Human Papillomavirus and Related Diseases Report WORLD

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1 Human Papillomavirus and Related Diseases Report WORLD Version posted at on 27 July 2017

2 - ii - Copyright and Permissions ICO Information Centre on HPV and Cancer (HPV Information Centre), All rights reserved. HPV Information Centre publications can be obtained from the HPV Information Centre Secretariat, Institut Català d Oncologia, Avda. Gran Via de l Hospitalet, L Hospitalet del Llobregat (Barcelona), Spain. hpvcentre@iconcologia.net. Requests for permission to reproduce or translate HPV Information Centre publications - whether for sale or for noncommercial distribution- should be addressed to the HPV Information Centre Secretariat, at the above address. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part the HPV Information Centre concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended the HPV Information Centre in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the HPV Information Centre to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the HPV Information Centre be liable for damages arising from its use. The development of this report has been supported by grants from the European Comission (7th Framework Programme grant HEALTH-F , HEALTH-F , HPV AHEAD). Recommended citation: Bruni L, Barrionuevo-Rosas L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report 27 July [Date Accessed]

3 - iii - Abbreviations Abbreviation HPV PREHDICT Project Table 1: Abbreviations Full term Human papillomavirus Health economic modelling of prevention strategies for HPV-related diseases in European countries ICO Information Centre on HPV and Cervical Cancer Genital warts Recurrent respiratory papillomatosis Squamous intraepithelial lesions Low-grade cervical lesions High-grade cervical lesions Invasive cervical cancer Carcinoma in situ Cervical intraepithelial neoplasia HPV Information Centre GW RRP SIL LSIL HSIL ICC CIS CIN AIN2/3 Anal intraepithelial neoplasia of grade 2 and/or 3 VIN 2/3 Vulvar intraepithelial neoplasia of grade 2 and/or 3 VaIN 2/3 Vaginal intraepithelial neoplasia of grade 2 and/or 3 PeIN 2/3 Penile intraepithelial neoplasia of grade 2 and/or 3 95% CI 95% confidence interval N Number of cases tested HPV Prev HPV prevalence ASR Age-standardised rate MSM Men who have sex with men Non MSM Heterosexual men SCC Squamous cell carcinomas STI Sexually transmitted infections HIV/AIDS Human immunodeficiency virus/acquired immunodeficiency syndrome TS Type specific EIA Enzyme immunoassay RLBM Reverse line blotting method RFLP Restriction fragment length polymorphism RHA Reverse hybridisation assay RLH Reverse line hybridisation LiPA Line probe assay SBH Southern blot hybridisation ISH In situ hybridisation MABA Micro array-based assay LBA Line blot assay HC2 Hybrid Capture 2 SAT Suspension array technology PCR Polymerase chain reaction SPF Short primer fragment q-pcr Quantitative polymerase chain reaction RLBH Reverse line blot hybridisation RT-PCR Real-time polymerase chain reaction DBH Dot blot hybridisation HR High risk DSA Direct sequence analysis MAA Microchip array assay

4 - iv - Executive summary Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer and there is growing evidence of HPV being a relevant factor in other anogenital cancers (anus, vulva, vagina and penis) as well as head and neck cancers. HPV types 16 and 18 are responsible for about 70% of all cervical cancer cases worldwide. HPV vaccines that prevent HPV 16 and 18 infections are now available and have the potential to reduce the incidence of cervical and other anogenital cancers. This report provides key information for Less developed regions on: cervical cancer; other anogenital cancers and head and neck cancers; HPV-related statistics; factors contributing to cervical cancer; cervical cancer screening practises; HPV vaccine introduction; and other relevant immunization indicators. The report is intended to strengthen the guidance for health policy implementation of primary and secondary cervical cancer prevention strategies in the region. The World has a population of 2,784 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 527,624 women are diagnosed with cervical cancer and 265,672 die from the disease. Cervical cancer ranks* as the fourth most frequent cancer among women in the World. * Ranking of cervical cancer incidence to other cancers among all women according to highest incidence rates (ranking 1st). Ranking is based on crude incidence rates (actual number of cervical cancer cases). Ranking using age-standardized rate (ASR) may differ. Table 2: Key statistics Population World Less developed regions More developed regions Women at risk for cervical cancer (Female population aged >=15 yrs) in millions 2, , Burden of cervical cancer Annual number of new cervical cancer cases 527, ,546 83,078 Standardized incidence rates per 100,000 population Annual number of cervical cancer deaths 265, ,158 35,514 Standardized mortality rates per 100,000 population Burden of cervical HPV infection Prevalence (%) of HPV 16 and/or HPV 18 among women with: Normal cytology Low-grade cervical lesions (LSIL/CIN-1) High-grade cervical lesions (HSIL/ CIN-2 / CIN-3 / CIS) Cervical cancer Please see the specific sections for more information.

5 LIST OF CONTENTS - v - Contents Abbreviations Executive summary iii iv 1 Introduction 1 2 Demographic and socioeconomic factors 3 3 Burden of HPV related cancers Cervical cancer Incidence Mortality Comparison of incidence and mortality Anogenital cancers other than the cervix Anal cancer Vulvar cancer Vaginal cancer Penile cancer Head and neck cancers Pharyngeal cancer (excluding nasopharynx) HPV related statistics HPV burden in women with normal cervical cytology, cervical precancerous lesions or invasive cervical cancer HPV prevalence in women with normal cervical cytology HPV type distribution among women with normal cervical cytology, precancerous cervical lesions and cervical cancer Terminology HPV burden in anogenital cancers other than the cervix Anal cancer and precancerous anal lesions Vulvar cancer and precancerous vulvar lesions Vaginal cancer and precancerous vaginal lesions Penile cancer and precancerous penile lesions HPV burden in men HPV burden in the head and neck Burden of oral HPV infection in healthy population HPV burden in head and neck cancers Factors contributing to cervical cancer Sexual behaviour and reproductive health indicators HPV preventive strategies Cervical cancer screening practices HPV vaccination HPV vaccine licensure and introduction Protective factors for cervical cancer References Glossary 322

6 LIST OF FIGURES - vi - List of Figures 1 World geographical regions Population pyramids by World, developing and developed regions, estimates for Population trends in four selected age groups by World, developing and developed regions for Age-standardised incidence rates of cervical cancer in the World (estimates for 2012) Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in Africa (estimates for 2012) Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in the Americas (estimates for 2012) Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in Asia (estimates for 2012) Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in Europe (estimates for 2012) Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in Oceania (estimates for 2012) Ranking of cervical cancer versus other cancers among all women and women aged years, according to incidence rates in the World (estimates for 2012) World age-standardised incidence rates by World and sub regions (estimates for 2012) Comparison of the ten most frequent cancers in all women by World, developing and developed regions (estimates for 2012) Comparison of the ten most frequent cancers in all women by World and continents (estimates for 2012) Comparison of the ten most frequent cancers in women aged years by World developing and developed regions (estimates for 2012) Comparison of the ten most frequent cancers in women aged years by World and continents (estimates for 2012) Age-specific incidence of cervical cancer by World, developing and developed regions and five continents Annual number of new cases of cervical cancer by age group in developing and developed regions and five continents World (estimates for 2012) Annual number of cases and age-specific incidence rates of cervical cancer in the World and its regions (estimates for 2012) Annual number of cases and age-specific incidence rates of cervical cancer in the World and its regions (estimates for 2012) (Continued) Age-standardised mortality rates of cervical cancer in the World (estimates for 2012) Ranking of cervical cancer versus other cancers among all women and women aged years, according to mortality rates in the World (estimates for 2012) World age-standardised mortality rates of cervical cancer by World and sub regions World (estimates for 2012) Comparison of the ten most frequent cancer deaths in all women in the World compared to developing and developed regions (estimates for 2012) Comparison of the ten most frequent cancer deaths in all women in the World compared to the continents (estimations for 2012) Comparison of the ten most frequent cancer deaths in women aged years by World, developing and developed regions (estimates for 2012) Comparison of the ten most frequent cancer deaths in women aged years by World and continents (estimates for 2012) Age-specific mortality of cervical cancer by World and continents Annual number of deaths of cervical cancer by age group by developing and developed regions and continents (estimates for 2012) Annual number of deaths and age-specific mortality rates of cervical cancer in the World and its regions (estimates for 2012) Annual number of deaths and age-specific mortality rates of cervical cancer in the World and its regions (estimates for 2012) (Continued) Age-specific incidence and mortality rates of cervical cancer in the World and its regions (estimates for 2012) Age-standardised incidence rates of other anogenital cancer in the World (estimates for 2012) Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in Africa (estimates for 2012) Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in the Americas (estimates for 2012) Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in Asia (estimates for 2012) Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in Europe (estimates for 2012) Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in Oceania (estimates for 2012) Age-standardised incidence rates of head and neck cancer in the World (estimates for 2012)

7 LIST OF FIGURES - vii - 39 Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in Africa (estimates for 2012) Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in the Americas (estimates for 2012) Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in Asia (estimates for 2012) Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in Europe (estimates for 2012) Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in Oceania (estimates for 2012) Comparison of cancer incidence and mortality of pharynx (excluding nasopharynx) by sex and age group in the World. Includes ICD-10 codes: C09-10,C12-14 (estimates for 2012) Comparison of cancer incidence and mortality of pharynx (excluding nasopharynx) in males by age group in the World and its regions.. Includes ICD-10 codes: C09-10,C12-14 (estimates for 2012) Comparison of cancer incidence and mortality of pharynx (excluding nasopharynx) in females by age group in the World and its regions.. Includes ICD-10 codes: C09-10,C12-14 (estimates for 2012) Prevalence of HPV among women with normal cervical cytology in the World Crude age-specific HPV prevalence (%) and 95% confidence interval in women with normal cervical cytology in the World and its regions Prevalence of HPV among women with normal cervical cytology in Africa by country and study Prevalence of HPV among women with normal cervical cytology in Africa by country and study (continued) Prevalence of HPV among women with normal cervical cytology in the Americas by country and study Prevalence of HPV among women with normal cervical cytology in the Americas by country and study (continued) Prevalence of HPV among women with normal cervical cytology in the Americas by country and study (continued) Prevalence of HPV among women with normal cervical cytology in the Americas by country and study (continued) Prevalence of HPV among women with normal cervical cytology in Asia by country and study Prevalence of HPV among women with normal cervical cytology in Asia by country and study (continued) Prevalence of HPV among women with normal cervical cytology in Asia by country and study (continued) Prevalence of HPV among women with normal cervical cytology in Asia by country and study (continued) Prevalence of HPV among women with normal cervical cytology in Asia by country and study (continued) Prevalence of HPV among women with normal cervical cytology in Asia by country and study (continued) Prevalence of HPV among women with normal cervical cytology in Europe by country and study Prevalence of HPV among women with normal cervical cytology in Europe by country and study (continued) Prevalence of HPV among women with normal cervical cytology in Europe by country and study (continued) Prevalence of HPV among women with normal cervical cytology in Europe by country and study (continued) Prevalence of HPV among women with normal cervical cytology in Oceania by country and study Prevalence of HPV 16 among women with normal cervical cytology in Africa by country and study Prevalence of HPV 16 among women with normal cervical cytology in the Americas by country and study Prevalence of HPV 16 among women with normal cervical cytology in the Americas by country and study (continued) Prevalence of HPV 16 among women with normal cervical cytology in Asia by country and study Prevalence of HPV 16 among women with normal cervical cytology in Asia by country and study (continued) Prevalence of HPV 16 among women with normal cervical cytology in Europe by country and study Prevalence of HPV 16 among women with normal cervical cytology in Europe by country and study (continued) Prevalence of HPV 16 among women with normal cervical cytology in Oceania by country and study Prevalence of HPV 16 among women with low-grade cervical lesions in Africa by country and study Prevalence of HPV 16 among women with low-grade cervical lesions in the Americas by country and study Prevalence of HPV 16 among women with low-grade cervical lesions in the Americas by country and study (continued) Prevalence of HPV 16 among women with low-grade cervical lesions in Asia by country and study Prevalence of HPV 16 among women with low-grade cervical lesions in Asia by country and study (continued) Prevalence of HPV 16 among women with low-grade cervical lesions in Europe by country and study Prevalence of HPV 16 among women with low-grade cervical lesions in Europe by country and study (continued) Prevalence of HPV 16 among women with low-grade cervical lesions in Oceania by country and study Prevalence of HPV 16 among women with high-grade cervical lesions in Africa by country and study Prevalence of HPV 16 among women with high-grade cervical lesions in the Americas by country and study Prevalence of HPV 16 among women with high-grade cervical lesions in the Americas by country and study (continued) Prevalence of HPV 16 among women with high-grade cervical lesions in Asia by country and study Prevalence of HPV 16 among women with high-grade cervical lesions in Asia by country and study (continued) Prevalence of HPV 16 among women with high-grade cervical lesions in Europe by country and study Prevalence of HPV 16 among women with high-grade cervical lesions in Europe by country and study (continued) Prevalence of HPV 16 among women with high-grade cervical lesions in Oceania by country and study Prevalence of HPV 16 among women with invasive cervical cancer in Africa by country and study Prevalence of HPV 16 among women with invasive cervical cancer in the Americas by country and study

8 LIST OF FIGURES - viii - 92 Prevalence of HPV 16 among women with invasive cervical cancer in the Americas by country and study (continued) Prevalence of HPV 16 among women with invasive cervical cancer in Asia by country and study Prevalence of HPV 16 among women with invasive cervical cancer in Asia by country and study (continued) Prevalence of HPV 16 among women with invasive cervical cancer in Asia by country and study (continued) Prevalence of HPV 16 among women with invasive cervical cancer in Europe by country and study Prevalence of HPV 16 among women with invasive cervical cancer in Europe by country and study (continued) Prevalence of HPV 16 among women with invasive cervical cancer in Europe by country and study (continued) Prevalence of HPV 16 among women with invasive cervical cancer in Oceania by country and study Comparison of the ten most frequent HPV oncogenic types among women with and without cervical lesions by World compared to developing and developed regions Comparison of the ten most frequent HPV types among women with invasive cervical cancer by histology by World, developing and developed regions Comparison of the ten most frequent HPV types in anal cancer cases in Africa and the World Comparison of the ten most frequent HPV types in anal cancer cases in the Americas and the World Comparison of the ten most frequent HPV types in anal cancer cases in Asia and the World Comparison of the ten most frequent HPV types in anal cancer cases in Europe and the World Comparison of the ten most frequent HPV types in anal cancer cases in Oceania and the World Comparison of the ten most frequent HPV types in AIN 2/3 cases in Africa and the World Comparison of the ten most frequent HPV types in AIN 2/3 cases in the Americas and the World Comparison of the ten most frequent HPV types in AIN 2/3 cases in Asia and the World Comparison of the ten most frequent HPV types in AIN 2/3 cases in Europe and the World Comparison of the ten most frequent HPV types in AIN 2/3 cases in Oceania and the World Comparison of the ten most frequent HPV types in vulvar cancer cases in Africa and the World Comparison of the ten most frequent HPV types in vulvar cancer cases in the Americas and the World Comparison of the ten most frequent HPV types in vulvar cancer cases in Asia and the World Comparison of the ten most frequent HPV types in vulvar cancer cases in Europe and the World Comparison of the ten most frequent HPV types in vulvar cancer cases in Oceania and the World Comparison of the ten most frequent HPV types in VIN 2/3 cases in Africa and the World Comparison of the ten most frequent HPV types in VIN 2/3 cases in the Americas and the World Comparison of the ten most frequent HPV types in VIN 2/3 cases in Asia and the World Comparison of the ten most frequent HPV types in VIN 2/3 cases in Europe and the World Comparison of the ten most frequent HPV types in VIN 2/3 cases in Oceania and the World Comparison of the ten most frequent HPV types in vaginal cancer cases in Africa and the World Comparison of the ten most frequent HPV types in vaginal cancer cases in the Americas and the World Comparison of the ten most frequent HPV types in vaginal cancer cases in Asia and the World Comparison of the ten most frequent HPV types in vaginal cancer cases in Europe and the World Comparison of the ten most frequent HPV types in vaginal cancer cases in Oceania and the World Comparison of the ten most frequent HPV types in VaIN 2/3 cases in Africa and the World Comparison of the ten most frequent HPV types in VaIN 2/3 cases in the Americas and the World Comparison of the ten most frequent HPV types in VaIN 2/3 cases in Asia and the World Comparison of the ten most frequent HPV types in VaIN 2/3 cases in Europe and the World Comparison of the ten most frequent HPV types in VaIN 2/3 cases in Oceania and the World Comparison of the ten most frequent HPV types in penile cancer cases in Africa and the World Comparison of the ten most frequent HPV types in penile cancer cases in the Americas and the World Comparison of the ten most frequent HPV types in penile cancer cases in Asia and the World Comparison of the ten most frequent HPV types in penile cancer cases in Europe and the World Comparison of the ten most frequent HPV types in penile cancer cases in Oceania and the World Comparison of the ten most frequent HPV types in PeIN 2/3 cases in Africa and the World Comparison of the ten most frequent HPV types in PeIN 2/3 cases in the Americas and the World Comparison of the ten most frequent HPV types in PeIN 2/3 cases in Asia and the World Comparison of the ten most frequent HPV types in PeIN 2/3 cases in Europe and the World Comparison of the ten most frequent HPV types in PeIN 2/3 cases in Oceania and the World Female smoking prevalence Total fertility rates World prevalence of hormonal contraceptive use World HIV prevalence Percentage of 15-year-old girls who report sexual intercourse Worldwide status of cervical cancer screening programmes Worldwide status of HPV vaccination programmes Worldwide prevalence of male circumcision Worldwide prevalence of condom use

9 LIST OF TABLES - ix - List of Tables 1 Abbreviations iii 2 Key statistics iv 3 World population estimates (in millions), World sociodemographic indicators, Incidence of cervical cancer by World region and sub regions (estimates for 2012) Cervical cancer mortality by World region and sub regions (estimates for 2012) Incidence of anal cancer by cancer registry and sex Incidence of vulvar cancer by cancer registry Incidence of vaginal cancer by cancer registry Incidence of penile cancer by cancer registry Cancer incidence of pharynx (excluding nasopharynx) by sex, in the World and its regions. Includes ICD-10 codes: C09-10, C12-14 (estimates for 2012) Cancer mortality of pharynx (excluding nasopharynx) by sex, in the World and its regions. Includes ICD-10 codes: C09-10, C12-14 (estimates for 2012) Prevalence of HPV 16/18 in women with normal cervical cytology, precancerous cervical lesions and invasive cervical cancer by World region and sub-regions Type-specific HPV prevalence in women with normal cervical cytology, precancerous cervical lesions and invasive cervical cancer Type-specific HPV prevalence among invasive cervical cancer cases by histology Studies on HPV prevalence among anal cancer cases (male and female) Studies on HPV prevalence among AIN 2/3 cases (male and female) Studies on HPV prevalence among vulvar cancer cases Studies on HPV prevalence among VIN 2/3 cases Studies on HPV prevalence among vaginal cancer cases Studies on HPV prevalence among VaIN 2/3 cases Studies on HPV prevalence among penile cancer cases Studies on HPV prevalence among PeIN 2/3 cases Studies on anogenital HPV prevalence among men Studies on anogenital HPV prevalence among men from special subgroups Studies on oral HPV prevalence among healthy populations Studies on HPV prevalence among cases of oral cavity cancer Studies on HPV prevalence among cases of oropharyngeal cancer Studies on HPV prevalence among cases of hypopharyngeal or laryngeal cancer Cervical cancer screening policies HPV vaccination policies for the female population in the World References of studies included Glossary

10 1 INTRODUCTION Introduction Figure 1: World geographical regions Northern Europe Eastern Europe Northern America Western Europe Central Asia Caribbean Southern Europe Northern Africa Western Asia Southern Asia Eastern Asia Central America Western Africa South Eastern Asia Micronesia Middle Africa Eastern Africa Polynesia Melanesia South America Australia and New Zealand Southern Africa Data sources: United Nations Statistics Division- Standard Country and Area Codes Classifications. The HPV Information Centre aims to compile and centralize updated data and statistics on HPV and HPV-related cancers. This report aims to summarize the data available to fully evaluate the burden of disease in the World and to facilitate stakeholders and relevant bodies of decision makers to formulate recommendations on the prevention of cervical cancer and other HPV-related cancers. Data include relevant cancer statistic estimates, epidemiological determinants of cervical cancer such as demographics, socioeconomic factors, risk factors, burden of HPV infection in women and men, and cervical screening and immunization practices. The report is structured into the following sections: Section 2, Demographic and socioeconomic factors. This section summarizes the sociodemographic profile of the World. For analytical purposes, the World is divided into five regions: Africa, the Americas, Asia, Europe and Oceania (Figure 1). Section 3, Burden of HPV related cancers. This section describes the current burden of invasive cervical cancer and other HPV-related cancers in the World with estimates of prevalence, incidence and mortality rates. Section 4, HPV related statistics. This section summarizes reports on prevalence of HPV and HPV type-specific distribution in women with normal cytology, women with precancerous lesions and invasive cervical cancer. In addition, the burden of HPV in other anogenital cancers (anus, vulva, vagina, and penis) are presented. Section 5, Factors contributing to cervical cancer. This section describes factors that can modify the natural history of HPV and cervical carcinogenesis such as smoking, parity, oral contraceptive use and co-infection with HIV. Section 6, Sexual behaviour and reproductive health indicators. This section presents sexual behaviour and reproductive health indicators that may be used as proxy measures of risk for HPV infection and anogenital cancers. Section 7, HPV preventive strategies. This section presents preventive strategies that include basic characteristics and performance of cervical cancer screening status, status of HPV vaccine licensure

11 1 INTRODUCTION introduction, and recommendations for national immunization programmes. Section 8, Protective factors for cervical cancer. This section presents the prevalence of male circumcision and condom use.

