Peru's 0.7, Mexico's 1.7, and Brazil's 2.0, a disparity the authors note is consistent with evidence that penile cancer disproportionately affects populations facing socioeconomic disadvantage, limited sanitation access, and lower circumcision rates, with delayed care-seeking averaging around 19 months in the region. Anal cancer showed a comparatively young age profile in Ecuador, with 57.8 percent of hospitalizations occurring before age 60, and the national average likely understates the risk in high-risk groups, given reported anal cancer incidence reaching 59.1 per 100,000 person-years among men who have sex with men living with HIV elsewhere in Latin America.

The authors are careful to spell out the limitations inherent in their data. Hospitalization records count discharge events rather than unique individuals, so repeated admissions for the same patient could not be linked and the figures should be read as measures of healthcare utilization rather than of new cancer cases. Mortality estimates depend on the completeness and accuracy of cause-of-death reporting, which previous assessments have shown varies geographically within Ecuador.

The absence of outpatient data means the true burden is almost certainly higher; a Peruvian study found outpatient consultations exceeded hospitalizations more than fivefold. The attributable fractions were also applied uniformly across ages and calendar years because finer-grained estimates were unavailable, making the HPV-attributable figures modeled estimates rather than direct measurements of tumor virology. Despite these caveats, the study establishes a national baseline at a strategically useful time.

Because the study period predates routine HPV vaccination of boys in Ecuador, future changes in hospitalization and mortality can be assessed against these figures. The country's 2024 decision to vaccinate nine-year-old boys aligns with Pan American Health Organization recommendations to close coverage gaps and consider immunizing both sexes, and its population impact will hinge on achieving high and equitable coverage, including catch-up strategies for unvaccinated individuals. Previous research in Ecuador has identified limited awareness of the link between HPV and cancer in men, alongside informational and health-system barriers to vaccination.

Given the long natural history of HPV-driven carcinogenesis, the current cancer burden largely reflects infections acquired before vaccines existed, meaning prevention must be paired with earlier diagnosis, timely treatment, and equitable access to oncologic care for the generation of men already affected.

Subject of Research: Hospitalization and mortality burden of HPV-associated cancers among men in Ecuador

Article Title: Hospitalization and mortality burden of human papillomavirus-associated cancers among men in Ecuador: a nationwide population-based study

Article References: Sánchez, X., Jimbo-Sotomayor, R., Silva, Z. M. D., Pungartnik, P. C., Orengo, J. C., & Parellada, C. I. (2026). Hospitalization and mortality burden of human papillomavirus-associated cancers among men in Ecuador: a nationwide population-based study. Frontiers in Public Health, 14, 1980521. https://doi.org/10.3389/fpubh.2026.1980521

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1980521

Keywords: HPV, Ecuador, cancer burden, hospitalizations, mortality, penile cancer, head and neck cancer, anal cancer, HPV vaccination, population-based study, Latin America, public health