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Date of this Version



CANCER Supplement November 15, 2008, Volume 113, Number 10; DOI 10.1002/cncr.23753


This supplement, known as the ABHACUS (Assessing the Burden of HPV-Associated Cancers in the United States) supplement, contains 22 articles. Together, these articles provide a comprehensive snapshot of data related to the occurrence and control of multiple cancers that have been associated with the human papillomavirus (HPV). These analyses highlight the burden of HPV associated cancers in the US population as a whole and among vulnerable population subgroups. We anticipate that these findings will be an important resource for enhancing existing strategies for the prevention and control of HPV associated cancers.

HPV is estimated to be responsible for 5.2% of the cancers diagnosed worldwide.1 Virtually 100% of cervical cancers are causally associated with HPV, and there is increasing evidence of the role that HPV plays in other anogenital cancers and oropharyngeal cancers. With the recent approval and recommendation of an HPV vaccine that contains HPV–16 and HPV–18, interest in quantifying the spectrum and burden of cancers is heightened. The International Agency for Research on Cancer (IARC) has determined that there is sufficient evidence for the carcinogenicity of HPV–16 in the cervix, vulva, vagina, penis, anus, oral cavity, and oropharynx.2 The IARC has found sufficient evidence of the role HPV–18 plays in cervical cancer, with limited or no evidence in other sites. Together, cervical cancer combined with the other HPV-associated cancers potentially afflicts an additional 25,000 persons every year in the US.

Worldwide and in the US, the excitement and concern surrounding the HPV vaccine has been profound. The excitement derives from the potential of the vaccine to reduce the burden of cervical cancer in countries that have no screening infrastructure as well as in countries such as the US, in which nearly 11,000 women each year are told they have invasive cervical cancer and 4000 die from this disease, despite the availability of screening. The HPV vaccine also has the potential to impact a significant proportion of other cancers for which there typically is no routine screening. Conversely, the concern is that vaccine recipients may not continue to undergo screening for cervical cancer. Yet another concern is that if vaccine uptake is lower in those groups at highest risk of developing cervical cancer, current racial/ethnic or geographic disparities could increase. We hope that the articles in this supplement will highlight the burden and disparities associated with these cancers before vaccine implementation.

This supplement includes an in-depth analysis of cancer incidence and mortality data from population- based central cancer registries that house highquality data. Fourteen articles are based mainly on cancer occurrence, using incidence data from population- based central cancer registries that participate in the Centers for Disease Control and Prevention (CDC)’s National Program of Cancer Registries (NPCR) and/or the National Cancer Institute (NCI)’s Surveillance, Epidemiology, and End Results (SEER) program. The NPCR program, which was established through the Cancer Registries Amendment Act passed by the US Congress in 1992, began providing financial support and technical assistance to population- based central cancer registries in 1994. This program currently supports central registries in 45 states, the District of Columbia, and 3 US territories; these registries cover approximately 96% of the US population. The SEER program, which was established as a result of the National Cancer Act of 1971, currently supports 14 such registries and 3 supplemental registries, covering approximately 26% of the US population. The population-based central cancer registries collect information on all reportable cancer cases within a state or another defined geographic area. Today, the NPCR and SEER programs together cover 100% of the US population, and data regarding more than 1 million new invasive cancer cases are added each year. Medical records are the primary source of the data. Both the NPCR and SEER data are collected and reported with the use of uniform data items and codes, as documented by the North American Association of Central Cancer Registries.3 The Institute of Medicine has recognized the importance of these 2 programs as valuable resources for studies on cancer.4

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