12 2 DEMOGRAPHIC AND SOCIOECONOMIC FACTORS Demographic and socioeconomic factors Figure 2: Population pyramids by World, developing and developed regions, estimates for 2017 World Males Females Under 5 53,342,033 82,918,928 51,775,314 64,809,269 75,902,498 87,382, ,938, ,435, ,391, ,056, ,317, ,256, ,789, ,916, ,480, ,085, ,620, ,305, ,830, ,010, ,886, ,256, ,473, ,334, ,491, ,010, ,987, ,092, ,234, ,235, ,774, ,746, ,829, ,366,060 Less developed regions Males Females Under 5 30,729,546 42,761,219 33,558,330 39,804,082 51,320,568 57,462,526 80,354,469 85,847, ,815, ,053, ,278, ,504, ,457, ,275, ,962, ,096, ,923, ,374, ,398, ,893, ,130, ,483, ,279, ,720, ,528, ,851, ,565, ,306, ,381, ,967, ,928, ,608, ,809, ,127,227 More developed regions Males Females Under 5 22,612,487 40,157,709 18,216,984 25,005,187 24,581,930 29,919,592 32,584,164 37,587,713 37,575,441 42,003,086 42,038,404 44,751,787 43,332,252 44,640,823 42,518,175 42,989,075 42,697,110 42,931,284 42,432,281 42,117,035 43,755,461 42,773,378 42,194,021 40,613,805 37,962,668 36,158,931 34,422,554 32,786,115 34,853,610 33,268,572 35,845,806 34,138,039 35,019,180 33,238,833 Population by sex and age group Data accessed on 27 Mar Please refer to original source for methods of estimation. Data sources: United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, DVD Edition. Available at: unpd/wpp/download/standard/population/. [Accessed on March 21, 2017].

13 2 DEMOGRAPHIC AND SOCIOECONOMIC FACTORS Figure 3: Population trends in four selected age groups by World, developing and developed regions for 2017 Projections World Projections Number of women (in millions) Women yrs Girls yrs Number of women (in millions) 5,200 4,200 3,200 2,200 1, All Women Women yrs Less developed regions Projections Number of women (in millions) Women yrs Girls yrs More developed regions Projections Projections Number of women (in millions) 5,200 4,200 3,200 2,200 1, All Women Women yrs Projections Number of women (in millions) Women yrs Girls yrs Number of women (in millions) 5,200 4,200 3,200 2,200 1, All Women Women yrs Female population trends Number of women by year and age group Data accessed on 27 Mar Please refer to original source for methods of estimation. Data sources: United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, DVD Edition. Available at: unpd/wpp/download/standard/population/. [Accessed on March 21, 2017]. (Continued on next page)

14 2 DEMOGRAPHIC AND SOCIOECONOMIC FACTORS ( Figure 3 continued from previous page)

15 2 DEMOGRAPHIC AND SOCIOECONOMIC FACTORS Table 3: World population estimates (in millions), 2017 Region / Country Male Female years 15+ years Total years 15+ years Total World Less developed regions a More developed regions b Africa Eastern Africa Middle Africa Northern Africa Southern Africa Western Africa c,d Americas e Caribbean f Central America Northern America g South America h Asia Central Asia Eastern Asia South-Eastern Asia Southern Asia Western Asia Europe Eastern Europe Northern Europe i Southern Europe j Western Europe k Oceania Australia & New Zealand Melanesia Micronesia l Polynesia m Data accessed on 27 Mar Please refer to original source for methods of estimation. Year of estimate: 2017; a Less developed regions comprise all regions of Africa, Asia (except Japan), Latin America and the Caribbean plus Melanesia, Micronesia and Polynesia. b More developed regions comprise Europe, Northern America, Australia/New Zealand and Japan. c Including Saint Helena, Ascension and Tristan da Cunha. d Including Saint Helena, Ascension, and Tristan da Cunha. e Aggregated by the HPV Information Centre pooling its individual areas/countries. f Including Anguilla, British Virgin Islands, Caribbean Netherlands, Cayman Islands, Dominica, Montserrat, Saint Kitts and Nevis, Sint Maarten (Dutch part) and Turks and Caicos Islands. g Including Bermuda, Greenland, and Saint-Pierre-et-Miquelon. h Including Falkland Islands (Malvinas). i Including Faeroe Islands, and Isle of Man. j Including Andorra, Gibraltar, Holy See, and San Marino. k Including Liechtenstein, and Monaco. l Including Marshall Islands, Nauru, Northern Mariana Islands, and Palau. m Including American Samoa, Cook Islands, Niue, Pitcairn, Tokelau, Tuvalu, and Wallis and Futuna Islands. Data sources: United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, DVD Edition. Available at: unpd/wpp/download/standard/population/. [Accessed on March 21, 2017]. Table 4: World sociodemographic indicators, 2017 Indicator Male Female Total Population in thousands 1,± 3,791, ,724, ,515,284.2 Population growth rate (%) 1, Median age of the population (in years) 1, Population living in urban areas (%) 2, Crude birth rate (births per 1,000) 1, Crude death rate (deaths per 1,000) 1, Life expectancy at birth (in years) 3,a,b Adult mortality rate (probability of dying between 15 and 60 years old per 1,000) 4 (Continued on next page)

16 2 DEMOGRAPHIC AND SOCIOECONOMIC FACTORS ( Table 4 continued from previous page) Indicator Male Female Total Under age five mortality rate (per 1,000 live births) 3,c Density of physicians (per 1,000 population) 5,d Gross national income per capita (PPP current international $) 6,e Adult literacy rate (%) (aged 15 and older) 7, Youth literacy rate (%) (aged years) 7, Net primary school enrollment ratio 7,f, Net secondary school enrollment ratio 7,f, Data accessed on 27 Mar Please refer to original source for methods of estimation. a World Population Prospects, the 2015 revision (WPP2015). New York (NY): United Nations DESA, Population Division. b WHO annual life tables for based on the WPP2015, on the data held in the WHO Mortality Database and on HIV mortality estimates prepared by UNAIDS. WHO Member States with a population of less than in 2015 were not included in the analysis. c Levels & Trends in Child Mortality. Report Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC): United Nations Children s Fund, World Health Organization, World Bank and United Nations; 2015 ( Web_9_Sept_15.pdf, accessed 26 March 2016). d Number of medical doctors (physicians), including generalist and specialist medical practitioners, per population. e GNI per capita based on purchasing power parity (PPP). PPP GNI is gross national income (GNI) converted to international dollars using purchasing power parity rates. An international dollar has the same purchasing power over GNI as a U.S. dollar has in the United States. GNI is the sum of value added by all resident producers plus any product taxes (less subsidies) not included in the valuation of output plus net receipts of primary income (compensation of employees and property income) from abroad. Data are in current international dollars based on the 2011 ICP round. f UIS Estimation Year of estimate: ± 2017; ; 2015; 2014; Data sources: 1 United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, DVD Edition. Available at: org/unpd/wpp/download/standard/population/. [Accessed on March 21, 2017]. 2 United Nations, Department of Economic and Social Affairs, Population Division (2014). World Urbanization Prospects: The 2014 Revision, CD-ROM Edition. Available at: https: //esa.un.org/unpd/wup/cd-rom/. [Accessed on March 21, 2017]. 3 World Health Statistics Geneva, World Health Organization, Available at: html. [Accessed on March 21, 2017]. 4 World Health Organization. Global Health Observatory data repository. Available at: [Accessed on March 21, 2017]. 5 The 2016 update, Global Health Workforce Statistics, World Health Organization, Geneva ( [Accessed on March 21, 2017]. 6 World Bank, World Development Indicators Database. Washington, DC. International Comparison Program database. Available at: aspx?source=world-development-indicators#. [Accessed on March 21, 2017]. 7 UNESCO Institute for Statistics Data Centre [online database]. Montreal, UNESCO Institute for Statistics. Available at: [Accessed on March 21, 2017].

17 3 BURDEN OF HPV RELATED CANCERS Burden of HPV related cancers 3.1 Cervical cancer Cancer of the cervix uteri is the 4th most common cancer among women worldwide, with an estimated 527,624 new cases and 265,672 deaths in 2012 (GLOBOCAN). The majority of cases are squamous cell carcinoma followed by adenocarcinomas. (Vaccine 2006, Vol. 24, Suppl 3; Vaccine 2008, Vol. 26, Suppl 10; Vaccine 2012, Vol. 30, Suppl 5; IARC Monographs 2007, Vol. 90) This section describes the current burden of invasive cervical cancer in the World and its regions with estimates of the annual number of new cases, deaths, incidence and mortality Incidence KEY STATS. About 527,624 new cervical cancer cases are diagnosed annually in World (estimates for 2012). Cervical cancer ranks* as the 4 th leading cause of female cancer in the World. Cervical cancer is the 2 nd most common female cancer in the women aged 15 to 44 years in World. * Ranking of cervical cancer incidence to other cancers among all women according to highest incidence rates (ranking 1st). Ranking is based on crude incidence rates (actual number of cervical cancer cases). Ranking using age-standardized rate (ASR) may differ. Figure 4: Age-standardised incidence rates of cervical cancer in the World (estimates for 2012) Data accessed on 15 Nov Rates per 100,000 women per year. For Sudan, South Sudan: Estimate for Sudan and South Sudan Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

18 3 BURDEN OF HPV RELATED CANCERS Figure 5: Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in Africa (estimates for 2012) Malawi Mozambique Comoros Zambia Zimbabwe Tanzania Swaziland Burundi Madagascar Uganda Mali Rwanda Senegal Kenya Lesotho Guinea Angola Ghana Somalia DR Congo South Africa Western Sahara South Sudan Botswana Sierra Leone Liberia Cameroon Guinea Bissau Mauritania Nigeria Cape Verde Benin Ethiopia Gambia Congo Eq. Guinea Burkina Faso Côte d'ivoire Togo CAR Gabon Chad Eritrea Djibouti Mauritius Namibia Morocco Libya Niger Algeria Sudan Tunisia Egypt Seychelles** S.Tome & Prin.** Cervical cancer: Age standardised incidence rate per 100,0000 women World Standard. Female (All ages) ** No rates are available. Data accessed on 15 Nov Rates per 100,000 women per year. For Sudan, South Sudan: Estimate for Sudan and South Sudan (Continued on next page)

19 3 BURDEN OF HPV RELATED CANCERS ( Figure 9 continued from previous page) Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

20 3 BURDEN OF HPV RELATED CANCERS Figure 6: Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in the Americas (estimates for 2012) Bolivia Guyana Suriname Nicaragua Paraguay Venezuela Peru Belize Dominican Rep. Honduras Ecuador Jamaica Barbados Haiti El Salvador Trinidad & Tob. Mexico Guatemala Argentina Bahamas Uruguay Panama Colombia Cuba Brazil Chile Costa Rica USA Canada St Vincent** St Lucia** St Kitts & Nev.** Grenada** Dominica** Antigua & Bar.** Cervical cancer: Age standardised incidence rate per 100,0000 women World Standard. Female (All ages) ** No rates are available. Data accessed on 15 Nov Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

21 3 BURDEN OF HPV RELATED CANCERS Figure 7: Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in Asia (estimates for 2012) Kazakhstan Mongolia Cambodia Kyrgyzstan India Myanmar Bangladesh Nepal Thailand Indonesia Brunei Philippines Malaysia Georgia Armenia Uzbekistan Timor Leste Turkmenistan Sri Lanka Bhutan Laos DPR Korea Maldives Japan Viet Nam Tajikistan Azerbaijan Rep. Korea UAE Afghanistan Singapore Pakistan China Bahrain Oman Qatar Lebanon Israel Turkey Kuwait Yemen Iraq Iran Saudi Arabia Syria Jordan Palestine Taiwan** Cervical cancer: Age standardised incidence rate per 100,0000 women World Standard. Female (All ages) ** No rates are available. Data accessed on 15 Nov Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

22 3 BURDEN OF HPV RELATED CANCERS Figure 8: Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in Europe (estimates for 2012) Romania Lithuania Bulgaria Serbia Montenegro Estonia Moldova Hungary Latvia Ukraine Slovakia Russia Czech Rep. Bosnia & H. Ireland Belarus Macedonia Poland Denmark Slovenia Croatia Norway Portugal Belgium Germany Iceland Spain Sweden UK Netherlands France Italy Austria Greece Albania Luxembourg Finland Cyprus Malta Switzerland San Marino** Monaco** Liechtenstein** Andorra** Cervical cancer: Age standardised incidence rate per 100,0000 women World Standard. Female (All ages) ** No rates are available. Data accessed on 15 Nov Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

23 3 BURDEN OF HPV RELATED CANCERS Figure 9: Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in Oceania (estimates for 2012) Fiji 37.8 Papua N. Guinea 34.5 Solomon Is Vanuatu 19.2 Samoa 17.1 Australia 5.5 New Zealand 5.3 Tuvalu** Tonga** Palau** Nauru** Marshall Is.** Kiribati** FS Micronesia** Cervical cancer: Age standardised incidence rate per 100,0000 women World Standard. Female (All ages) ** No rates are available. Data accessed on 15 Nov Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

24 3 BURDEN OF HPV RELATED CANCERS Table 5: Incidence of cervical cancer by World region and sub regions (estimates for 2012) Cumulative risk (%) Ranking of CC Area N cases Crude rate a ASR a ages 0-74 years b All women Women years World 527, Less developed regions 444, More developed regions 83, Africa 99, Eastern Africa 45, Middle Africa 11, Northern Africa 5, Southern Africa 8, Western Africa 27, Americas 83, Caribbean 5, Central America 18, Northern America 14, South America 45, Asia 284, Central Asia 5, Eastern Asia 78, Southern Asia 145, South-Eastern 50, Asia Western Asia 4, Europe 58, Eastern Europe 33, Northern Europe 5, Southern Europe 9, Western Europe 9, Oceania 2, Australia & New Zealand Melanesia 1, Micronesia Polynesia Data accessed on 15 Nov Standardised rates have ben estimated using the direct method and the World population as the reference. Ranking of cervical cancer incidence to other cancers among all women ages years according to highest incidence rates (ranking 1st). Ranking is based on crude incidence rates (actual number of cervical cancer cases). Ranking using ASR may differ. a Rates per 100,000 women per year. b Cumulative risk (incidence) is the probability or risk of individuals getting from the disease during ages 0-74 years. For cancer, it is expressed as the % of new born children who would be expected to develop from a particular cancer before the age of 75 if they had the rates of cancer observed in the period in the absence of competing causes. Data sources: 1 Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

25 3 BURDEN OF HPV RELATED CANCERS Figure 10: Ranking of cervical cancer versus other cancers among all women and women aged years, according to incidence rates in the World (estimates for 2012) Data accessed on 15 Nov Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

26 3 BURDEN OF HPV RELATED CANCERS Figure 11: World age-standardised incidence rates by World and sub regions (estimates for 2012) World, developed and developing regions Less developed 15.7 Eastern Africa Melanesia Southern Africa Middle Africa World 14.0 Western Africa Central America Caribbean South America Southern Asia More developed 9.9 Central Asia South Eastern Asia Five continents Eastern Europe Africa 27.6 Polynesia Northern Europe Micronesia Americas 14.9 Southern Europe Eastern Asia Asia 12.7 Western Europe Northern America Europe 11.4 Northern Africa Australia & New Zealand Oceania 10.2 Western Asia Continental sub regions Cervical cancer: Age standardised mortality rate per 100,000 women World Standard. Female (All ages) Data accessed on 15 Nov Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

27 3 BURDEN OF HPV RELATED CANCERS Figure 12: Comparison of the ten most frequent cancers in all women by World, developing and developed regions (estimates for 2012) World More developed regions Breast 43.1 Breast 73.4 Colorectum(a) 14.3 Colorectum(a) 23.6 Cervix uteri 14.0 Lung 19.6 Lung 13.6 Corpus uteri 14.7 Corpus uteri 8.2 Thyroid 11.1 Stomach 7.5 Cervix uteri 9.9 Ovary 6.1 Melanoma of skin 9.3 Thyroid 6.1 Ovary 9.1 Liver 5.4 Non Hodgkin lymphoma(b) 7.1 Non Hodgkin lymphoma(b) 4.1 Stomach 6.7 Breast Cervix uteri Lung Colorectum(a) Stomach Liver Corpus uteri Ovary Thyroid Oesophagus Less developed regions Age standardised incidence rate per 100,000 women Data accessed on 15 Nov a Includes anal cancer (C21). b Includes HIV disease resulting in malignant neoplasms (B21). Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

28 3 BURDEN OF HPV RELATED CANCERS Figure 13: Comparison of the ten most frequent cancers in all women by World and continents (estimates for 2012) World Asia Breast 43.1 Breast 29.1 Colorectum(a) 14.3 Cervix uteri 12.7 Cervix uteri 14.0 Lung 12.7 Lung 13.6 Colorectum(a) 11.1 Corpus uteri 8.2 Stomach 9.3 Stomach 7.5 Liver 6.9 Ovary 6.1 Corpus uteri 5.9 Thyroid 6.1 Ovary 5.0 Liver 5.4 Thyroid 5.0 Non Hodgkin lymphoma(b) 4.1 Oesophagus Africa Europe Breast 36.2 Breast 69.9 Cervix uteri 27.6 Colorectum(a) 23.6 Colorectum(a) 5.8 Lung 15.1 Liver 5.8 Corpus uteri 13.9 Ovary 4.8 Cervix uteri 11.4 Non Hodgkin lymphoma(b) 3.8 Ovary 9.9 Corpus uteri 3.5 Melanoma of skin 8.9 Oesophagus 3.5 Thyroid 7.8 Stomach 3.2 Stomach 6.4 Kaposi sarcoma(c) 2.9 Non Hodgkin lymphoma(b) Americas Oceania Breast 67.6 Breast 79.2 Lung 21.6 Colorectum(a) 29.2 Colorectum(a) 17.6 Melanoma of skin 25.5 Cervix uteri 14.9 Lung 20.0 Corpus uteri 12.3 Corpus uteri 12.3 Thyroid 12.1 Thyroid 11.3 Non Hodgkin lymphoma(b) 7.0 Cervix uteri 10.2 Ovary 6.8 Non Hodgkin lymphoma(b) 9.4 Melanoma of skin 6.2 Ovary 8.0 Leukaemia 5.6 Leukaemia Age standardised incidence rate per 100,000 women Data accessed on 15 Nov a Includes anal cancer (C21). b Includes HIV disease resulting in malignant neoplasms (B21). c Includes B21.0 (HIV disease resulting in Kaposi sarcoma). (Continued on next page)

29 3 BURDEN OF HPV RELATED CANCERS ( Figure 13 continued from previous page) Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from: Figure 14: Comparison of the ten most frequent cancers in women aged years by World developing and developed regions (estimates for 2012) World More developed regions Breast 21.8 Breast 37.0 Cervix uteri 11.1 Cervix uteri 11.8 Thyroid 5.8 Thyroid 11.7 Ovary 3.1 Melanoma of skin 8.2 Colorectum(a) 2.5 Ovary 4.8 Corpus uteri 2.2 Colorectum(a) 4.4 Leukaemia 2.1 Corpus uteri 3.4 Brain, nervous system 1.7 Hodgkin lymphoma 2.9 Non Hodgkin lymphoma(b) 1.6 Brain, nervous system 2.7 Lung 1.5 Non Hodgkin lymphoma(b) 2.7 Breast Cervix uteri Thyroid Ovary Colorectum(a) Leukaemia Corpus uteri Brain, nervous system Stomach Non Hodgkin lymphoma(b) Less developed regions Age standardised incidence rate per 100,000 women Data accessed on 15 Nov a Includes anal cancer (C21). b Includes HIV disease resulting in malignant neoplasms (B21). Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

