Trends in HPV-Attributable Cancers in Norway: Beyond Cervical Cancer

Overview

This study analyzed HPV-attributable cancer incidence in Norway from 1990 to 2023, revealing a decline in cervical squamous cell carcinoma (SCC) incidence since 2018, while HPV-related cancers not prevented by screening, especially oropharyngeal SCC in men, have increased. Forecasts suggest these rising trends will continue through 2038, highlighting a shifting burden of HPV-associated cancers.

Background

Human papillomavirus (HPV) is a common sexually transmitted infection linked to multiple cancers, most notably cervical cancer (CC). Norway has implemented organized cervical screening since 1995 and introduced HPV vaccination for girls in 2009 and boys in 2018. While cervical cancer incidence has been impacted by screening and vaccination, other HPV-related cancers lack early detection programs and have shown increasing incidence trends, particularly in high-income countries like Norway.

Data Highlights

Key Findings

• Incidence of HPV-attributable oropharyngeal squamous cell carcinoma in men increased significantly with an annual percentage change of 4.5% (P < .01).
• Overall incidence of HPV-related cancers not prevented by cervical screening rose steadily at 2.8% annually (P < .01), surpassing cervical cancer incidence.
• Cervical squamous cell carcinoma incidence in women decreased by 6% annually from 2018 to 2023 (95% CI, −9.9 to −1.9; P < .01), reflecting screening and vaccination impact.
• HPV vaccination was introduced nationally for girls in 2009 and boys in 2018, with a catch-up campaign for girls aged 19–26 between 2016–2019; no catch-up program exists for men.
• No early detection or treatment programs currently exist for noncervical HPV-related precancers or cancers in Norway.

Clinical Implications

The rising incidence of HPV-attributable cancers beyond cervical cancer, particularly oropharyngeal cancers in men, underscores the need for expanded preventive strategies including vaccination coverage and possibly screening innovations. Continued cervical screening and HPV vaccination remain critical to sustain the decline in cervical cancer incidence. Clinicians should be aware of the shifting epidemiology of HPV-related cancers to guide patient counseling and public health efforts.

Conclusion

While cervical cancer incidence is declining in Norway due to effective screening and vaccination, the overall burden of HPV-attributable cancers is increasing, driven by noncervical sites. Addressing this evolving landscape requires additional preventive measures beyond current cervical cancer programs.

References

1. Cancer Registry of Norway/2024 -- Exploring Trends in HPV-Associated Cancers in Norway