Increased risk of second cancers at sites associated with HPV after a prior HPV-associated malignancy, a systematic review and meta-analysis

Abstract

Background High-risk human papilloma viruses (HPV) are a causative agent of anogenital and oropharyngeal cancers. Patients treated for a preinvasive or invasive HPV-associated cancer may be at increased risk of a second such malignancy. Methods We performed a systematic review and random effects meta-analysis to estimate the risk of HPV-associated cancer after prior diagnosis. Studies reporting second cancers at anogenital and oropharyngeal sites after prior diagnoses (preinvasive/invasive HPV-associated cancer) were identified. Studies reporting standardised incidence ratios (SIRs) were included in formal meta-analyses of second cancer risk. (PROSPERO ID: CRD42016046974). Results Searches returned 5599 titles, including 60 unique, eligible studies. Thirty-two (98 comparisons) presented SIRs for second cervical, anal, vulvo-vaginal, penile, and/or oropharyngeal cancers, included in the meta-analyses. All studies (and 95/98 comparisons) reported increased cancers in the population with previous HPV-associated cancer when compared to controls. Pooled SIRs for second primary cancers ranged from 1.75 (95% CI 0.66−4.67) for cervical cancer after primary anal cancer, to 13.69 (95% CI 8.56−21.89) for anal cancer after primary vulvo-vaginal cancer. Conclusions We have quantified the increased risk of second HPV-associated cancer following diagnosis and treatment for initial cancer or preinvasive disease. This has important implications for follow-up, screening, and future therapeutic trials.

A meta‐analysis of anal cancer incidence by risk group: Toward a unified anal cancer risk scale

“…Elevated SIR for anal cancer following cervical or vulvo-vaginal cancer are well established. 10 However, the current work highlights some substantial differences between these gynecological cancers.…”

“…Thus, there exist a number of groups at known elevated anal cancer risk. These include men who have sex with men (MSM), 8 persons living with HIV (PLHIV), 9 women with HPV‐related gynecological cancer or precancerous lesions, 10 as well as iatrogenically immunosuppressed recipients, most notably solid organ transplant recipients (SOTRs) 11 …”

“…These include men who have sex with men (MSM), 8 persons living with HIV (PLHIV), 9 women with HPV-related gynecological cancer or precancerous lesions, 10 as well as iatrogenically immunosuppressed recipients, most notably solid organ transplant recipients (SOTRs). 11 Anal cancer risks are often articulated as standardized incidence ratios (SIRs), comparing observed anal cancers with those expected among the general population of similar age, gender and/or time period.…”

Young Women and Oral Human Papillomavirus—Vaccination Is Associated With Protection

“…It is also important to understand whether HPV infections in 1 anatomic site can be associated with infection at other sites. Other studies [6][7][8] have shown these links between cervical and anal infections and disease, and now the study by Schlecht et al 1 associates cervical HPV detection with oral HPV detection, although not yet with disease.…”

Comment on “Increased risk of second cancers at sites associated with HPV after a prior HPV-associated malignancy, a systematic review and meta-analysis”

“…The systematic review and meta-analysis study "Increased risk of second cancers at sites associated with HPV after a prior HPVassociated malignancy, a systematic review and meta-analysis", presented by Gilbert et al and published in BJC, has been read by us with interest. 1 Our meta-analysis research team would like to bring into attention a few valid improvements to the paper. Therefore, this study may serve a better position as a citable article.…”