30 3 BURDEN OF HPV RELATED CANCERS Figure 15: Comparison of the ten most frequent cancers in women aged years by World and continents (estimates for 2012) World Asia Breast 21.8 Breast 18.8 Cervix uteri 11.1 Cervix uteri 9.5 Thyroid 5.8 Thyroid 5.1 Ovary 3.1 Ovary 3.0 Colorectum(a) 2.5 Corpus uteri 2.5 Corpus uteri 2.2 Colorectum(a) 2.2 Leukaemia 2.1 Leukaemia 2.2 Brain, nervous system 1.7 Brain, nervous system 1.7 Non Hodgkin lymphoma(b) 1.6 Stomach 1.7 Lung 1.5 Lung Africa Europe Breast 20.3 Breast 35.0 Cervix uteri 12.5 Cervix uteri 13.2 Kaposi sarcoma(c) 3.9 Melanoma of skin 8.0 Ovary 2.4 Thyroid 7.3 Non Hodgkin lymphoma(b) 2.3 Ovary 5.1 Colorectum(a) 1.9 Colorectum(a) 3.8 Liver 1.6 Hodgkin lymphoma 3.2 Thyroid 1.5 Brain, nervous system 2.8 Leukaemia 1.4 Corpus uteri 2.5 Lip, oral cavity 0.7 Non Hodgkin lymphoma(b) Americas Oceania Breast 27.2 Breast 37.2 Cervix uteri 15.3 Melanoma of skin 15.8 Thyroid 12.2 Cervix uteri 12.7 Melanoma of skin 3.9 Thyroid 11.6 Colorectum(a) 3.6 Colorectum(a) 4.2 Ovary 3.2 Ovary 4.0 Leukaemia 2.5 Corpus uteri 2.7 Brain, nervous system 2.4 Non Hodgkin lymphoma(b) 2.6 Corpus uteri 2.3 Hodgkin lymphoma 2.4 Non Hodgkin lymphoma(b) 2.3 Lip, oral cavity Age standardised incidence rate per 100,000 women Data accessed on 15 Nov a Includes anal cancer (C21). b Includes HIV disease resulting in malignant neoplasms (B21). c Includes B21.0 (HIV disease resulting in Kaposi sarcoma). (Continued on next page)

31 3 BURDEN OF HPV RELATED CANCERS ( Figure 15 continued from previous page) Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from: Figure 16: Age-specific incidence of cervical cancer by World, developed and developing regions and five continents World Africa Americas Asia Europe Oceania Age specific rates of cervical cancer per 100, >=75 Age group (years) Data accessed on 15 Nov Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

32 3 BURDEN OF HPV RELATED CANCERS Figure 17: Annual number of new cases of cervical cancer by age group in developing and developed regions and five continents World (estimates for 2012) DEVELOPED AND DEVELOPING REGIONS Less developed regions More developed regions Annual number of new cases of cervical cancer * * 92337* Asia Africa FIVE CONTINENTS Americas Europe Oceania Annual number of new cases of cervical cancer * * 92337* * Less developed regions years: cases years: cases. 65+ years: cases. * More developed regions years: cases years: cases. 65+ years: cases. * Asia years: cases years: cases. 65+ years: cases. * Africa years: cases years: cases. 65+ years: cases. * Americas years: cases years: cases. 65+ years: cases. * Europe years: cases years: cases. 65+ years: cases. * Oceania years: 701 cases years: 1151 cases. 65+ years: 343 cases. Data accessed on 15 Nov (Continued on next page)

33 3 BURDEN OF HPV RELATED CANCERS ( Figure 17 continued from previous page) Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

34 3 BURDEN OF HPV RELATED CANCERS Figure 18: Annual number of cases and age-specific incidence rates of cervical cancer in the World and its regions (estimates for 2012) World Africa Age specific rates of cervical cancer(a) * Annual number of cases of cervical cancer * * 19637* * World yrs: 754 cases yrs: 6445 cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases. * Africa yrs: 352 cases yrs: 1091 cases yrs: 3310 cases yrs: 6198 cases yrs: 8686 cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases. Data accessed on 15 Nov a Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

35 3 BURDEN OF HPV RELATED CANCERS Figure 19: Annual number of cases and age-specific incidence rates of cervical cancer in the World and its regions (estimates for 2012) (Continued) Americas Europe Age specific rates of cervical cancer(a) Annual number of cases of cervical cancer * 22679* * 13242* Asia Oceania Age specific rates of cervical cancer(a) * Annual number of cases of cervical cancer * * 1151* * Americas yrs: 180 cases yrs: 2047 cases yrs: 4668 cases yrs: 6901 cases yrs: 8883 cases yrs: 9817 cases yrs: 9862 cases yrs: 8951 cases yrs: 7771 cases yrs: 6514 cases. * Asia yrs: 195 cases yrs: 2443 cases yrs: 8394 cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases. * Europe yrs: 22 cases yrs: 798 cases yrs: 2639 cases yrs: 4235 cases yrs: 5548 cases yrs: 6449 cases yrs: 7020 cases yrs: 7137 cases yrs: 6518 cases yrs: 5221 cases. * Oceania yrs: 4 cases yrs: 60 cases yrs: 144 cases yrs: 208 cases yrs: 280 cases yrs: 317 cases yrs: 278 cases yrs: 235 cases yrs: 181 cases yrs: 140 cases. Data accessed on 15 Nov (Continued on next page)

36 3 BURDEN OF HPV RELATED CANCERS ( Figure 19 continued from previous page) a Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from: NOTE. For time trends in cervical cancer incidence, please refer to individual country data.

37 3 BURDEN OF HPV RELATED CANCERS Mortality KEY STATS. About 265,672 new cervical cancer deaths occur annually in the World (estimations for 2012). Cervical cancer ranks* as the 4 th leading cause of female cancer deaths in the World. Cervical cancer is the 2 nd most common female cancer deaths in women aged 15 to 44 years in the World. * Ranking of cervical cancer incidence to other cancers among all women according to highest incidence rates (ranking 1st). Ranking is based on crude incidence rates (actual number of cervical cancer cases). Ranking using age-standardized rate (ASR) may differ. Figure 20: Age-standardised mortality rates of cervical cancer in the World (estimates for 2012) Data accessed on 15 Nov ASR: Age-standardized rate, Standardized rates have been estimated using the direct method and the World population as the reference; Rates per 100,000 women per year. For Sudan, South Sudan: Estimate for Sudan and South Sudan Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

38 3 BURDEN OF HPV RELATED CANCERS Table 6: Cervical cancer mortality by World region and sub regions (estimates for 2012) Cumulative risk (%) Ranking of CC Area N cases Crude rate a ASR a ages 0-74 years b All women Women years World 265, Less developed regions 230, More developed regions 35, Africa 60, Eastern Africa 28, Middle Africa 7, Northern Africa 2, Southern Africa 4, Western Africa 16, Americas 35, Caribbean 2, Central America 6, Northern America 7, South America 19, Asia 144, Central Asia 2, Eastern Asia 36, Southern Asia 79, South-Eastern 23, Asia Western Asia 1, Europe 24, Eastern Europe 15, Northern Europe 1, Southern Europe 3, Western Europe 3, Oceania 1, Australia & New Zealand Melanesia Micronesia Polynesia Data accessed on 15 Nov Standardised rates have ben estimated using the direct method and the World population as the reference. Ranking of cervical cancer mortality to other cancers among all women ages years according to highest mortality rates (ranking 1st). Ranking is based on crude mortality rates(actual number of cervical cancer deaths). Ranking using AST may differ. a Rates per 100,000 women per year. b Cumulative risk (mortality) is the probability or risk of individuals dying from the disease during ages 0-74 years. For cancer, it is expressed as the % of new born children who would be expected to die from a particular cancer before the age of 75 if they had the rates of cancer observed in the period in the absence of competing causes. Data sources: 1 Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

39 3 BURDEN OF HPV RELATED CANCERS Figure 21: Ranking of cervical cancer versus other cancers among all women and women aged years, according to mortality rates in the World (estimates for 2012) Data accessed on 15 Nov Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

40 3 BURDEN OF HPV RELATED CANCERS Figure 22: World age-standardised mortality rates of cervical cancer by World and sub regions World (estimates for 2012) World, developed and developing regions Less developed 8.3 Eastern Africa Middle Africa Melanesia Western Africa World 6.8 Southern Africa Southern Asia Central America South America Caribbean More developed 3.3 South Eastern Asia 0 10 Central Asia Five continents Eastern Europe Africa 17.5 Polynesia Eastern Asia Northern Africa Asia 6.4 Micronesia Northern America Americas 5.9 Southern Europe Northern Europe Oceania 4.5 Western Asia Western Europe Europe 3.8 Australia & New Zealand Continental sub regions Cervical cancer: Age standardised mortality rate per 100,000 women World Standard. Female (All ages) Data accessed on 15 Nov Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

41 3 BURDEN OF HPV RELATED CANCERS Figure 23: Comparison of the ten most frequent cancer deaths in all women in the World compared to developing and developed regions (estimates for 2012) World More developed regions Breast 12.9 Breast 14.9 Lung 11.1 Lung 14.3 Colorectum(a) 6.9 Colorectum(a) 9.3 Cervix uteri 6.8 Pancreas 5.5 Stomach 5.7 Ovary 5.0 Liver 5.1 Stomach 4.2 Ovary 3.7 Cervix uteri 3.3 Pancreas 3.4 Leukaemia 2.8 Leukaemia 2.8 Brain, nervous system 2.7 Oesophagus 2.7 Liver Breast Lung Cervix uteri Stomach Liver Colorectum(a) Oesophagus Ovary Leukaemia Pancreas Less developed regions Age standardised mortality rate per 100,000 women Data accessed on 15 Nov a Includes anal cancer (C21). Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

42 3 BURDEN OF HPV RELATED CANCERS Figure 24: Comparison of the ten most frequent cancer deaths in all women in the World compared to the continents (estimations for 2012) World Asia Breast 12.9 Lung 11.0 Lung 11.1 Breast 10.2 Colorectum(a) 6.9 Stomach 7.1 Cervix uteri 6.8 Liver 6.6 Stomach 5.7 Cervix uteri 6.4 Liver 5.1 Colorectum(a) 6.0 Ovary 3.7 Oesophagus 3.8 Pancreas 3.4 Ovary 3.0 Leukaemia 2.8 Leukaemia 2.6 Oesophagus 2.7 Pancreas Africa Europe Cervix uteri 17.5 Breast 16.1 Breast 17.3 Lung 11.8 Liver 5.6 Colorectum(a) 9.9 Colorectum(a) 4.2 Ovary 5.4 Ovary 3.8 Pancreas 5.3 Oesophagus 3.3 Stomach 4.6 Stomach 3.0 Cervix uteri 3.8 Non Hodgkin lymphoma(b) 2.9 Brain, nervous system 3.0 Leukaemia 2.4 Leukaemia 2.8 Lung 2.4 Corpus uteri Americas Oceania Lung 15.9 Breast 15.6 Breast 14.0 Lung 14.1 Colorectum(a) 7.4 Colorectum(a) 8.2 Cervix uteri 5.9 Ovary 4.9 Pancreas 5.0 Pancreas 4.6 Ovary 4.3 Cervix uteri 4.5 Stomach 3.7 Leukaemia 2.9 Leukaemia 3.4 Liver 2.9 Liver 3.3 Brain, nervous system 2.6 Brain, nervous system 2.7 Non Hodgkin lymphoma(b) Age standardised mortality rate per 100,000 women Data accessed on 15 Nov a Includes anal cancer (C21). b Includes HIV disease resulting in malignant neoplasms (B21). Data sources: (Continued on next page)

43 3 BURDEN OF HPV RELATED CANCERS ( Figure 24 continued from previous page) Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from: Figure 25: Comparison of the ten most frequent cancer deaths in women aged years by World, developing and developed regions (estimates for 2012) World More developed regions Breast 5.4 Breast 4.2 Cervix uteri 3.2 Cervix uteri 2.2 Leukaemia 1.5 Lung 1.2 Colorectum(a) 1.1 Brain, nervous system 1.1 Ovary 1.1 Ovary 1.1 Liver 1.0 Colorectum(a) 1.0 Lung 1.0 Leukaemia 0.9 Stomach 1.0 Stomach 0.8 Brain, nervous system 0.9 Melanoma of skin 0.6 Non Hodgkin lymphoma(b) 0.7 Non Hodgkin lymphoma(b) 0.4 Breast Cervix uteri Leukaemia Colorectum(a) Liver Ovary Stomach Lung Brain, nervous system Non Hodgkin lymphoma(b) Less developed regions Age standardised mortality rate per 100,000 women Data accessed on 15 Nov a Includes anal cancer (C21). b Includes HIV disease resulting in malignant neoplasms (B21). Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

44 3 BURDEN OF HPV RELATED CANCERS Figure 26: Comparison of the ten most frequent cancer deaths in women aged years by World and continents (estimates for 2012) World Asia Breast 5.4 Breast 5.0 Cervix uteri 3.2 Cervix uteri 2.7 Leukaemia 1.5 Leukaemia 1.7 Colorectum(a) 1.1 Stomach 1.2 Ovary 1.1 Colorectum(a) 1.1 Liver 1.0 Lung 1.1 Lung 1.0 Ovary 1.1 Stomach 1.0 Liver 1.0 Brain, nervous system 0.9 Brain, nervous system 0.9 Non Hodgkin lymphoma(b) 0.7 Oesophagus Africa Europe Breast 8.8 Breast 4.4 Cervix uteri 5.3 Cervix uteri 2.5 Kaposi sarcoma(c) 1.8 Lung 1.4 Liver 1.6 Brain, nervous system 1.3 Non Hodgkin lymphoma(b) 1.5 Ovary 1.2 Colorectum(a) 1.2 Stomach 1.0 Leukaemia 1.2 Colorectum(a) 0.9 Ovary 1.2 Leukaemia 0.9 Stomach 0.6 Melanoma of skin 0.7 Brain, nervous system 0.4 Non Hodgkin lymphoma(b) Americas Oceania Breast 4.0 Breast 5.6 Cervix uteri 3.3 Cervix uteri 3.7 Leukaemia 1.5 Ovary 1.4 Brain, nervous system 1.1 Leukaemia 1.1 Colorectum(a) 1.1 Liver 1.1 Stomach 1.0 Colorectum(a) 1.0 Lung 0.9 Brain, nervous system 0.8 Ovary 0.9 Melanoma of skin 0.8 Non Hodgkin lymphoma(b) 0.6 Lip, oral cavity 0.7 Liver 0.5 Stomach Age standardised mortality rate per 100,000 women Data accessed on 15 Nov a Includes anal cancer (C21). b Includes HIV disease resulting in malignant neoplasms (B21). c Includes B21.0 (HIV disease resulting in Kaposi sarcoma). (Continued on next page)

45 3 BURDEN OF HPV RELATED CANCERS ( Figure 26 continued from previous page) Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from: Figure 27: Age-specific mortality of cervical cancer by World and continents Age specific mortality rates of cervical cancer per 100, World Africa Americas Asia Europe Oceania >=75 Age group (years) Data accessed on 15 Nov Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

46 3 BURDEN OF HPV RELATED CANCERS Figure 28: Annual number of deaths of cervical cancer by age group by developing and developed regions and continents (estimates for 2012) DEVELOPED AND DEVELOPING REGIONS Less developed regions More developed regions Annual number of cervical cancer deaths * 85534* 28201* Asia Africa FIVE CONTINENTS Americas Europe Oceania Annual number of cervical cancer deaths * 85534* 28201* * Less developed regions years: cases years: cases. 65+ years: cases. * More developed regions years: 3071 cases years: cases. 65+ years: cases. * Asia years: cases years: cases. 65+ years: cases. * Africa years: 8065 cases years: cases. 65+ years: cases. * Americas years: 4168 cases years: cases. 65+ years: cases. * Europe years: 2212 cases years: cases. 65+ years: cases. * Oceania years: 189 cases years: 545 cases. 65+ years: 329 cases. Data accessed on 15 Nov (Continued on next page)

47 3 BURDEN OF HPV RELATED CANCERS ( Figure 28 continued from previous page) Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

48 3 BURDEN OF HPV RELATED CANCERS Figure 29: Annual number of deaths and age-specific mortality rates of cervical cancer in the World and its regions (estimates for 2012) World Africa Age specific rates of cervical cancer(a) Annual number of deaths of cervical cancer * * * * World yrs: 314 cases yrs: 1101 cases yrs: 3654 cases yrs: 8158 cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases. Africa yrs: 265 cases yrs: 553 cases yrs: 1331 cases yrs: 2360 cases yrs: 3551 cases yrs: 4707 cases yrs: 6021 cases yrs: 7190 cases yrs: 7801 cases yrs: 7601 cases. Data accessed on 15 Nov a Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

49 3 BURDEN OF HPV RELATED CANCERS Figure 30: Annual number of deaths and age-specific mortality rates of cervical cancer in the World and its regions (estimates for 2012) (Continued) Americas Europe Age specific rates of cervical cancer(a) Annual number of deaths of cervical cancer * * * * Asia Oceania Age specific rates of cervical cancer(a) Annual number of deaths of cervical cancer * * * 545* Americas yrs: 12 cases yrs: 137 cases yrs: 620 cases yrs: 1325 cases yrs: 2067 cases yrs: 2852 cases yrs: 3629 cases yrs: 3997 cases yrs: 3944 cases yrs: 3598 cases. Asia yrs: 34 cases yrs: 363 cases yrs: 1333 cases yrs: 3699 cases yrs: 8138 cases yrs: cases yrs: cases yrs: cases yrs: cases yrs: cases. Europe yrs: 2 cases yrs: 32 cases yrs: 332 cases yrs: 715 cases yrs: 1131 cases yrs: 1565 cases yrs: 2088 cases yrs: 2647 cases yrs: 2850 cases yrs: 2629 cases. Oceania yrs: 1 cases yrs: 16 cases yrs: 36 cases yrs: 56 cases yrs: 80 cases yrs: 107 cases yrs: 111 cases yrs: 122 cases yrs: 105 cases yrs: 100 cases. Data accessed on 15 Nov a Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

50 3 BURDEN OF HPV RELATED CANCERS Comparison of incidence and mortality Figure 31: Age-specific incidence and mortality rates of cervical cancer in the World and its regions (estimates for 2012) Africa Europe Age specific rates of cervical cancer per 100, Americas >= Oceania >= >= >= >= Asia Incidence Mortality Data accessed on 15 Nov Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

51 3 BURDEN OF HPV RELATED CANCERS Anogenital cancers other than the cervix Data on HPV role in anogenital cancers other than the cervix are limited, but there is an increasing body of evidence strongly linking HPV DNA with cancers of the anus, vulva, vagina, and penis. Although these cancers are much less frequent compared to cervical cancer, their association with HPV make them potentially preventable and subject to similar preventative strategies as those for cervical cancer. (Vaccine 2006, Vol. 24, Suppl 3; Vaccine 2008, Vol. 26, Suppl 10; Vaccine 2012, Vol. 30, Suppl 5; IARC Monographs 2007, Vol. 90) Figure 32: Age-standardised incidence rates of other anogenital cancer in the World (estimates for 2012) Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. Other anogenital cancer cases (vulvar, vaginal, anal, and penile). GLOBOCAN quality index for availability of incidence data: - For Afghanistan, Angola, Albania, Armenia, Azerbaijan, Burundi, Bahamas, Belize, Bolivia, Barbados, Central African Republic, DR Congo, Comoros, Cape Verde, Djibouti, Dominican Republic, Eritrea, Western Sahara, Georgia, Guadeloupe, Guinea-Bissau, Equatorial Guinea, Greece, Guatemala, French Guiana, Guyana, Honduras, Haiti, Hungary, Kazakhstan, Kyrgyzstan, Cambodia, Laos, Liberia, Lesotho, Republic of Moldova, Madagascar, Maldives, Macedonia, Myanmar, Montenegro, Mauritania, Nicaragua, Nepal, Panama, Papua New Guinea, DPR Korea, Paraguay, Senegal, Solomon Islands, Sierra Leone, El Salvador, Somalia, South Sudan, Suriname, Syria, Chad, Tajikistan, Turkmenistan, Timor-Leste, Uzbekistan, Venezuela: No data. - For United Arab Emirates, Bosnia & Herzegovina, Bhutan, Botswana, Fiji, Gambia, Guam, Jordan, Lebanon, Sri Lanka, Luxembourg, Mongolia, Mauritius, Namibia, New Caledonia, French Polynesia, Reunion, Russian Federation, Saudi Arabia, Swaziland, Trinidad & Tobago, Vanuatu, Samoa, South Africa: National data (rates). - For Argentina, Brazil, Switzerland, Germany, Spain, France, Italy, Japan, Philippines, Serbia, Thailand: High quality regional (coverage between 10% and 50%). - For Australia, Austria, Belgium, Bulgaria, Bahrain, Belarus, Canada, Costa Rica, Cyprus, Czech Republic, Denmark, Estonia, Finland, United Kingdom, Croatia, Ireland, Iceland, Israel, Republic of Korea, Kuwait, Lithuania, Latvia, Malta, Martinique, Netherlands, Norway, New Zealand, Oman, Puerto Rico, Qatar, Singapore, Slovakia, Slovenia, Sweden, Ukraine, Uruguay, USA: High quality national data or high quality regional (coverage greater than 50%). - For Benin, Burkina Faso, Bangladesh, Brunei, Côte d Ivoire, Gabon, Ghana, Indonesia, Iraq, Palestine, Rwanda, Sudan, Togo: Frequency data. - For Chile, China, Colombia, Cuba, Algeria, Ecuador, Egypt, India, Iran, Jamaica, Libya, Malawi, Malaysia, Poland, Portugal, Tunisia, Turkey, Uganda, Zimbabwe: High quality regional (coverage lower than 10%). - For Cameroon, Congo, Ethiopia, Guinea, Kenya, Morocco, Mexico, Mali, Mozambique, Niger, Nigeria, Pakistan, Peru, Romania, Tanzania, Viet Nam, Yemen, Zambia: Regional data (rates). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Afghanistan, Angola, Burundi, Benin, Central African Republic, DR Congo, Comoros, Cape Verde, Djibouti, Eritrea, Western Sahara, Guinea-Bissau, Equatorial Guinea, Cambodia, Laos, Liberia, Lesotho, Madagascar, Maldives, Myanmar, Montenegro, Mauritania, Nepal, DPR Korea, Rwanda, Senegal, Solomon Islands, Sierra Leone, Somalia, South Sudan, Syria, Chad, Timor-Leste: The rates are those of neighbouring countries or registries in the same area - For Albania, Greece, Hungary, Luxembourg, Republic of Moldova, Macedonia, Portugal, Romania, Serbia: Estimated from national mortality estimates by modelling using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries - For United Arab Emirates, Belgium, Bosnia & Herzegovina, Bhutan, Botswana, Cyprus, Gambia, Guam, Lebanon, Sri Lanka, Mongolia, Mauritius, Namibia, New Caledonia, Oman, Qatar, Swaziland, Ukraine, Uruguay, Samoa: Most recent rates applied to 2012 population - For Argentina, Brazil, Switzerland, Chile, China, Colombia, Cuba, Ecuador, Spain, France, Italy, Japan, Poland: Estimated from national mortality by modelling using incidence mortality ratios derived from recorded data in country-specific cancer registries - For Armenia, Azerbaijan, Bahamas, Belize, Barbados, Brunei, Dominican Republic, Fiji, Georgia, Guadeloupe, Guatemala, French Guiana, Guyana, Honduras, Haiti, Jamaica, Kazakhstan, Kyrgyzstan, Mexico, Nicaragua, Panama, Peru, Paraguay, El Salvador, Suriname, Tajikistan, Turkmenistan, Trinidad & Tobago, Uzbekistan, Venezuela, Viet Nam, Vanuatu: Estimated from national mortality estimates using modelled survival - For Australia, Austria, Bulgaria, Bahrain, Belarus, Canada, Costa Rica, Czech Republic, Germany, Denmark, Estonia, Finland, United Kingdom, Croatia, Ireland, Iceland, Israel, Jordan, Republic of Korea, Kuwait, Lithuania, Latvia, Malta, Martinique, Netherlands, Norway, New Zealand, Puerto Rico, French Polynesia, Reunion, Russian Federation, Saudi Arabia, Singapore, Slovakia, Slovenia, Sweden, USA, South Africa: Rates projected to For Burkina Faso, Bangladesh, Bolivia, Côte d Ivoire, Gabon, Ghana, Iraq, Mozambique, Papua New Guinea, Palestine, Sudan, Togo: Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of different cancers (by age and sex) - For Cameroon, Congo, Ethiopia, Guinea, Libya, Mali, Malawi, Niger, Uganda, Yemen, Zambia: One cancer registry covering part of a country is used as representative of the country profile - For Algeria, Egypt, Indonesia, India, Iran, Kenya, Morocco, Malaysia, Nigeria, Pakistan, Philippines, Thailand, Tunisia, Turkey, Tanzania, Zimbabwe: Estimated as the weighted average of the local rates Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017

52 3 BURDEN OF HPV RELATED CANCERS Figure 33: Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in Africa (estimates for 2012) Mauritius Kenya South Africa Somalia Rwanda Zimbabwe Uganda Madagascar South Sudan Malawi Gabon Ethiopia Burundi Zambia Mali Eritrea Djibouti DR Congo Eq. Guinea Burkina Faso Angola Tanzania Comoros Botswana Togo Chad Swaziland Senegal Niger Mozambique Ghana Cameroon CAR Namibia Mauritania Cape Verde Congo Côte d'ivoire Benin Sierra Leone Nigeria Lesotho Liberia Guinea Bissau Guinea Libya Egypt Algeria Tunisia Morocco Gambia Western Sahara Sudan Seychelles** S.Tome & Prin.** Age standardised incidence rate per 100,0000 women World Standard ** No rates are available. Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. (Continued on next page)

53 3 BURDEN OF HPV RELATED CANCERS Other anogenital cancer cases (vulvar, vaginal, anal, and penile). ( Figure 33 continued from previous page) GLOBOCAN quality index for availability of incidence data: - For Sudan, Benin, Côte d Ivoire, Ghana, Togo, Burkina Faso, Gabon, Rwanda: Frequency data. - For Western Sahara, Guinea-Bissau, Liberia, Lesotho, Sierra Leone, Cape Verde, Mauritania, Central African Republic, Senegal, Chad, Comoros, Angola, Equatorial Guinea, DR Congo, Djibouti, Eritrea, Burundi, South Sudan, Madagascar, Somalia: No data. - For Gambia, Namibia, Swaziland, Botswana, South Africa, Mauritius: National data (rates). - For Morocco, Guinea, Nigeria, Congo, Cameroon, Mozambique, Niger, Tanzania, Mali, Zambia, Ethiopia, Kenya: Regional data (rates). - For Tunisia, Algeria, Egypt, Libya, Malawi, Uganda, Zimbabwe: High quality regional (coverage lower than 10%). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Sudan, Côte d Ivoire, Ghana, Mozambique, Togo, Burkina Faso, Gabon: Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of different cancers (by age and sex) - For Western Sahara, Guinea-Bissau, Liberia, Lesotho, Sierra Leone, Benin, Cape Verde, Mauritania, Central African Republic, Senegal, Chad, Comoros, Angola, Equatorial Guinea, DR Congo, Djibouti, Eritrea, Burundi, South Sudan, Madagascar, Rwanda, Somalia: The rates are those of neighbouring countries or registries in the same area - For Gambia, Namibia, Swaziland, Botswana, Mauritius: Most recent rates applied to 2012 population - For Morocco, Tunisia, Algeria, Egypt, Nigeria, Tanzania, Zimbabwe, Kenya: Estimated as the weighted average of the local rates - For Libya, Guinea, Congo, Cameroon, Niger, Mali, Zambia, Ethiopia, Malawi, Uganda: One cancer registry covering part of a country is used as representative of the country profile - For South Africa: Rates projected to 2012 Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017

54 3 BURDEN OF HPV RELATED CANCERS Figure 34: Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in the Americas (estimates for 2012) Barbados Uruguay El Salvador USA Canada Bahamas Argentina Trinidad & Tob. Brazil Guyana Bolivia Suriname Jamaica Costa Rica Peru Panama Cuba Colombia Chile Haiti Honduras Ecuador Dominican Rep. Belize Paraguay Mexico Guatemala Venezuela Nicaragua St Vincent** St Lucia** St Kitts & Nev.** Grenada** Dominica** Antigua & Bar.** Age standardised incidence rate per 100,0000 women World Standard ** No rates are available. Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. (Continued on next page)

55 3 BURDEN OF HPV RELATED CANCERS Other anogenital cancer cases (vulvar, vaginal, anal, and penile). ( Figure 34 continued from previous page) GLOBOCAN quality index for availability of incidence data: - For Nicaragua, Venezuela, Guatemala, Paraguay, Belize, Dominican Republic, Honduras, Haiti, Panama, Suriname, Bolivia, Guyana, Bahamas, El Salvador, Barbados: No data. - For Mexico, Peru: Regional data (rates). - For Ecuador, Chile, Colombia, Cuba, Jamaica: High quality regional (coverage lower than 10%). - For Costa Rica, Canada, USA, Uruguay: High quality national data or high quality regional (coverage greater than 50%). - For Brazil, Argentina: High quality regional (coverage between 10% and 50%). - For Trinidad & Tobago: National data (rates). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Nicaragua, Venezuela, Guatemala, Mexico, Paraguay, Belize, Dominican Republic, Honduras, Haiti, Panama, Peru, Jamaica, Suriname, Guyana, Trinidad & Tobago, Bahamas, El Salvador, Barbados: Estimated from national mortality estimates using modelled survival - For Ecuador, Chile, Colombia, Cuba, Brazil, Argentina: Estimated from national mortality by modelling using incidence mortality ratios derived from recorded data in country-specific cancer registries - For Costa Rica, Canada, USA: Rates projected to For Bolivia: Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of different cancers (by age and sex) - For Uruguay: Most recent rates applied to 2012 population Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017

56 3 BURDEN OF HPV RELATED CANCERS Figure 35: Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in Asia (estimates for 2012) Kazakhstan India Israel Timor Leste Cambodia Georgia Armenia Singapore Rep. Korea China Azerbaijan DPR Korea Malaysia Myanmar Jordan Syria Philippines Lebanon Iran Indonesia Viet Nam Turkey Turkmenistan Palestine Laos Kyrgyzstan Japan Iraq Brunei Uzbekistan Tajikistan Thailand Saudi Arabia Qatar Pakistan Maldives Kuwait Bahrain Afghanistan Yemen Oman Nepal Mongolia Sri Lanka Bhutan Bangladesh UAE Taiwan** Age standardised incidence rate per 100,0000 women World Standard ** No rates are available. Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. (Continued on next page)

57 3 BURDEN OF HPV RELATED CANCERS Other anogenital cancer cases (vulvar, vaginal, anal, and penile). ( Figure 35 continued from previous page) GLOBOCAN quality index for availability of incidence data: - For United Arab Emirates, Bhutan, Sri Lanka, Mongolia, Saudi Arabia, Lebanon, Jordan: National data (rates). - For Bangladesh, Brunei, Iraq, Palestine, Indonesia: Frequency data. - For Nepal, Afghanistan, Maldives, Tajikistan, Uzbekistan, Kyrgyzstan, Laos, Turkmenistan, Syria, Myanmar, DPR Korea, Azerbaijan, Armenia, Georgia, Cambodia, Timor-Leste, Kazakhstan: No data. - For Oman, Bahrain, Kuwait, Qatar, Republic of Korea, Singapore, Israel: High quality national data or high quality regional (coverage greater than 50%). - For Yemen, Pakistan, Viet Nam: Regional data (rates). - For Thailand, Japan, Philippines: High quality regional (coverage between 10% and 50%). - For Turkey, Iran, Malaysia, China, India: High quality regional (coverage lower than 10%). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For United Arab Emirates, Bhutan, Sri Lanka, Mongolia, Oman, Qatar, Lebanon: Most recent rates applied to 2012 population - For Bangladesh, Iraq, Palestine: Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of different cancers (by age and sex) - For Nepal, Afghanistan, Maldives, Laos, Syria, Myanmar, DPR Korea, Cambodia, Timor-Leste: The rates are those of neighbouring countries or registries in the same area - For Yemen: One cancer registry covering part of a country is used as representative of the country profile - For Bahrain, Kuwait, Saudi Arabia, Jordan, Republic of Korea, Singapore, Israel: Rates projected to For Pakistan, Thailand, Turkey, Indonesia, Iran, Philippines, Malaysia, India: Estimated as the weighted average of the local rates - For Tajikistan, Uzbekistan, Brunei, Kyrgyzstan, Turkmenistan, Viet Nam, Azerbaijan, Armenia, Georgia, Kazakhstan: Estimated from national mortality estimates using modelled survival - For Japan, China: Estimated from national mortality by modelling using incidence mortality ratios derived from recorded data in country-specific cancer registries Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017

58 3 BURDEN OF HPV RELATED CANCERS Figure 36: Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in Europe (estimates for 2012) Denmark France Norway Netherlands Iceland Belgium Ireland UK Sweden Luxembourg Germany Slovenia Austria Serbia Montenegro Lithuania Italy Croatia Switzerland Malta Latvia Finland Estonia Spain Czech Rep. Bulgaria Slovakia Portugal Macedonia Hungary Cyprus Albania Ukraine Russia Romania Moldova Greece Poland Bosnia & H. Belarus San Marino** Monaco** Liechtenstein** Andorra** Age standardised incidence rate per 100,0000 women World Standard ** No rates are available. Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. (Continued on next page)

59 3 BURDEN OF HPV RELATED CANCERS Other anogenital cancer cases (vulvar, vaginal, anal, and penile). ( Figure 36 continued from previous page) GLOBOCAN quality index for availability of incidence data: - For Belarus, Ukraine, Cyprus, Slovakia, Bulgaria, Czech Republic, Estonia, Finland, Latvia, Malta, Croatia, Lithuania, Austria, Slovenia, Sweden, United Kingdom, Ireland, Belgium, Iceland, Netherlands, Norway, Denmark: High quality national data or high quality regional (coverage greater than 50%). - For Bosnia & Herzegovina, Russian Federation, Luxembourg: National data (rates). - For Poland, Portugal: High quality regional (coverage lower than 10%). - For Greece, Republic of Moldova, Albania, Hungary, Macedonia, Montenegro: No data. - For Romania: Regional data (rates). - For Spain, Switzerland, Italy, Serbia, Germany, France: High quality regional (coverage between 10% and 50%). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Belarus, Russian Federation, Slovakia, Bulgaria, Czech Republic, Estonia, Finland, Latvia, Malta, Croatia, Lithuania, Austria, Slovenia, Germany, Sweden, United Kingdom, Ireland, Iceland, Netherlands, Norway, Denmark: Rates projected to For Bosnia & Herzegovina, Ukraine, Cyprus, Belgium: Most recent rates applied to 2012 population - For Poland, Spain, Switzerland, Italy, France: Estimated from national mortality by modelling using incidence mortality ratios derived from recorded data in country-specific cancer registries - For Greece, Republic of Moldova, Romania, Albania, Hungary, Macedonia, Portugal, Serbia, Luxembourg: Estimated from national mortality estimates by modelling using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries - For Montenegro: The rates are those of neighbouring countries or registries in the same area Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017

60 3 BURDEN OF HPV RELATED CANCERS Figure 37: Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in Oceania (estimates for 2012) Australia 1.3 New Zealand 1.2 Samoa 0.7 Papua N. Guinea 0.7 Fiji 0.6 Solomon Is. 0.5 Vanuatu 0.4 Tuvalu** Tonga** Palau** Nauru** Marshall Is.** Kiribati** FS Micronesia** Age standardised incidence rate per 100,0000 women World Standard ** No rates are available. Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. (Continued on next page)

61 3 BURDEN OF HPV RELATED CANCERS Other anogenital cancer cases (vulvar, vaginal, anal, and penile). ( Figure 37 continued from previous page) GLOBOCAN quality index for availability of incidence data: - For Vanuatu, Fiji, Samoa: National data (rates). - For Solomon Islands, Papua New Guinea: No data. - For New Zealand, Australia: High quality national data or high quality regional (coverage greater than 50%). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Vanuatu, Fiji: Estimated from national mortality estimates using modelled survival - For Solomon Islands: The rates are those of neighbouring countries or registries in the same area - For Papua New Guinea: Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of different cancers (by age and sex) - For Samoa: Most recent rates applied to 2012 population - For New Zealand, Australia: Rates projected to 2012 Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer Anal cancer Anal cancer is rare in the general population with an average worldwide incidence of 1 per 100,000, but is reported to be increasing in more developed regions. Globally, there are an estimated 27,000 new cases every year (de Martel C et al. Lancet Oncol 2012;13(6):607-15). Women have higher incidences of anal cancer than men. Incidence is particularly high among populations of men who have sex with men (MSM), women with history of cervical or vulvar cancer, and immunosuppressed populations, including those who are HIV-infected and patients with a history of organ transplantation. These cancers are predominantly squamous cell carcinoma, adenocarcinomas, or basaloid and cloacogenic carcinomas. Table 7: Incidence of anal cancer by cancer registry and sex Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c Algeria 1 Setif Argentina 1 Bahia Blanca Cordoba Mendoza Tierra del Fuego Australia 1 Australian Capital Territory New South Wales Northern Territory Northern Territory (Indigenous) Northern Territory (Non-Indigenous) Queensland South Tasmania Victoria Western Austria 1 National Tyrol Vorarlberg Bahrain 1 National (Bahraini) Belarus 1 National Belgium 1 National Brazil 1 (Continued on next page)

62 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c Aracaju Belo Horizonte Cuiaba Fortaleza Goiania Sao Paulo Bulgaria 1 National Canada 1 Alberta British Columbia Manitoba National New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Chile 1 Bío Bío Province Region of Antofagasta Valdivia China 1 Beijing City Cixian County Haining County Harbin City, Nangang District Hong Kong Jiashan County Jiaxing City Macao Qidong County Shanghai City Wuhan City Yangcheng County Yanting County Zhongshan City Colombia 1 Bucaramanga Cali Manizales Pasto Costa Rica 1 National (Continued on next page)

63 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c Croatia 1 National Cuba 1 Villa Clara Cyprus 1 National Czech Rep. 1 National Denmark 1 National Ecuador 1 Cuenca Quito Egypt 1 Gharbiah Estonia 1 National Finland 1 National France 1 Bas-Rhin Calvados Doubs Haut-Rhin Herault Isere Loire Atlantique Manche Martinique Somme Tarn Vendee Gambia 2 National Germany 1 Brandenburg Bremen Free State Of Saxony Hamburg Mecklenburg-Western Pomerania Munich North Rhine-Westphalia Saarland Schleswig-Holstein Iceland 1 National India 1 Bangalore Barshi, Paranda and Bhum Bhopal (Continued on next page)

64 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c Chennai Dindigul, Ambilikkai Karunagappally Mizoram Mumbai New Delhi Poona Sikkim State Trivandrum Iran 1 Golestan Province Ireland 1 National Israel 1 National National (Jews) National (Non-Jews) Italy 1 Biella Brescia Catania and Messina Catanzaro Como Ferrara Florence and Prato Friuli-Venezia Giulia Genoa Latina Lecco Lombardy, South Mantua Milan Modena Naples Nuoro Palermo Parma Ragusa Reggio Emilia Romagna Salerno Sassari Sondrio South Tyrol Syracuse Trapani Trento Turin Umbria (Continued on next page)

65 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c Varese Veneto Jamaica 1 Kingston and St Andrew Japan 1 Aichi Prefecture Fukui Prefecture Hiroshima Miyagi Prefecture Nagasaki Prefecture Niigata Prefecture Osaka Prefecture Saga Prefecture Kuwait 1 National National (Kuwaitis) National (Non-Kuwaitis) Latvia 1 National Libya 1 Benghazi Lithuania 1 National Malawi 1 Blantyre Malaysia 1 Penang Penang (Chinese) Penang (Indian) Penang (Malay) Mali 2 Bamako Malta 1 National Netherlands 1 Eindhoven National New Zealand 1 National National (Maori) National (Other) National (Pacific Islander) Norway 1 National Oman 3 Omani Pakistan 3 South Karachi Peru 3 Trujillo Philippines 1 (Continued on next page)

66 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c Manila Rizal Poland 1 Cracow Kielce Lower Silesia Podkarpackie Portugal 1 Azores Qatar 1 National (Qatari) Rep. Korea 1 Busan Daegu Daejeon Gwangju Incheon Jejudo National Seoul Ulsan Russia 1 Saint Petersburg Saudi Arabia 1 Riyadh (Saudi) Serbia 1 Central Singapore 1 National National (Chinese) National (Indian) National (Malay) Slovakia 1 National Slovenia 1 National South Africa 1 PROMEC Spain 1 Albacete Asturias Basque Country Canary Islands Ciudad Real Cuenca Girona Granada La Rioja Mallorca Murcia Navarra (Continued on next page)

67 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c Tarragona Sweden 1 National Switzerland 1 Basel Geneva Graubunden and Glarus Neuchatel St Gall-Appenzell Ticino Valais Vaud Zurich Thailand 1 Bangkok Chiang Mai Chonburi Khon Kaen Lampang Songkhla Tunisia 1 North Turkey 1 Antalya Edirne Izmir Trabzon Uganda 1 Kyadondo county UK 1 England England, East of England Region England, North Western England, Northern and Yorkshire England, Oxford Region England, South and Western Regions England, Thames England, Trent England, West Midlands Northern Ireland Scotland Wales Ukraine 1 National Uruguay 1 National USA 1 Alabama (Continued on next page)

68 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c Alabama (Black) Alabama (White) Alaska Alaska (American Indian) Arizona Arizona (American Indian) Arizona (Asian and Pacific Islander) Arizona (Black) Arizona (White) Arkansas Arkansas (Black) Arkansas (White) California California (American Indian) California (Asian and Pacific Islander) California (Black) California (White) California, Los Angeles County California, Los Angeles County (Asian and Pacific Islander) California, Los Angeles County (Black) California, Los Angeles County (Chinese) California, Los Angeles County (Filipino) California, Los Angeles County (Hispanic White) California, Los Angeles County (Japanese) California, Los Angeles County (Korean) California, Los Angeles County (Non-Hispanic White) California, Los Angeles County (White) California: San Francisco California: San Francisco (Asian and Pacific Islander) California: San Francisco (Black) California: San Francisco (Hispanic White) (Continued on next page)

69 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c California: San Francisco (Non-Hispanic White) California: San Francisco (White) Colorado Colorado (Asian and Pacific Islander) Colorado (Black) Colorado (White) Connecticut Connecticut (Black) Connecticut (White) Delaware Delaware (Black) Delaware (White) Florida Florida (Asian and Pacific Islander) Florida (Black) Florida (White) Georgia Georgia (Asian and Pacific Islander) Georgia (Black) Georgia (White) Georgia, Atlanta Georgia, Atlanta (Black) Georgia, Atlanta (White) Hawaii Hawaii (Chinese) Hawaii (Filipino) Hawaii (Hawaiian) Hawaii (Japanese) Hawaii (White) Idaho Illinois Illinois (Asian and Pacific Islander) Illinois (Black) Illinois (White) Indiana Indiana (Black) Indiana (White) Iowa Kentucky Louisiana , Louisiana (Black) , (Continued on next page)

70 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c Louisiana (White) , Louisiana, New Orleans , Louisiana, New Orleans (Black) Louisiana, New Orleans (White) , , Maine Massachusetts Massachusetts (Asian and Pacific Islander) Massachusetts (Black) Massachusetts (White) Michigan Michigan (Asian and Pacific Islander) Michigan (Black) Michigan (White) Michigan, Detroit Michigan, Detroit (Black) Michigan, Detroit (White) Mississippi Missouri Missouri (Black) Missouri (White) Montana Montana (American Indian) Nebraska Nebraska (Black) Nebraska (White) New Hampshire New Jersey New Jersey (Black) New Jersey (White) New Mexico New Mexico (Hispanic White) New Mexico (Non-Hispanic White) New Mexico (White) New York State New York State (Asian and Pacific Islander) New York State (Black) New York State (White) (Continued on next page)

71 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c North Carolina North Carolina (American Indian) North Carolina (Asian and Pacific Islander) North Carolina (Black) North Carolina (White) North Dakota NPCR (42 States) NPCR (42 States) (American Indian) NPCR (42 States) (Asian and Pacific Islander) NPCR (42 States) (Black) NPCR (42 States) (White) Ohio Ohio (Asian and Pacific Islander) Ohio (Black) Ohio (White) Oklahoma Oklahoma (American Indian) Oklahoma (Black) Oklahoma (White) Oregon Oregon (Asian and Pacific Islander) Oregon (Black) Oregon (White) Pennsylvania Pennsylvania (Asian and Pacific Islander) Pennsylvania (Black) Pennsylvania (White) Puerto Rico Rhode Island Rhode Island (Black) Rhode Island (White) SEER (18 Registries) SEER (18 Registries) (Asian and Pacific Islander) SEER (18 Registries) (Black) SEER (18 Registries) (Hispanic White) SEER (18 Registries) (Non-Hispanic White) SEER (18 Registries) (White) (Continued on next page)

72 3 BURDEN OF HPV RELATED CANCERS ( Table 7 continued from previous page) Male Female Country / Registry Period N cases a Crude rate b ASR b N cases a Crude rate c ASR c SEER (9 Registries) SEER (9 Registries) (Black) SEER (9 Registries) (White) South Carolina South Carolina (Black) South Carolina (White) South Dakota Tennessee Tennessee (Black) Tennessee (White) Texas Texas (Asian and Pacific Islander) Texas (Black) Texas (White) Utah Vermont Virginia Virginia (Asian and Pacific Islander) Virginia (Black) Virginia (White) Washington State Washington, Seattle West Virginia Wisconsin Wisconsin (Black) Wisconsin (White) Wyoming Viet Nam 2 Hanoi Ho Chi Minh City Zimbabwe 1 Harare (African) Data accessed on 05 May a Accumulated number of cases during the period in the population covered by the corresponding registry. b Rates per 100,000 men per year. c Rates per 100,000 women per year. Data sources: 1 Forman D, Bray F, Brewster DH, Gombe Mbalawa C, Kohler B, Piñeros M, Steliarova-Foucher E, Swaminathan R and Ferlay J eds (2013). Cancer Incidence in Five Continents, Vol. X (electronic version) Lyon, IARC. 2 Parkin, D.M., Whelan, S.L., Ferlay, J., Teppo, L., and Thomas, D.B., eds (2002). Cancer Incidence in Five Continents, Vol. VIII. IARC Scientific Publications No. 155, Lyon, IARC. 3 Curado. M. P., Edwards, B., Shin. H.R., Storm. H., Ferlay. J., Heanue. M. and Boyle. P., eds (2007). Cancer Incidence in Five Continents, Vol. IX. IARC Scientific Publications No. 160, Lyon, IARC. NOTE. For time trends in anal cancer incidence, please refer to individual country data.

73 3 BURDEN OF HPV RELATED CANCERS Vulvar cancer Cancer of the vulva is rare among women worldwide, with an estimated 27,000 new cases in 2008, representing 4% of all gynaecologic cancers (de Martel C et al. Lancet Oncol 2012;13(6):607-15). Worldwide, about 60% of all vulvar cancer cases occur in more developed countries. Vulvar cancer has two distinct histological patterns with two different risk factor profiles: (1) basaloid/warty types (2) keratinizing types. Basaloid/warty lesions are more common in young women, are very often associated with HPV DNA detection (75-100%), and have a similar risk factor profile as cervical cancer. Keratinizing vulvar carcinomas represent the majority of the vulvar lesions (>60%), they occur more often in older women and are more rarely associated with HPV (IARC Monograph Vol 100B) Table 8: Incidence of vulvar cancer by cancer registry Female Country name Cancer registry Period N cases a Crude rate b ASR b Africa Algeria 1 Setif Egypt 1 Gharbiah Gambia 2 National Libya 1 Benghazi Malawi 1 Blantyre Mali 2 Bamako South Africa 1 PROMEC Tunisia 1 North Uganda 1 Kyadondo county Zimbabwe 1 Harare (African) Americas Argentina 1 Bahia Blanca Cordoba Mendoza Tierra del Fuego Brazil 1 Aracaju Belo Horizonte Cuiaba Fortaleza Goiania Sao Paulo Canada 1 Alberta British Columbia Manitoba National New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Chile 1 Bío Bío Province Region of Antofagasta Valdivia Colombia 1 Bucaramanga Cali Manizales Pasto Costa Rica 1 National Cuba 1 Villa Clara (Continued on next page)

74 3 BURDEN OF HPV RELATED CANCERS ( Table 8 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Ecuador 1 Cuenca Quito Jamaica 1 Kingston and St Andrew Peru 3 Trujillo Uruguay 1 National USA 1 Alabama (Black) Alabama (White) Alabama Alaska Alaska (American Indian) Arizona (Asian and Pacific Islander) Arizona (American Indian) Arizona Arizona (Black) Arizona (White) Arkansas Arkansas (White) Arkansas (Black) California (American Indian) California (Asian and Pacific Islander) California (Black) California (White) California California, Los Angeles County California, Los Angeles County (Black) California, Los Angeles County (Chinese) California, Los Angeles County (Filipino) California, Los Angeles County (Hispanic White) California, Los Angeles County (Japanese) California, Los Angeles County (Korean) California, Los Angeles County (Non-Hispanic White) California, Los Angeles County (White) California, Los Angeles County (Asian and Pacific Islander) California: San Francisco (Asian and Pacific Islander) California: San Francisco (Hispanic White) California: San Francisco California: San Francisco (Black) California: San Francisco (Non-Hispanic White) California: San Francisco (White) Colorado Colorado (Asian and Pacific Islander) Colorado (Black) Colorado (White) Connecticut (Black) Connecticut Connecticut (White) Delaware (Black) Delaware (White) Delaware Florida Florida (Asian and Pacific Islander) (Continued on next page)

75 3 BURDEN OF HPV RELATED CANCERS ( Table 8 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Florida (Black) Florida (White) Georgia Georgia (Asian and Pacific Islander) Georgia (Black) Georgia (White) Georgia, Atlanta Georgia, Atlanta (Black) Georgia, Atlanta (White) Hawaii (Filipino) Hawaii (Hawaiian) Hawaii (Japanese) Hawaii (White) Hawaii (Chinese) Hawaii Idaho Illinois (Black) Illinois (White) Illinois (Asian and Pacific Islander) Illinois Indiana (Black) Indiana (White) Indiana Iowa Kentucky Louisiana , Louisiana (White) , Louisiana (Black) , Louisiana, New Orleans , Louisiana, New Orleans (Black) , Louisiana, New Orleans (White) , Maine Massachusetts Massachusetts (Asian and Pacific Islander) Massachusetts (Black) Massachusetts (White) Michigan Michigan (Asian and Pacific Islander) Michigan (Black) Michigan (White) Michigan, Detroit Michigan, Detroit (Black) Michigan, Detroit (White) Mississippi Missouri (Continued on next page)

76 3 BURDEN OF HPV RELATED CANCERS ( Table 8 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Missouri (Black) Missouri (White) Montana (American Indian) Montana Nebraska Nebraska (Black) Nebraska (White) New Hampshire New Jersey New Jersey (White) New Jersey (Black) New Mexico New Mexico (Hispanic White) New Mexico (Non-Hispanic White) New Mexico (White) New York State New York State (Asian and Pacific Islander) New York State (Black) New York State (White) North Carolina North Carolina (White) North Carolina (Asian and Pacific Islander) North Carolina (American Indian) North Carolina (Black) North Dakota NPCR (42 States) NPCR (42 States) (American Indian) NPCR (42 States) (Asian and Pacific Islander) NPCR (42 States) (Black) NPCR (42 States) (White) Ohio Ohio (Asian and Pacific Islander) Ohio (Black) Ohio (White) Oklahoma Oklahoma (American Indian) Oklahoma (Black) Oklahoma (White) Oregon Oregon (Asian and Pacific Islander) Oregon (Black) Oregon (White) Pennsylvania (Black) Pennsylvania (Asian and Pacific Islander) Pennsylvania Pennsylvania (White) Puerto Rico Rhode Island Rhode Island (White) Rhode Island (Black) SEER (18 Registries) (Asian and Pacific Islander) SEER (18 Registries) (Black) (Continued on next page)

77 3 BURDEN OF HPV RELATED CANCERS ( Table 8 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b SEER (18 Registries) (Hispanic White) SEER (18 Registries) (White) SEER (18 Registries) SEER (18 Registries) (Non-Hispanic White) SEER (9 Registries) (White) SEER (9 Registries) SEER (9 Registries) (Black) South Carolina (Black) South Carolina South Carolina (White) South Dakota Tennessee (Black) Tennessee (White) Tennessee Texas (White) Texas (Asian and Pacific Islander) Texas (Black) Texas Utah Vermont Virginia Virginia (Black) Virginia (White) Virginia (Asian and Pacific Islander) Washington State Washington, Seattle West Virginia Wisconsin (Black) Wisconsin Wisconsin (White) Wyoming Asia Bahrain 1 National (Bahraini) China 1 Beijing City Cixian County Haining County Harbin City, Nangang District Hong Kong Jiashan County Jiaxing City Macao Qidong County Shanghai City Wuhan City Yangcheng County Yanting County Zhongshan City India 1 Bangalore Barshi, Paranda and Bhum Bhopal Chennai Dindigul, Ambilikkai Karunagappally Mizoram (Continued on next page)

78 3 BURDEN OF HPV RELATED CANCERS ( Table 8 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Mumbai New Delhi Poona Sikkim State Trivandrum Iran 1 Golestan Province Israel 1 National National (Non-Jews) National (Jews) Japan 1 Aichi Prefecture Fukui Prefecture Hiroshima Miyagi Prefecture Nagasaki Prefecture Niigata Prefecture Osaka Prefecture Saga Prefecture Kuwait 1 National National (Non-Kuwaitis) National (Kuwaitis) Malaysia 1 Penang (Malay) Penang (Indian) Penang Penang (Chinese) Oman 3 Omani Pakistan 3 South Karachi Philippines 1 Manila Rizal Qatar 1 National (Qatari) Rep. Korea 1 Busan Daegu Daejeon Gwangju Incheon Jejudo National Seoul Ulsan Saudi Arabia 1 Riyadh (Saudi) Singapore 1 National (Indian) National (Chinese) National National (Malay) Thailand 1 Bangkok Chiang Mai Chonburi Khon Kaen Lampang Songkhla Turkey 1 Antalya Edirne Izmir Trabzon Viet Nam 2 Hanoi (Continued on next page)

79 3 BURDEN OF HPV RELATED CANCERS ( Table 8 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Ho Chi Minh City Europe Austria 1 National Tyrol Vorarlberg Belarus 1 National Belgium 1 National Bulgaria 1 National Croatia 1 National Cyprus 1 National Czech Rep. 1 National Denmark 1 National Estonia 1 National Finland 1 National France 1 Bas-Rhin Calvados Doubs Haut-Rhin Herault Isere Loire Atlantique Manche Martinique Somme Tarn Vendee Germany 1 Brandenburg Bremen Free State Of Saxony Hamburg Mecklenburg-Western Pomerania Munich North Rhine-Westphalia Saarland Schleswig-Holstein Iceland 1 National Ireland 1 National Italy 1 Biella Brescia Catania and Messina Catanzaro Como Ferrara Florence and Prato Friuli-Venezia Giulia Genoa Latina Lecco Lombardy, South Mantua Milan Modena Naples Nuoro (Continued on next page)

80 3 BURDEN OF HPV RELATED CANCERS ( Table 8 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Palermo Parma Ragusa Reggio Emilia Romagna Salerno Sassari Sondrio South Tyrol Syracuse Trapani Trento Turin Umbria Varese Veneto Latvia 1 National Lithuania 1 National Malta 1 National Netherlands 1 Eindhoven National Norway 1 National Poland 1 Cracow Kielce Lower Silesia Podkarpackie Portugal 1 Azores Russia 1 Saint Petersburg Serbia 1 Central Slovakia 1 National Slovenia 1 National Spain 1 Albacete Asturias Basque Country Canary Islands Ciudad Real Cuenca Girona Granada La Rioja Mallorca Murcia Navarra Tarragona Sweden 1 National Switzerland 1 Basel Geneva Graubunden and Glarus Neuchatel St Gall-Appenzell Ticino Valais Vaud Zurich (Continued on next page)

81 3 BURDEN OF HPV RELATED CANCERS ( Table 8 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b UK 1 England England, East of England Region England, North Western England, Northern and Yorkshire England, Oxford Region England, South and Western Regions England, Thames England, Trent England, West Midlands Northern Ireland Scotland Wales Ukraine 1 National Oceania Australia 1 Australian Capital Territory New South Wales Northern Territory (Indigenous) Northern Territory Northern Territory (Non-Indigenous) Queensland South Tasmania Victoria Western New Zealand 1 National (Other) National (Pacific Islander) National (Maori) National Data accessed on 05 May a Accumulated number of cases during the period in the population covered by the corresponding registry. b Rates per 100,000 women per year. Data sources: 1 Forman D, Bray F, Brewster DH, Gombe Mbalawa C, Kohler B, Piñeros M, Steliarova-Foucher E, Swaminathan R and Ferlay J eds (2013). Cancer Incidence in Five Continents, Vol. X (electronic version) Lyon, IARC. 2 Parkin, D.M., Whelan, S.L., Ferlay, J., Teppo, L., and Thomas, D.B., eds (2002). Cancer Incidence in Five Continents, Vol. VIII. IARC Scientific Publications No. 155, Lyon, IARC. 3 Curado. M. P., Edwards, B., Shin. H.R., Storm. H., Ferlay. J., Heanue. M. and Boyle. P., eds (2007). Cancer Incidence in Five Continents, Vol. IX. IARC Scientific Publications No. 160, Lyon, IARC. NOTE. For time trends in vulvar cancer incidence, please refer to individual country data.

82 3 BURDEN OF HPV RELATED CANCERS Vaginal cancer Cancer of the vagina is a rare cancer, with an estimated 13,000 new cases in 2008, representing 2% of all gynaecologic cancers (de Martel C et al. Lancet Oncol 2012;13(6):607-15). Although unreported and similar to cervical cancer, the majority of vaginal cancer cases (68%) occur in less developed countries. Most vaginal cancers are squamous cell carcinoma (90%) generally attributable to HPV, followed by clear cell adenocarcinomas and melanoma. Metastatic cervical cancer can be misclassified as cancer of the vagina. Invasive vaginal cancer is diagnosed primarily in old women (>=65 years) and the diagnosis is rare in women under 45 years whereas the peak incidence of carcinoma in situ is observed between ages 55 and 70 (Vaccine 2008, Vol. 26, Suppl 10) Table 9: Incidence of vaginal cancer by cancer registry Female Country name Cancer registry Period N cases a Crude rate b ASR b Africa Algeria 1 Setif Egypt 1 Gharbiah Gambia 2 National Libya 1 Benghazi Malawi 1 Blantyre Mali 2 Bamako South Africa 1 PROMEC Tunisia 1 North Uganda 1 Kyadondo county Zimbabwe 1 Harare (African) Americas Argentina 1 Bahia Blanca Cordoba Mendoza Tierra del Fuego Brazil 1 Aracaju Belo Horizonte Cuiaba Fortaleza Goiania Sao Paulo Canada 1 Alberta British Columbia Manitoba National New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Chile 1 Bío Bío Province Region of Antofagasta Valdivia Colombia 1 Bucaramanga Cali Manizales Pasto Costa Rica 1 National Cuba 1 Villa Clara (Continued on next page)

83 3 BURDEN OF HPV RELATED CANCERS ( Table 9 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Ecuador 1 Cuenca Quito Jamaica 1 Kingston and St Andrew Peru 3 Trujillo Uruguay 1 National USA 1 Alabama (Black) Alabama (White) Alabama Alaska Alaska (American Indian) Arizona (Asian and Pacific Islander) Arizona (American Indian) Arizona Arizona (Black) Arizona (White) Arkansas Arkansas (White) Arkansas (Black) California (American Indian) California (Asian and Pacific Islander) California (Black) California (White) California California, Los Angeles County California, Los Angeles County (Black) California, Los Angeles County (Chinese) California, Los Angeles County (Filipino) California, Los Angeles County (Hispanic White) California, Los Angeles County (Japanese) California, Los Angeles County (Korean) California, Los Angeles County (Non-Hispanic White) California, Los Angeles County (White) California, Los Angeles County (Asian and Pacific Islander) California: San Francisco (Asian and Pacific Islander) California: San Francisco (Hispanic White) California: San Francisco California: San Francisco (Black) California: San Francisco (Non-Hispanic White) California: San Francisco (White) Colorado Colorado (Asian and Pacific Islander) Colorado (Black) Colorado (White) Connecticut (Black) Connecticut Connecticut (White) Delaware (Black) Delaware (White) Delaware Florida Florida (Asian and Pacific Islander) (Continued on next page)

84 3 BURDEN OF HPV RELATED CANCERS ( Table 9 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Florida (Black) Florida (White) Georgia Georgia (Asian and Pacific Islander) Georgia (Black) Georgia (White) Georgia, Atlanta Georgia, Atlanta (Black) Georgia, Atlanta (White) Hawaii (Filipino) Hawaii (Hawaiian) Hawaii (Japanese) Hawaii (White) Hawaii (Chinese) Hawaii Idaho Illinois (Black) Illinois (White) Illinois (Asian and Pacific Islander) Illinois Indiana (Black) Indiana (White) Indiana Iowa Kentucky Louisiana , Louisiana (White) , Louisiana (Black) , Louisiana, New Orleans , Louisiana, New Orleans (Black) , Louisiana, New Orleans (White) , Maine Massachusetts Massachusetts (Asian and Pacific Islander) Massachusetts (Black) Massachusetts (White) Michigan Michigan (Asian and Pacific Islander) Michigan (Black) Michigan (White) Michigan, Detroit Michigan, Detroit (Black) Michigan, Detroit (White) Mississippi Missouri (Continued on next page)

85 3 BURDEN OF HPV RELATED CANCERS ( Table 9 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Missouri (Black) Missouri (White) Montana (American Indian) Montana Nebraska Nebraska (Black) Nebraska (White) New Hampshire New Jersey New Jersey (White) New Jersey (Black) New Mexico New Mexico (Hispanic White) New Mexico (Non-Hispanic White) New Mexico (White) New York State New York State (Asian and Pacific Islander) New York State (Black) New York State (White) North Carolina North Carolina (White) North Carolina (Asian and Pacific Islander) North Carolina (American Indian) North Carolina (Black) North Dakota NPCR (42 States) NPCR (42 States) (American Indian) NPCR (42 States) (Asian and Pacific Islander) NPCR (42 States) (Black) NPCR (42 States) (White) Ohio Ohio (Asian and Pacific Islander) Ohio (Black) Ohio (White) Oklahoma Oklahoma (American Indian) Oklahoma (Black) Oklahoma (White) Oregon Oregon (Asian and Pacific Islander) Oregon (Black) Oregon (White) Pennsylvania (Black) Pennsylvania (Asian and Pacific Islander) Pennsylvania Pennsylvania (White) Puerto Rico Rhode Island Rhode Island (White) Rhode Island (Black) SEER (18 Registries) (Asian and Pacific Islander) SEER (18 Registries) (Black) (Continued on next page)

86 3 BURDEN OF HPV RELATED CANCERS ( Table 9 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b SEER (18 Registries) (Hispanic White) SEER (18 Registries) (White) SEER (18 Registries) SEER (18 Registries) (Non-Hispanic White) SEER (9 Registries) (White) SEER (9 Registries) SEER (9 Registries) (Black) South Carolina (Black) South Carolina South Carolina (White) South Dakota Tennessee (Black) Tennessee (White) Tennessee Texas (White) Texas (Asian and Pacific Islander) Texas (Black) Texas Utah Vermont Virginia Virginia (Black) Virginia (White) Virginia (Asian and Pacific Islander) Washington State Washington, Seattle West Virginia Wisconsin (Black) Wisconsin Wisconsin (White) Wyoming Asia Bahrain 1 National (Bahraini) China 1 Beijing City Cixian County Haining County Harbin City, Nangang District Hong Kong Jiashan County Jiaxing City Macao Qidong County Shanghai City Wuhan City Yangcheng County Yanting County Zhongshan City India 1 Bangalore Barshi, Paranda and Bhum Bhopal Chennai Dindigul, Ambilikkai Karunagappally Mizoram (Continued on next page)

87 3 BURDEN OF HPV RELATED CANCERS ( Table 9 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Mumbai New Delhi Poona Sikkim State Trivandrum Iran 1 Golestan Province Israel 1 National National (Non-Jews) National (Jews) Japan 1 Aichi Prefecture Fukui Prefecture Hiroshima Miyagi Prefecture Nagasaki Prefecture Niigata Prefecture Osaka Prefecture Saga Prefecture Kuwait 1 National National (Non-Kuwaitis) National (Kuwaitis) Malaysia 1 Penang (Malay) Penang (Indian) Penang Penang (Chinese) Oman 3 Omani Pakistan 3 South Karachi Philippines 1 Manila Rizal Qatar 1 National (Qatari) Rep. Korea 1 Busan Daegu Daejeon Gwangju Incheon Jejudo National Seoul Ulsan Saudi Arabia 1 Riyadh (Saudi) Singapore 1 National (Indian) National (Chinese) National National (Malay) Thailand 1 Bangkok Chiang Mai Chonburi Khon Kaen Lampang Songkhla Turkey 1 Antalya Edirne Izmir Trabzon Viet Nam 2 Hanoi (Continued on next page)

88 3 BURDEN OF HPV RELATED CANCERS ( Table 9 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Ho Chi Minh City Europe Austria 1 National Tyrol Vorarlberg Belarus 1 National Belgium 1 National Bulgaria 1 National Croatia 1 National Cyprus 1 National Czech Rep. 1 National Denmark 1 National Estonia 1 National Finland 1 National France 1 Bas-Rhin Calvados Doubs Haut-Rhin Herault Isere Loire Atlantique Manche Martinique Somme Tarn Vendee Germany 1 Brandenburg Bremen Free State Of Saxony Hamburg Mecklenburg-Western Pomerania Munich North Rhine-Westphalia Saarland Schleswig-Holstein Iceland 1 National Ireland 1 National Italy 1 Biella Brescia Catania and Messina Catanzaro Como Ferrara Florence and Prato Friuli-Venezia Giulia Genoa Latina Lecco Lombardy, South Mantua Milan Modena Naples Nuoro (Continued on next page)

89 3 BURDEN OF HPV RELATED CANCERS ( Table 9 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b Palermo Parma Ragusa Reggio Emilia Romagna Salerno Sassari Sondrio South Tyrol Syracuse Trapani Trento Turin Umbria Varese Veneto Latvia 1 National Lithuania 1 National Malta 1 National Netherlands 1 Eindhoven National Norway 1 National Poland 1 Cracow Kielce Lower Silesia Podkarpackie Portugal 1 Azores Russia 1 Saint Petersburg Serbia 1 Central Slovakia 1 National Slovenia 1 National Spain 1 Albacete Asturias Basque Country Canary Islands Ciudad Real Cuenca Girona Granada La Rioja Mallorca Murcia Navarra Tarragona Sweden 1 National Switzerland 1 Basel Geneva Graubunden and Glarus Neuchatel St Gall-Appenzell Ticino Valais Vaud Zurich (Continued on next page)

90 3 BURDEN OF HPV RELATED CANCERS ( Table 9 continued from previous page) Female Country name Cancer registry Period N cases a Crude rate b ASR b UK 1 England England, East of England Region England, North Western England, Northern and Yorkshire England, Oxford Region England, South and Western Regions England, Thames England, Trent England, West Midlands Northern Ireland Scotland Wales Ukraine 1 National Oceania Australia 1 Australian Capital Territory New South Wales Northern Territory (Indigenous) Northern Territory Northern Territory (Non-Indigenous) Queensland South Tasmania Victoria Western New Zealand 1 National (Other) National (Pacific Islander) National (Maori) National Data accessed on 05 May Please refer to original source (available at a Accumulated number of cases during the period in the population covered by the corresponding registry. b Rates per 100,000 women per year. Data sources: 1 Forman D, Bray F, Brewster DH, Gombe Mbalawa C, Kohler B, Piñeros M, Steliarova-Foucher E, Swaminathan R and Ferlay J eds (2013). Cancer Incidence in Five Continents, Vol. X (electronic version) Lyon, IARC. 2 Parkin, D.M., Whelan, S.L., Ferlay, J., Teppo, L., and Thomas, D.B., eds (2002). Cancer Incidence in Five Continents, Vol. VIII. IARC Scientific Publications No. 155, Lyon, IARC. 3 Curado. M. P., Edwards, B., Shin. H.R., Storm. H., Ferlay. J., Heanue. M. and Boyle. P., eds (2007). Cancer Incidence in Five Continents, Vol. IX. IARC Scientific Publications No. 160, Lyon, IARC. NOTE. For time trends in vaginal cancer incidence, please refer to individual country data.

91 3 BURDEN OF HPV RELATED CANCERS Penile cancer The annual burden of penile cancer has been estimated to be 22,000 cases worldwide with incidence rates strongly correlating with those of cervical cancer (de Martel C et al. Lancet Oncol 2012;13(6):607-15). Penile cancer is rare and most commonly affects men aged years. Incidence rates are higher in less developed countries than in more developed countries, accounting for up to 10% of male cancers in some parts of Africa, South America and Asia. Precursor cancerous penile lesions (PeIN) are rare. Cancers of the penis are primarily of squamous cell carcinomas (SCC) (95%) and the most common penile SCC histologic sub-types are keratinising (49%), mixed warty-basaloid (17%), verrucous (8%) warty (6%), and basaloid (4%). HPV is most commonly detected in basaloid and warty tumours but is less common in keratinising and verrucous tumours. Approximately % of PeIN lesions are HPV DNA positive. Table 10: Incidence of penile cancer by cancer registry Male Country name Cancer registry Period N cases a Crude rate b ASR b Africa Algeria 1 Setif Egypt 1 Gharbiah Gambia 2 National Libya 1 Benghazi Malawi 1 Blantyre Mali 2 Bamako Mozambique 3 Lourenco Marques Nigeria 4 Ibadan Senegal 5 Dakar South Africa 1 PROMEC Tunisia 1 North Uganda 1 Kyadondo county Zimbabwe 1 Harare (African) Americas Argentina 1 Bahia Blanca Cordoba Mendoza Tierra del Fuego Brazil 1 Aracaju Belo Horizonte Cuiaba Fortaleza Goiania Sao Paulo Canada 1 Alberta British Columbia Manitoba National New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Chile 1 Bío Bío Province Region of Antofagasta Valdivia (Continued on next page)

92 3 BURDEN OF HPV RELATED CANCERS ( Table 10 continued from previous page) Male Country name Cancer registry Period N cases a Crude rate b ASR b Colombia 1 Bucaramanga Cali Manizales Pasto Costa Rica 1 National Cuba 1 Villa Clara Ecuador 1 Cuenca Quito Jamaica 1 Kingston and St Andrew Paraguay 6 Asuncion Region Peru 7 Trujillo Uruguay 1 National USA 1 Alabama Alabama (Black) Alabama (White) Alaska Alaska (American Indian) Arizona Arizona (Asian and Pacific Islander) Arizona (Black) Arizona (White) Arizona (American Indian) Arkansas Arkansas (White) Arkansas (Black) California California (American Indian) California (Asian and Pacific Islander) California (Black) California (White) California, Los Angeles County California, Los Angeles County (Chinese) California, Los Angeles County (Filipino) California, Los Angeles County (Hispanic White) California, Los Angeles County (Non-Hispanic White) California, Los Angeles County (White) California, Los Angeles County (Asian and Pacific Islander) California, Los Angeles County (Black) California, Los Angeles County (Japanese) California, Los Angeles County (Korean) California: San Francisco California: San Francisco (Asian and Pacific Islander) California: San Francisco (Black) California: San Francisco (Non-Hispanic White) California: San Francisco (White) California: San Francisco (Hispanic White) Colorado Colorado (Asian and Pacific Islander) Colorado (Black) Colorado (White) Connecticut (Continued on next page)

93 3 BURDEN OF HPV RELATED CANCERS ( Table 10 continued from previous page) Male Country name Cancer registry Period N cases a Crude rate b ASR b Connecticut (Black) Connecticut (White) Delaware Delaware (Black) Delaware (White) Florida Florida (Asian and Pacific Islander) Florida (White) Florida (Black) Georgia Georgia (Black) Georgia (White) Georgia (Asian and Pacific Islander) Georgia, Atlanta Georgia, Atlanta (Black) Georgia, Atlanta (White) Hawaii Hawaii (Chinese) Hawaii (Filipino) Hawaii (Japanese) Hawaii (White) Hawaii (Hawaiian) Idaho Illinois (Black) Illinois (White) Illinois (Asian and Pacific Islander) Illinois Indiana Indiana (Black) Indiana (White) Iowa Kentucky Louisiana (White) , Louisiana , Louisiana (Black) , Louisiana, New Orleans (White) , Louisiana, New Orleans , Louisiana, New Orleans (Black) , Maine Massachusetts Massachusetts (Black) Massachusetts (White) Massachusetts (Asian and Pacific Islander) Michigan Michigan (White) (Continued on next page)

94 3 BURDEN OF HPV RELATED CANCERS ( Table 10 continued from previous page) Male Country name Cancer registry Period N cases a Crude rate b ASR b Michigan (Black) Michigan (Asian and Pacific Islander) Michigan, Detroit Michigan, Detroit (Black) Michigan, Detroit (White) Mississippi Missouri (Black) Missouri (White) Missouri Montana Montana (American Indian) Nebraska Nebraska (Black) Nebraska (White) New Hampshire New Jersey New Jersey (White) New Jersey (Black) New Mexico New Mexico (Non-Hispanic White) New Mexico (White) New Mexico (Hispanic White) New York State New York State (White) New York State (Asian and Pacific Islander) New York State (Black) North Carolina North Carolina (American Indian) North Carolina (Asian and Pacific Islander) North Carolina (Black) North Carolina (White) North Dakota NPCR (42 States) NPCR (42 States) (White) NPCR (42 States) (American Indian) NPCR (42 States) (Asian and Pacific Islander) NPCR (42 States) (Black) Ohio Ohio (White) Ohio (Asian and Pacific Islander) Ohio (Black) Oklahoma Oklahoma (American Indian) Oklahoma (White) Oklahoma (Black) Oregon (Asian and Pacific Islander) Oregon (Black) Oregon Oregon (White) Pennsylvania Pennsylvania (Asian and Pacific Islander) Pennsylvania (White) Pennsylvania (Black) (Continued on next page)

95 3 BURDEN OF HPV RELATED CANCERS ( Table 10 continued from previous page) Male Country name Cancer registry Period N cases a Crude rate b ASR b Puerto Rico Rhode Island Rhode Island (Black) Rhode Island (White) SEER (18 Registries) SEER (18 Registries) (Asian and Pacific Islander) SEER (18 Registries) (Black) SEER (18 Registries) (Hispanic White) SEER (18 Registries) (Non-Hispanic White) SEER (18 Registries) (White) SEER (9 Registries) SEER (9 Registries) (Black) SEER (9 Registries) (White) South Carolina South Carolina (White) South Carolina (Black) South Dakota Tennessee Tennessee (Black) Tennessee (White) Texas (Asian and Pacific Islander) Texas (Black) Texas (White) Texas Utah Vermont Virginia Virginia (Black) Virginia (White) Virginia (Asian and Pacific Islander) Washington State Washington, Seattle West Virginia Wisconsin Wisconsin (Black) Wisconsin (White) Wyoming Asia Bahrain 1 National (Bahraini) China 1 Beijing City Cixian County Haining County Harbin City, Nangang District Hong Kong Jiashan County Jiaxing City Macao Qidong County Shanghai City Wuhan City Yangcheng County Yanting County Zhongshan City (Continued on next page)

96 3 BURDEN OF HPV RELATED CANCERS ( Table 10 continued from previous page) Male Country name Cancer registry Period N cases a Crude rate b ASR b India 1 Bangalore Barshi, Paranda and Bhum Bhopal Chennai Dindigul, Ambilikkai Karunagappally Mizoram Mumbai New Delhi Poona Sikkim State Trivandrum Iran 1 Golestan Province Israel 1 National National (Jews) National (Non-Jews) Japan 1 Aichi Prefecture Fukui Prefecture Hiroshima Miyagi Prefecture Nagasaki Prefecture Niigata Prefecture Osaka Prefecture Saga Prefecture Kuwait 1 National (Non-Kuwaitis) National National (Kuwaitis) Kyrgyzstan 6 National Malaysia 1 Penang (Malay) Penang (Chinese) Penang Penang (Indian) Oman 7 Omani Pakistan 7 South Karachi Philippines 1 Manila Rizal Qatar 1 National (Qatari) Rep. Korea 1 Busan Daegu Daejeon Gwangju Incheon Jejudo National Seoul Ulsan Saudi Arabia 1 Riyadh (Saudi) Singapore 1 National National (Indian) National (Malay) National (Chinese) Thailand 1 Bangkok Chiang Mai Chonburi (Continued on next page)

97 3 BURDEN OF HPV RELATED CANCERS ( Table 10 continued from previous page) Male Country name Cancer registry Period N cases a Crude rate b ASR b Khon Kaen Lampang Songkhla Turkey 1 Antalya Edirne Izmir Trabzon Viet Nam 2 Hanoi Ho Chi Minh City Europe Austria 1 National Tyrol Vorarlberg Belarus 1 National Belgium 1 National Bulgaria 1 National Croatia 1 National Cyprus 1 National Czech Rep. 1 National Denmark 1 National Estonia 1 National Finland 1 National France 1 Bas-Rhin Calvados Doubs Haut-Rhin Herault Isere Loire Atlantique Manche Martinique Somme Tarn Vendee Germany 1 Brandenburg Bremen Free State Of Saxony Hamburg Mecklenburg-Western Pomerania Munich North Rhine-Westphalia Saarland Schleswig-Holstein Hungary 6 County Szabolcs-Szatmar County Vas Iceland 1 National Ireland 1 National Italy 1 Biella Brescia Catania and Messina Catanzaro Como Ferrara Florence and Prato (Continued on next page)

98 3 BURDEN OF HPV RELATED CANCERS ( Table 10 continued from previous page) Male Country name Cancer registry Period N cases a Crude rate b ASR b Friuli-Venezia Giulia Genoa Latina Lecco Lombardy, South Mantua Milan Modena Naples Nuoro Palermo Parma Ragusa Reggio Emilia Romagna Salerno Sassari Sondrio South Tyrol Syracuse Trapani Trento Turin Umbria Varese Veneto Latvia 1 National Lithuania 1 National Malta 1 National Netherlands 1 Eindhoven National Norway 1 National Poland 1 Cracow Kielce Lower Silesia Podkarpackie Portugal 1 Azores Romania 6 County Cluj Russia 1 Saint Petersburg Serbia 1 Central Slovakia 1 National Slovenia 1 National Spain 1 Albacete Asturias Basque Country Canary Islands Ciudad Real Cuenca Girona Granada La Rioja Mallorca Murcia Navarra (Continued on next page)

99 3 BURDEN OF HPV RELATED CANCERS ( Table 10 continued from previous page) Male Country name Cancer registry Period N cases a Crude rate b ASR b Tarragona Sweden 1 National Switzerland 1 Basel Geneva Graubunden and Glarus Neuchatel St Gall-Appenzell Ticino Valais Vaud Zurich UK 1 England England, East of England Region England, North Western England, Northern and Yorkshire England, Oxford Region England, South and Western Regions England, Thames England, Trent England, West Midlands Northern Ireland Scotland Wales Ukraine 1 National Oceania Australia 1 Australian Capital Territory New South Wales Northern Territory Northern Territory (Non-Indigenous) Northern Territory (Indigenous) Queensland South Tasmania Victoria Western New Zealand 1 National (Maori) National National (Other) National (Pacific Islander) Data accessed on 05 May Please refer to original source (available at a Accumulated number of cases during the period in the population covered by the corresponding registry. b Rates per 100,000 men per year. Data sources: 1 Forman D, Bray F, Brewster DH, Gombe Mbalawa C, Kohler B, Piñeros M, Steliarova-Foucher E, Swaminathan R and Ferlay J eds (2013). Cancer Incidence in Five Continents, Vol. X (electronic version) Lyon, IARC. 2 Parkin, D.M., Whelan, S.L., Ferlay, J., Teppo, L., and Thomas, D.B., eds (2002). Cancer Incidence in Five Continents, Vol. VIII. IARC Scientific Publications No. 155, Lyon, IARC. 3 Doll, R.,Payne, P.,Waterhouse, J.A.H., eds (1966). Cancer Incidence in Five Continents, Vol. I. Union Internationale Contre le Cancer, Geneva. 4 Waterhouse, J.,Muir, C.S.,Correa, P.,Powell, J., eds (1976). Cancer Incidence in Five Continents, Vol. III. IARC Scientific Publications No. 15, Lyon, IARC. 5 Waterhouse, J.,Muir, C.S.,Shanmugaratnam, K.,Powell, J., eds (1982). Cancer Incidence in Five Continents, Vol. IV. IARC Scientific Publications No. 42, Lyon, IARC. 6 Parkin, D.M.,Muir, C.S.,Whelan, S.L.,Gao, Y.-T.,Ferlay, J.,Powell, J., eds (1992). Cancer Incidence in Five Continents, Vol. VI. IARC Scientific Publications No. 120, Lyon, IARC. 7 Curado. M. P., Edwards, B., Shin. H.R., Storm. H., Ferlay. J., Heanue. M. and Boyle. P., eds (2007). Cancer Incidence in Five Continents, Vol. IX. IARC Scientific Publications No. 160, Lyon, IARC. NOTE. For time trends in penile cancer incidence, please refer to individual country data.

100 3 BURDEN OF HPV RELATED CANCERS Head and neck cancers The majority of head and neck cancers are associated with high tobacco and alcohol consumption. However, increasing trends in the incidence at specific sites suggest that other etiological factors are involved, and infection by certain high-risk types of HPV (i.e. HPV16) have been reported to be associated with head and neck cancers, in particular with oropharyngeal cancer. Current evidence suggests that HPV16 is associated with tonsil cancer (including Waldeyer ring cancer), base of tongue cancer and other oropharyngeal cancer sites. Associations with other head and neck cancer sites such as oral cancer are neither strong nor consistent when compared to molecular-epidemiological data on HPV and oropharyngeal cancer. Association with laryngeal cancer is still unclear (IARC Monograph Vol 100B). Figure 38: Age-standardised incidence rates of head and neck cancer in the World (estimates for 2012) Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. Head and neck cancer cases (oropharynx, oral cavity and larynx). GLOBOCAN quality index for availability of incidence data: - For Afghanistan, Angola, Albania, Armenia, Azerbaijan, Burundi, Bahamas, Belize, Bolivia, Barbados, Central African Republic, DR Congo, Comoros, Cape Verde, Djibouti, Dominican Republic, Eritrea, Western Sahara, Georgia, Guadeloupe, Guinea-Bissau, Equatorial Guinea, Greece, Guatemala, French Guiana, Guyana, Honduras, Haiti, Hungary, Kazakhstan, Kyrgyzstan, Cambodia, Laos, Liberia, Lesotho, Republic of Moldova, Madagascar, Maldives, Macedonia, Myanmar, Montenegro, Mauritania, Nicaragua, Nepal, Panama, Papua New Guinea, DPR Korea, Paraguay, Senegal, Solomon Islands, Sierra Leone, El Salvador, Somalia, South Sudan, Suriname, Syria, Chad, Tajikistan, Turkmenistan, Timor-Leste, Uzbekistan, Venezuela: No data. - For United Arab Emirates, Bosnia & Herzegovina, Bhutan, Botswana, Fiji, Gambia, Guam, Jordan, Lebanon, Sri Lanka, Luxembourg, Mongolia, Mauritius, Namibia, New Caledonia, French Polynesia, Reunion, Russian Federation, Saudi Arabia, Swaziland, Trinidad & Tobago, Vanuatu, Samoa, South Africa: National data (rates). - For Argentina, Brazil, Switzerland, Germany, Spain, France, Italy, Japan, Philippines, Serbia, Thailand: High quality regional (coverage between 10% and 50%). - For Australia, Austria, Belgium, Bulgaria, Bahrain, Belarus, Canada, Costa Rica, Cyprus, Czech Republic, Denmark, Estonia, Finland, United Kingdom, Croatia, Ireland, Iceland, Israel, Republic of Korea, Kuwait, Lithuania, Latvia, Malta, Martinique, Netherlands, Norway, New Zealand, Oman, Puerto Rico, Qatar, Singapore, Slovakia, Slovenia, Sweden, Ukraine, Uruguay, USA: High quality national data or high quality regional (coverage greater than 50%). - For Benin, Burkina Faso, Bangladesh, Brunei, Côte d Ivoire, Gabon, Ghana, Indonesia, Iraq, Palestine, Rwanda, Sudan, Togo: Frequency data. - For Chile, China, Colombia, Cuba, Algeria, Ecuador, Egypt, India, Iran, Jamaica, Libya, Malawi, Malaysia, Poland, Portugal, Tunisia, Turkey, Uganda, Zimbabwe: High quality regional (coverage lower than 10%). - For Cameroon, Congo, Ethiopia, Guinea, Kenya, Morocco, Mexico, Mali, Mozambique, Niger, Nigeria, Pakistan, Peru, Romania, Tanzania, Viet Nam, Yemen, Zambia: Regional data (rates). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Afghanistan, Angola, Burundi, Benin, Central African Republic, DR Congo, Comoros, Cape Verde, Djibouti, Eritrea, Western Sahara, Guinea-Bissau, Equatorial Guinea, Cambodia, Laos, Liberia, Lesotho, Madagascar, Maldives, Myanmar, Montenegro, Mauritania, Nepal, DPR Korea, Rwanda, Senegal, Solomon Islands, Sierra Leone, Somalia, South Sudan, Syria, Chad, Timor-Leste: The rates are those of neighbouring countries or registries in the same area - For Albania, Greece, Hungary, Luxembourg, Republic of Moldova, Macedonia, Portugal, Romania, Serbia: Estimated from national mortality estimates by modelling using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries - For United Arab Emirates, Belgium, Bosnia & Herzegovina, Bhutan, Botswana, Cyprus, Gambia, Guam, Lebanon, Sri Lanka, Mongolia, Mauritius, Namibia, New Caledonia, Oman, Qatar, Swaziland, Ukraine, Uruguay, Samoa: Most recent rates applied to 2012 population - For Argentina, Brazil, Switzerland, Chile, China, Colombia, Cuba, Ecuador, Spain, France, Italy, Japan, Poland: Estimated from national mortality by modelling using incidence mortality ratios derived from recorded data in country-specific cancer registries - For Armenia, Azerbaijan, Bahamas, Belize, Barbados, Brunei, Dominican Republic, Fiji, Georgia, Guadeloupe, Guatemala, French Guiana, Guyana, Honduras, Haiti, Jamaica, Kazakhstan, Kyrgyzstan, Mexico, Nicaragua, Panama, Peru, Paraguay, El Salvador, Suriname, Tajikistan, Turkmenistan, Trinidad & Tobago, Uzbekistan, Venezuela, Viet Nam, Vanuatu: Estimated from national mortality estimates using modelled survival - For Australia, Austria, Bulgaria, Bahrain, Belarus, Canada, Costa Rica, Czech Republic, Germany, Denmark, Estonia, Finland, United Kingdom, Croatia, Ireland, Iceland, Israel, Jordan, Republic of Korea, Kuwait, Lithuania, Latvia, Malta, Martinique, Netherlands, Norway, New Zealand, Puerto Rico, French Polynesia, Reunion, Russian Federation, Saudi Arabia, Singapore, Slovakia, Slovenia, Sweden, USA, South Africa: Rates projected to For Burkina Faso, Bangladesh, Bolivia, Côte d Ivoire, Gabon, Ghana, Iraq, Mozambique, Papua New Guinea, Palestine, Sudan, Togo: Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of different cancers (by age and sex) - For Cameroon, Congo, Ethiopia, Guinea, Libya, Mali, Malawi, Niger, Uganda, Yemen, Zambia: One cancer registry covering part of a country is used as representative of the country profile - For Algeria, Egypt, Indonesia, India, Iran, Kenya, Morocco, Malaysia, Nigeria, Pakistan, Philippines, Thailand, Tunisia, Turkey, Tanzania, Zimbabwe: Estimated as the weighted average of the local rates Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017

101 3 BURDEN OF HPV RELATED CANCERS Figure 39: Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in Africa (estimates for 2012) South Africa Tanzania Rwanda Namibia Mauritius Madagascar Kenya Eq. Guinea Gabon Cameroon Botswana Zimbabwe Zambia Uganda Tunisia Togo Chad Swaziland South Sudan Somalia Sierra Leone Senegal Sudan Niger Mozambique Mali Morocco Lesotho Libya Guinea Ghana Western Sahara Eritrea Egypt Algeria Djibouti Comoros DR Congo CAR Burkina Faso Benin Burundi Angola Seychelles** S.Tome & Prin.** Nigeria** Malawi** Mauritania** Liberia** Guinea Bissau** Gambia** Ethiopia** Cape Verde** Congo** Côte d'ivoire** Age standardised incidence rate per 100,0000 women World Standard ** No rates are available. Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. (Continued on next page)

102 3 BURDEN OF HPV RELATED CANCERS Head and neck cancer cases (oropharynx, oral cavity and larynx). ( Figure 43 continued from previous page) GLOBOCAN quality index for availability of incidence data: - For Côte d Ivoire, Benin, Burkina Faso, Ghana, Sudan, Togo, Gabon, Rwanda: Frequency data. - For Congo, Ethiopia, Nigeria, Guinea, Morocco, Mali, Mozambique, Niger, Zambia, Cameroon, Kenya, Tanzania: Regional data (rates). - For Cape Verde, Guinea-Bissau, Liberia, Mauritania, Angola, Burundi, Central African Republic, DR Congo, Comoros, Djibouti, Eritrea, Western Sahara, Lesotho, Senegal, Sierra Leone, Somalia, South Sudan, Chad, Equatorial Guinea, Madagascar: No data. - For Gambia, Swaziland, Botswana, Mauritius, Namibia, South Africa: National data (rates). - For Malawi, Algeria, Egypt, Libya, Tunisia, Uganda, Zimbabwe: High quality regional (coverage lower than 10%). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Côte d Ivoire, Burkina Faso, Ghana, Mozambique, Sudan, Togo, Gabon: Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of different cancers (by age and sex) - For Congo, Ethiopia, Malawi, Guinea, Libya, Mali, Niger, Uganda, Zambia, Cameroon: One cancer registry covering part of a country is used as representative of the country profile - For Cape Verde, Guinea-Bissau, Liberia, Mauritania, Angola, Burundi, Benin, Central African Republic, DR Congo, Comoros, Djibouti, Eritrea, Western Sahara, Lesotho, Senegal, Sierra Leone, Somalia, South Sudan, Chad, Equatorial Guinea, Madagascar, Rwanda: The rates are those of neighbouring countries or registries in the same area - For Gambia, Swaziland, Botswana, Mauritius, Namibia: Most recent rates applied to 2012 population - For Nigeria, Algeria, Egypt, Morocco, Tunisia, Zimbabwe, Kenya, Tanzania: Estimated as the weighted average of the local rates - For South Africa: Rates projected to 2012 Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017

103 3 BURDEN OF HPV RELATED CANCERS Figure 40: Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in the Americas (estimates for 2012) USA Canada Dominican Rep. Barbados Uruguay Cuba Brazil Venezuela Trinidad & Tob. Paraguay Panama Guyana Guatemala Bahamas Suriname El Salvador Peru Nicaragua Mexico Jamaica Haiti Honduras Ecuador Costa Rica Colombia Chile Bolivia Belize Argentina St Vincent** St Lucia** St Kitts & Nev.** Grenada** Dominica** Antigua & Bar.** Age standardised incidence rate per 100,0000 women World Standard ** No rates are available. Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. (Continued on next page)

104 3 BURDEN OF HPV RELATED CANCERS Head and neck cancer cases (oropharynx, oral cavity and larynx). ( Figure 43 continued from previous page) GLOBOCAN quality index for availability of incidence data: - For Argentina, Brazil: High quality regional (coverage between 10% and 50%). - For Belize, Bolivia, Honduras, Haiti, Nicaragua, El Salvador, Suriname, Bahamas, Guatemala, Guyana, Panama, Paraguay, Venezuela, Barbados, Dominican Republic: No data. - For Chile, Colombia, Ecuador, Jamaica, Cuba: High quality regional (coverage lower than 10%). - For Costa Rica, Uruguay, Canada, USA: High quality national data or high quality regional (coverage greater than 50%). - For Mexico, Peru: Regional data (rates). - For Trinidad & Tobago: National data (rates). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Argentina, Chile, Colombia, Ecuador, Brazil, Cuba: Estimated from national mortality by modelling using incidence mortality ratios derived from recorded data in country-specific cancer registries - For Belize, Honduras, Haiti, Jamaica, Mexico, Nicaragua, Peru, El Salvador, Suriname, Bahamas, Guatemala, Guyana, Panama, Paraguay, Trinidad & Tobago, Venezuela, Barbados, Dominican Republic: Estimated from national mortality estimates using modelled survival - For Bolivia: Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of different cancers (by age and sex) - For Costa Rica, Canada, USA: Rates projected to For Uruguay: Most recent rates applied to 2012 population Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017

105 3 BURDEN OF HPV RELATED CANCERS Figure 41: Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in Asia (estimates for 2012) Rep. Korea India Myanmar Japan Timor Leste Bangladesh Maldives Sri Lanka Cambodia Viet Nam Turkmenistan Thailand Philippines Pakistan Nepal Malaysia Mongolia Kazakhstan Georgia Armenia Afghanistan Yemen Uzbekistan Turkey Tajikistan Syria Singapore Saudi Arabia Qatar Palestine DPR Korea Oman Lebanon Laos Kyrgyzstan Jordan Israel Iraq Iran Indonesia China Bhutan Brunei Bahrain Azerbaijan UAE Taiwan** Kuwait** Age standardised incidence rate per 100,0000 women World Standard ** No rates are available. Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. (Continued on next page)

106 3 BURDEN OF HPV RELATED CANCERS Head and neck cancer cases (oropharynx, oral cavity and larynx). ( Figure 43 continued from previous page) GLOBOCAN quality index for availability of incidence data: - For Kuwait, Bahrain, Israel, Oman, Qatar, Singapore, Republic of Korea: High quality national data or high quality regional (coverage greater than 50%). - For United Arab Emirates, Bhutan, Jordan, Lebanon, Saudi Arabia, Mongolia, Sri Lanka: National data (rates). - For Azerbaijan, Kyrgyzstan, Laos, DPR Korea, Syria, Tajikistan, Uzbekistan, Afghanistan, Armenia, Georgia, Kazakhstan, Nepal, Turkmenistan, Cambodia, Maldives, Timor-Leste, Myanmar: No data. - For Brunei, Indonesia, Iraq, Palestine, Bangladesh: Frequency data. - For China, Iran, Turkey, Malaysia, India: High quality regional (coverage lower than 10%). - For Yemen, Pakistan, Viet Nam: Regional data (rates). - For Philippines, Thailand, Japan: High quality regional (coverage between 10% and 50%). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Kuwait, Bahrain, Israel, Jordan, Saudi Arabia, Singapore, Republic of Korea: Rates projected to For United Arab Emirates, Bhutan, Lebanon, Oman, Qatar, Mongolia, Sri Lanka: Most recent rates applied to 2012 population - For Azerbaijan, Brunei, Kyrgyzstan, Tajikistan, Uzbekistan, Armenia, Georgia, Kazakhstan, Turkmenistan, Viet Nam: Estimated from national mortality estimates using modelled survival - For China, Japan: Estimated from national mortality by modelling using incidence mortality ratios derived from recorded data in country-specific cancer registries - For Indonesia, Iran, Turkey, Malaysia, Pakistan, Philippines, Thailand, India: Estimated as the weighted average of the local rates - For Iraq, Palestine, Bangladesh: Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of different cancers (by age and sex) - For Laos, DPR Korea, Syria, Afghanistan, Nepal, Cambodia, Maldives, Timor-Leste, Myanmar: The rates are those of neighbouring countries or registries in the same area - For Yemen: One cancer registry covering part of a country is used as representative of the country profile Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017

107 3 BURDEN OF HPV RELATED CANCERS Figure 42: Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in Europe (estimates for 2012) Hungary Slovakia Romania France Germany Belgium Moldova Denmark Czech Rep. Belarus Poland Luxembourg Switzerland Austria Ukraine Lithuania Russia Portugal UK Bulgaria Netherlands Latvia Ireland Estonia Slovenia Serbia Norway Croatia Sweden Montenegro Finland Spain Malta Italy Iceland Bosnia & H. Macedonia Albania Greece Cyprus San Marino** Monaco** Liechtenstein** Andorra** Age standardised incidence rate per 100,0000 women World Standard ** No rates are available. Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. (Continued on next page)

108 3 BURDEN OF HPV RELATED CANCERS Head and neck cancer cases (oropharynx, oral cavity and larynx). ( Figure 43 continued from previous page) GLOBOCAN quality index for availability of incidence data: - For Cyprus, Iceland, Malta, Finland, Sweden, Croatia, Norway, Slovenia, Estonia, Ireland, Latvia, Netherlands, Bulgaria, United Kingdom, Lithuania, Ukraine, Austria, Belarus, Czech Republic, Denmark, Belgium, Slovakia: High quality national data or high quality regional (coverage greater than 50%). - For Greece, Albania, Macedonia, Montenegro, Republic of Moldova, Hungary: No data. - For Bosnia & Herzegovina, Russian Federation, Luxembourg: National data (rates). - For Italy, Spain, Serbia, Switzerland, Germany, France: High quality regional (coverage between 10% and 50%). - For Portugal, Poland: High quality regional (coverage lower than 10%). - For Romania: Regional data (rates). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Cyprus, Bosnia & Herzegovina, Ukraine, Belgium: Most recent rates applied to 2012 population - For Greece, Albania, Macedonia, Serbia, Portugal, Luxembourg, Republic of Moldova, Romania, Hungary: Estimated from national mortality estimates by modelling using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries - For Iceland, Malta, Finland, Sweden, Croatia, Norway, Slovenia, Estonia, Ireland, Latvia, Netherlands, Bulgaria, United Kingdom, Russian Federation, Lithuania, Austria, Belarus, Czech Republic, Denmark, Germany, Slovakia: Rates projected to For Italy, Spain, Switzerland, Poland, France: Estimated from national mortality by modelling using incidence mortality ratios derived from recorded data in country-specific cancer registries - For Montenegro: The rates are those of neighbouring countries or registries in the same area Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017

109 3 BURDEN OF HPV RELATED CANCERS Figure 43: Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in Oceania (estimates for 2012) Australia 0.9 Papua N. Guinea 0.8 New Zealand 0.6 Vanuatu 0.2 Solomon Is. 0.1 Fiji 0.1 Samoa** Tuvalu** Tonga** Palau** Nauru** Marshall Is.** Kiribati** FS Micronesia** Age standardised incidence rate per 100,0000 women World Standard ** No rates are available. Data accessed on 08 May ASR: Age-standardized rate, rates per 100,000 per year. Please refer to original source for methods. (Continued on next page)

110 3 BURDEN OF HPV RELATED CANCERS Head and neck cancer cases (oropharynx, oral cavity and larynx). ( Figure 43 continued from previous page) GLOBOCAN quality index for availability of incidence data: - For Samoa, Fiji, Vanuatu: National data (rates). - For Solomon Islands, Papua New Guinea: No data. - For New Zealand, Australia: High quality national data or high quality regional (coverage greater than 50%). GLOBOCAN quality index of methods for calculating incidence: Methods to estimate the sex- and age-specific incidence rates of cancer for a specific country: - For Samoa: Most recent rates applied to 2012 population - For Fiji, Vanuatu: Estimated from national mortality estimates using modelled survival - For Solomon Islands: The rates are those of neighbouring countries or registries in the same area - For New Zealand, Australia: Rates projected to For Papua New Guinea: Age/sex specific rates for "all cancers" were partitioned using data on relative frequency of different cancers (by age and sex) Data sources: de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer Pharyngeal cancer (excluding nasopharynx) Table 11: Cancer incidence of pharynx (excluding nasopharynx) by sex, in the World and its regions. Includes ICD-10 codes: C09-10, C12-14 (estimates for 2012). MALE FEMALE Area N cases Crude a ASR a Cum risk b N cases Crude a ASR a Cum risk b rate (%) ages rate (%) ages World Less developed regions More developed regions Africa Eastern Africa Middle Africa Northern Africa Southern Africa Western Africa Americas Caribbean Central America Northern America South America Asia Central Asia Eastern Asia Southern Asia South-Eastern Asia Western Asia Europe Eastern Europe Northern Europe Southern Europe Western Europe Oceania Australia & New Zealand Melanesia Micronesia Polynesia Data accessed on 15 Nov a Male: Rates per 100,000 men per year. Female: Rates per 100,000 women per year. b Cumulative risk (incidence) is the probability or risk of individuals getting from the disease during ages 0-74 years. For cancer, it is expressed as the % of new born children who would be expected to develop from a particular cancer before the age of 75 if they had the rates of cancer observed in the period in the absence of competing causes. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from: Table 12: Cancer mortality of pharynx (excluding nasopharynx) by sex, in the World and its regions. Includes ICD-10 codes: C09-10, C12-14 (estimates for 2012). MALE FEMALE Area N cases Crude a ASR a Cum risk b N cases Crude a ASR a Cum risk b rate (%) ages rate (%) ages World (Continued on next page)

111 3 BURDEN OF HPV RELATED CANCERS ( Table 12 continued from previous page) MALE FEMALE Area N cases Crude a ASR a Cum risk b N cases Crude a ASR a Cum risk b rate (%) ages rate (%) ages Less developed regions More developed regions Africa Eastern Africa Middle Africa Northern Africa Southern Africa Western Africa Americas Caribbean Central America Northern America South America Asia Central Asia Eastern Asia Southern Asia South-Eastern Asia Western Asia Europe Eastern Europe Northern Europe Southern Europe Western Europe Oceania Australia & New Zealand Melanesia Micronesia Polynesia Data accessed on 15 Nov a Male: Rates per 100,000 men per year. Female: Rates per 100,000 women per year. b Cumulative risk (mortality) is the probability or risk of individuals dying from the disease during ages 0-74 years. For cancer, it is expressed as the % of new born children who would be expected to die from a particular cancer before the age of 75 if they had the rates of cancer observed in the period in the absence of competing causes. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

112 3 BURDEN OF HPV RELATED CANCERS Figure 44: Comparison of cancer incidence and mortality of pharynx (excluding nasopharynx) by sex and age group in the World. Includes ICD-10 codes: C09-10,C12-14 (estimates for 2012) MALE 25 World 25 Less developed regions 25 More developed regions Age specific rates of pharyngeal cancer (excluding nasopharynx) per 100, World >= FEMALE 25 Less developed regions >= More developed regions >= >=75 Incidence >= Mortality >=75 Data accessed on 15 Nov Male: Rates per 100,000 men per year. Female: Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

113 3 BURDEN OF HPV RELATED CANCERS Figure 45: Comparison of cancer incidence and mortality of pharynx (excluding nasopharynx) in males by age group in the World and its regions.. Includes ICD-10 codes: C09-10,C12-14 (estimates for 2012) 30 World Asia Age specific rates of pharyngeal cancer (excluding nasopharynx) per 100, Africa Americas >= >= Europe Oceania >= >= >=75 Incidence Mortality >=75 Age group (years) Data accessed on 15 Nov Male: Rates per 100,000 men per year. Female: Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from: (Continued on next page)

114 3 BURDEN OF HPV RELATED CANCERS ( Figure 45 continued from previous page) Figure 46: Comparison of cancer incidence and mortality of pharynx (excluding nasopharynx) in females by age group in the World and its regions.. Includes ICD-10 codes: C09-10,C12-14 (estimates for 2012) 5 World 5 Asia Age specific rates of pharyngeal cancer (excluding nasopharynx) per 100, Africa Americas >= >= Europe Oceania >= >= >=75 Incidence Mortality >=75 Age group (years)

115 3 BURDEN OF HPV RELATED CANCERS Data accessed on 15 Nov Male: Rates per 100,000 men per year. Female: Rates per 100,000 women per year. Data sources: Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; Available from:

116 4 HPV RELATED STATISTICS HPV related statistics HPV infection is commonly found in the anogenital tract of men and women with and without clinical lesions. The aetiological role of HPV infection among women with cervical cancer is well-established, and there is growing evidence of its central role in other anogenital sites. HPV is also responsible for other diseases such as recurrent juvenile respiratory papillomatosis and genital warts, both mainly caused by HPV types 6 and 11(Lacey CJ, Vaccine 2006; 24(S3):35). For this section, the methodologies used to compile the information on HPV burden are derived from systematic reviews and meta-analyses of the literature. Due to the limitations of HPV DNA detection methods and study designs used, these data should be interpreted with caution and used only as a guide to assess the burden of HPV infection in the population. (Vaccine 2006, Vol. 24, Suppl 3; Vaccine 2008, Vol. 26, Suppl 10; Vaccine 2012, Vol. 30, Suppl 5; IARC Monographs 2007, Vol. 90). 4.1 HPV burden in women with normal cervical cytology, cervical precancerous lesions or invasive cervical cancer The statistics shown in this section focus on HPV infection in the cervix uteri. HPV cervical infection results in cervical morphological lesions ranging from normalcy (cytologically normal women) to different stages of precancerous lesions (CIN-1, CIN-2, CIN-3/CIS) and invasive cervical cancer. HPV infection is measured by means of HPV DNA detection in cervical cells (fresh tissue, paraffin embedded or exfoliated cells). The prevalence of HPV increases with severity of the lesion. HPV causes virtually 100% of cases of cervical cancer, and an underestimation of HPV prevalence in cervical cancer is most likely due to the limitations of study methodologies. Worldwide, HPV-16 and 18, the two vaccine-preventable types. contribute to over 70% of all cervical cancer cases, between 41%-67% of high-grade cervical lesions and 16-32% of low-grade cervical lesions. After HPV-16/18, the six most common HPV types are the same in all world regions, namely 31, 33, 35, 45, 52 and 58; these account for an additional 20% of cervical cancers worldwide (Clifford G et al. Vaccine 2006;24(S3):26-34). Methods: Prevalence and type distribution of human papillomavirus in cervical carcinoma, low-grade cervical lesions, high-grade cervical lesions and normal cytology: systematic review and meta-analysis A systematic review of the literature was conducted regarding the worldwide HPV-prevalence and type distribution for cervical carcinoma, low-grade cervical lesions, high-grade cervical lesions and normal cytology from 1990 to data as of indicated in each section. The search terms for the review were HPV AND cerv* using Pubmed. There were no limits in publication language. References cited in selected articles were also investigated. Inclusion criteria were: HPV DNA detection by means of PCR or HC2, a minimum of 20 cases for cervical carcinoma, 20 cases for low-grade cervical lesions, 20 cases for highgrade cervical lesions and 100 cases for normal cytology and a detailed description of HPV DNA detection and genotyping techniques used. The number of cases tested and HPV positive extracted for each study were pooled to estimate the prevalence of HPV DNA and the HPV type distribution globally and by geographical region. Binomial 95% confidence intervals were calculated for each HPV prevalence. For more details refer to the methods document.

117 4 HPV RELATED STATISTICS HPV prevalence in women with normal cervical cytology Figure 47: Prevalence of HPV among women with normal cervical cytology in the World Data updated on 15 Dec 2016 (data as of 30 Jun 2015). The samples for HPV testing come from cervical specimens (fresh / fixed biopsies or exfoliated cells). Data sources: See references in Section 9.

118 4 HPV RELATED STATISTICS Figure 48: Crude age-specific HPV prevalence (%) and 95% confidence interval in women with normal cervical cytology in the World and its regions HPV prevalence (%) Europe Oceania < < HPV prevalence (%) Africa Asia < < HPV prevalence (%) Americas World < < Age group (years) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). Data sources: See references in Section 9.

119 4 HPV RELATED STATISTICS Figure 49: Prevalence of HPV among women with normal cervical cytology in Africa by country and study Country Study Age N % (95% CI) Algeria Hammouda 2011 a ( ) Hammouda 2005 (Algiers) ( ) Benin Burkina Faso Piras 2011 b Ouédraogo 2015 c ( ) 41.5 ( ) Cameroon Catarino 2016 c ( ) Untiet 2014 (Yaoundé) c ( ) Tebeu 2015 (Tiko and Yaoundé) c ( ) Côte d'ivoire La Ruche 1998 (Abidjan) d ( ) La Ruche 1998 (Abidjan) e ( ) Adjorlolo Johnson 2010 (Abidjan) ( ) DR Congo Sangwa Lugoma 2011 f >=30 1, ( ) Hovland 2010 (Bukavu) ( ) Egypt Shaltout 2014 c ( ) Abdel Aziz 2006 (Cairo) ( ) Ethiopia Leyh Bannurah 2014 (Gurage) c ( ) Ruland 2006 (Gurage) c ( ) Gabon Si Mohamed 2005 (Libreville) c ( ) Gambia Wall 2005 (Farafenni) ( ) Ghana Yar 2016 c ( ) Guinea Keita 2009 (Conakry) ( ) Kenya Temmerman 1999 (Nairobi) c ( ) De Vuyst 2010 (Mombasa) >= ( ) De Vuyst 2003 (Nairobi) ( ) Yamada 2008 (Nairobi) c ( ) Maranga 2013 (Nairobi) ( ) Mali Schluterman 2013 (Naréna) c ( ) Tracy 2011 (Bamako) c ( ) Morocco Alhamany 2010 (Rabat) ( ) Bennani 2012 (Fez) ( ) Amrani 2003 (Rabat) ( ) Belglaiaa ( ) Chaouki 1998 (Rabat) ( ) Mozambique Castellsagué 2001 (Manhiça) ( ) Naucler 2011 (Maputo) ( ) Nigeria Gage 2012 (Irun) >=15 1, ( ) Thomas 2004 (Idikan (Ibadan)) ( ) Pimentel 2013 g ( ) Dareng 2016 c >= ( ) Akarolo Anthony 2013 (Abuja) c ( ) Manga 2015 c ( ) 0% 10% 20% 30% 40% 50% 60% 70% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Zeralda (Algiers) (Continued on next page)

120 4 HPV RELATED STATISTICS ( Figure 49 continued from previous page) b Abomey, Atakora, Cotonou, Djougou, Lagune, Lokossa, Parakou, Porto-Novo and Tanguetà c Women from the general population, including some with cytological cervical abnormalities d HIV negative women (controls of women with HSIL) e HIV negative women (controls of women with LSIL) f Mbuku, Kinshasa g Okene, Abuja and Katari Data sources: See references in Section 9.

121 4 HPV RELATED STATISTICS Figure 50: Prevalence of HPV among women with normal cervical cytology in Africa by country and study (continued) Country Study Age N % (95% CI) Rwanda Sinayobye 2014 a , ( ) Singh 2009 a >= ( ) Veldhuijzen 2012 (Kigali) a ( ) Senegal Hawes 2003 (Dakar) a >=15 3, ( ) Hanisch 2013 (Dakar) a , ( ) Xi 2003 (Dakar) , ( ) Mbaye 2014 (Dakar) ( ) Mbaye 2014 (Thiès) ( ) Astori 1999 (Dakar) ( ) Mbaye 2014 (Saint Louis) a ( ) Mbaye 2014 (Louga) ( ) South Africa McDonald 2012 (Khayelitsha) , ( ) Denny 2005 (Khayelitsha) a , ( ) Richter 2013 a,b , ( ) Wright 2000 (Cape Town) , ( ) Allan 2008 (Cape Town) ( ) Giuliano 2015 a ( ) Jones 2007 (Cape Town) >= ( ) Mbulawa 2015 a ( ) Tanzania Dartell 2014 c , ( ) Vidal 2011 (Kilimanjaro) >= ( ) Watson Jones 2013 (Mwanza) ( ) Tunisia Guettiti ( ) Hassen 2003 (Sousse) ( ) Uganda Jeronimo 2014 (Kampala) , ( ) Banura 2008 (Kampala) a ( ) Safaeian 2007 (Rakai) a ( ) Asiimwe 2008 (Bushenyi District) a ( ) Odida 2011 (Kampala) ( ) Moses 2015 a ( ) Taube 2010 (Kampala) ( ) Zimbabwe Fukuchi 2009 a,d , ( ) Nowak 2011 a,e ( ) Womack 2000 e ( ) Baay 2004 (Mupfure) a ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Women from the general population, including some with cytological cervical abnormalities b Tshwane District, Gauteng province c Dar es Salaam, Pwani, Mwanza d Chitungwiza, Epworth (Harare) e Chitungwiza and Harare Data sources: See references in Section 9.

122 4 HPV RELATED STATISTICS Figure 51: Prevalence of HPV among women with normal cervical cytology in the Americas by country and study Country Study Age N % (95% CI) Argentina Matos 2003 (Entre Ríos) ( ) Chouhy 2013 a ( ) Chouhy 2013 (Buenos Aires) ( ) Abba 2003 (La Plata) ( ) Badano 2011 (Posadas City) ( ) Belize Cathro 2009 (Belize City) ( ) Bolivia Cervantes 2003 b,c ( ) Brazil Trottier 2006 (Sao Paulo) , ( ) Lorenzi 2013 d , ( ) Girianelli 2010 e , ( ) Roteli Martins 2011 c , ( ) Magalhães , ( ) Carestiato 2006 (Rio de Janeiro) ( ) Oliveira 2007 (Pacoti, Ceara) c ( ) Franco 1995 (Paraiba) c ( ) Tomita ( ) Noronha 2005 (Para) ( ) Figueiredo Alves 2013 (Goiana) c ( ) da Silva 2012 f ( ) Miranda 2012 g ( ) Chagas ( ) de Abreu 2012 h ( ) Augusto 2014 (Niterói City) ( ) Coser 2013 (Cruz Alta) ( ) Rocha 2013 i ( ) Pinto 2011 (Pará) c >= ( ) Caixeta ( ) Vieira ( ) Oliveira 2010 j ( ) Lorenzato 2000 (Recife) ( ) Pinto 2011 (Tucuruí) >= ( ) Lippman 2010 (Sao Pulo) ( ) Muñoz 1996 (Sao Paulo) ( ) Campos 2014 (Campo Grande) c ( ) de Oliveira 2013 (Rio Grande) c >= ( ) Cassel 2014 (Porto Alegre) ( ) Entiauspe 2014 (Pelotas) ( ) Silva 2009 (Maricá) ( ) Silva 2009 (Itaboraí) ( ) Tamegão Lopes 2014 k ( ) 0% 10% 20% 30% 40% 50% 60% 70% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Granadero Baigorria City (Santa Fe Province) (Continued on next page)

123 4 HPV RELATED STATISTICS ( Figure 51 continued from previous page) b Amazonian lowland c Women from the general population, including some with cytological cervical abnormalities d Barretos (Sao Paulo) e Duque de Caxias and Nova Iguaçu (State of Rio de Janeiro) f Paiçandú (Paraná) g Ouro Preto city (Minas Gerais) h Maringá, Paiçandú and Uniao da Vitoria (Paraná State) i Coari (Amazonas State) j Niterói City (Rio de Janeiro) k Juruti (Pará) Data sources: See references in Section 9.

124 4 HPV RELATED STATISTICS Figure 52: Prevalence of HPV among women with normal cervical cytology in the Americas by country and study (continued) Country Study Age N % (95% CI) Brazil Fernandes 2009 (Natal) ( ) Canada Louvanto 2014 (Montreal) a , ( ) Jiang 2013 b , ( ) Mayrand 2006 c , ( ) Ogilvie 2013 (British Columbia) a 4, ( ) Moore 2009 (British Columbia) >=15 4, ( ) Young 1997 (Winnipeg) 1, ( ) Sellors 2000 (Ontario) ( ) Richardson 2003 (Montreal) ( ) Demers 2012 (Manitoba) >= ( ) Kapala 2007 (Ontario) ( ) Roteli Martins ( ) Chile Ferreccio 2013 (Santiago) , ( ) Ferreccio 2008 a , ( ) Ferreccio 2004 (Santiago) ( ) Montalvo 2011 (Arica) ( ) Colombia Molano 2002 (Bogota) , ( ) Soto De Leon 2011 d , ( ) Camargo 2014 (Bogotá) a , ( ) Leon 2009 (Girardot) ( ) Muñoz 1996 (Cali) ( ) Costa Rica Herrero 2005 (Guanacaste) , ( ) Safaeian 2007 (Guanacaste) , ( ) Cuba Soto 2014 (La Havana) ( ) Ecuador Brown 2009 (Guayas) ( ) Cecchini ( ) Guatemala Vallès 2009 (Escuintla) ( ) Guyana Kightlinger , ( ) Haiti Walmer 2013 a,e , ( ) Mandigo ( ) Honduras Tábora 2009 (Tegucigalpa) ( ) Ferrera 1999 (Tegucigalpa) ( ) Ferrera 2011 (Tegucigalpa) a ( ) Tábora 2005 (Tegucigalpa) ( ) Jamaica Lewis Bell ( ) Watt 2009 (Western Jamaica) a ( ) Mexico Lazcano Ponce 2010 f , ( ) Salmerón 2003 (Morelos) , ( ) Illades Aguiar 2010 g , ( ) Lazcano Ponce 2001 (Morelos) , ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Women from the general population, including some with cytological cervical abnormalities (Continued on next page)

125 4 HPV RELATED STATISTICS ( Figure 52 continued from previous page) b Northwest Territories, Nunavut, Labrador, Yukon. c Montreal and Newfoundland d Bogotá, Leticia, Chaparral, Giradot and Tumaco e Port-au-Prince, Leogane f Northern and Southern Mexico City, State of Mexico,Guerrero, Michoacán, Morelos, Jalisco, Nuevo León,Oaxaca, Querétaro, Veracruz and Yucatán g Acapulco, Chilpancingo and Iguala (State of Guerrero) Data sources: See references in Section 9.

126 4 HPV RELATED STATISTICS Figure 53: Prevalence of HPV among women with normal cervical cytology in the Americas by country and study (continued) Country Study Age N % (95% CI) Mexico Hernández Girón 2005 a,b , ( ) Salcedo , ( ) Giuliano 2001 (Sonora) ( ) López Rivera 2012 (Mexico City) ( ) Carrillo García ( ) Parada 2010 (State of Mexico) b ( ) Sánchez Anguiano 2006 c ( ) Aguilar Lemarroy ( ) Orozco Colín 2010 b,d ( ) Orozco Colín 2010 (Acapulco) ( ) Monroy 2010 (Mexico City) ( ) Giuliano 2005 (Sonora) ( ) Illades Aguiar 2009 (Acapulco) ( ) Hernández Avila 1997 b,e ( ) Rojo Contreras 2008 f ( ) Nicaragua Jeronimo 2014 (Masaya Province) , ( ) Paraguay Mendoza 2011 (Asunción) ( ) Torres 2009 (Asunción) ( ) Rolón 2000 (Asunción) ( ) Peru Almonte 2007 (San Martin) , ( ) Iwasaki 2014 b,g , ( ) García ( ) Silva Caso 2014 (Cajamarca) ( ) Martorell 2012 h ( ) Santos 2001 (Lima) ( ) Suriname Geraets 2014 (Paramaribo) b >= ( ) Geraets ( ) Trinidad & Tob. Andall Brereton 2011 (North) b ( ) Ragin 2007 (Tobago) ( ) USA Cuzick ,145, ( ) Castle 2009 i , ( ) Monsonego 2015 (23 states) >=25 38, ( ) Wheeler 2013 (New Mexico) 33, ( ) Sherman 2003 (Portland) , ( ) Castle 2012 (Portland) b , ( ) Schiffman 2011 (Portland) , ( ) Dunne 2013 j , ( ) Zhao 2007 (Pittsburgh) , ( ) Datta 2008 k , ( ) Goodman 2008 (Hawaii) , ( ) 0% 10% 20% 30% 40% 50% 60% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Cuernavaca (Continued on next page)

127 4 HPV RELATED STATISTICS ( Figure 53 continued from previous page) b Women from the general population, including some with cytological cervical abnormalities c Durango City d Lázaro Cárdenas e Mexico City f Guadalajara g Iquitos, Cajamarca, Piura, Chiclayo, Lima, Arequipa, Cuzco and Juliana h Iquitos and Loretos i Northern California j San Francisco Bay, Sacramento, Central Valley, Northwest Oregon and Southwest Washington Areas k Boston, Baltimore, New Orleans, Denver, Seattle, Los Angeles Data sources: See references in Section 9.

128 4 HPV RELATED STATISTICS Figure 54: Prevalence of HPV among women with normal cervical cytology in the Americas by country and study (continued) Country Study Age N % (95% CI) USA Dunne 2007 a , ( ) Insinga , ( ) Cibas 2007 (Boston) , ( ) Giuliano 1999 (Tucson) ( ) Giuliano 2001 (Arizona) ( ) Winer 2003 (Seattle) a ( ) Moscicki 2001 (San Francisco) ( ) Khanna 2007 (Baltimore) ( ) Kahn 2008 (Cincinnati) a ( ) Kotloff 1998 (Maryland) ( ) Evans 2006 (Vermont) ( ) Swan 1999 (Texas) ( ) Smith 2003 (Iowa) ( ) Tarkowski 2004 (Atlanta) ( ) Hernandez 2004 (Hawaii) >= ( ) Chaturvedi 2005 (New Orleans) ( ) Smith 2004 (Iowa) ( ) Uruguay Berois 2014 (Montevideo) ( ) Ramas ( ) Venezuela Téllez ( ) Michelli ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Women from the general population, including some with cytological cervical abnormalities Data sources: See references in Section 9.

129 4 HPV RELATED STATISTICS Figure 55: Prevalence of HPV among women with normal cervical cytology in Asia by country and study Country Study Age N % (95% CI) Bahrain Hajjaj ( ) Bangladesh Nahar 2014 (Dhaka and Mirzapur) a , ( ) Bhutan Tshomo 2014 (Thimphu) , ( ) China Wei 2014 b , ( ) Chen 2012 (Chaozhou) a , ( ) Wang 2012 a,b , ( ) Mai 2014 c >=18 22, ( ) DU 2012 (Shenzhen) a , ( ) Zhang 2013 (Shangai) a , ( ) Belinson 2011 d , ( ) Moy 2010 e , ( ) Zhao 2013 f , ( ) Belinson 2003 g , ( ) Zhang 2008 (Shangai) a , ( ) Sun 2012 a,h , ( ) Li 2010 (Beijing) , ( ) Zhao 2014 (Jiangsi Province) , ( ) Ye 2010 (Zhejiang Province) a , ( ) Wang 2013 (Shenzhen) a >=15 4, ( ) Wu 2013 i , ( ) Li 2013 (Hunan Province) , ( ) Yuan 2011 (Shandong Province) , ( ) Jin 2010 j , ( ) Chan 2009 (Hong Kong) , ( ) Chen 2013 (Urumqi) a , ( ) Qiao 2008 k , ( ) Wu 2010 a,l , ( ) Chan 2002 (Hong Kong) , ( ) Belinson 2001 h , ( ) Lin 2008 (Guandong) a , ( ) Yip 2010 (Macao) a , ( ) Lu 2015 (Beijing) a 1, ( ) Yeoh 2006 (Hong Kong) 1, ( ) Zhang 2012 a,m , ( ) Wu 2007 (Shenzhen) ( ) Sui 2013 a,n ( ) Ye 2010 o ( ) Li 2006 (Shenyang) ( ) Dai 2006 (Shanxi) ( ) Wang 2014 (Luoyang (Henan)) a ( ) 0% 10% 20% 30% 40% 50% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Women from the general population, including some with cytological cervical abnormalities b Shenyang (Liaoning Province) c Shantou City (Guandong Province) (Continued on next page)

130 4 HPV RELATED STATISTICS d Guangdong Province e Shanxi, Jiangxi and Gansu Provinces f Yangcheng, Xinmi and Tonggu g Yangcheng and Xiangyuan (Shanxi) h Qujing (Yunnan Province) i Beijing, Shanghai, Shanxi, Henan, Xinjiang j Tibetan Autonomous Region k Wuxiang and Xiangyuan (Shanxi Province) l Shenzhen (Guangdong Province) m Wufeng County (Hubei Province) n Uyghur (Yutian County, Xingjian Province) o Lishui County (Zhejiang Province) Data sources: See references in Section 9. ( Figure 55 continued from previous page)

131 4 HPV RELATED STATISTICS Figure 56: Prevalence of HPV among women with normal cervical cytology in Asia by country and study (continued) Country Study Age N % (95% CI) China He 2008 (Hangzhou) ( ) Chui 2012 (Macau) a ( ) Bian 2013 (Beijing) ( ) Yu 2013 a,b ( ) Wu 2010 (Fujian Province) ( ) Wang 2013 (Huzhou) a ( ) Hu 2011 (Jaingsu Province) ( ) Ding 2014 (Beijing) ( ) Sun 2010 (Liaoning Province) ( ) Georgia Alibegashvili 2011 (Tbilisi) , ( ) India Basu 2013 (West Bengal) a , ( ) Sankaranarayanan 2005 a,c , ( ) Mittal 2014 (Kolkata) a , ( ) Sankaranarayanan 2004 d , ( ) Jeronimo 2014 e , ( ) Jeronimo 2014 (Hyderabad) , ( ) Sankaranarayanan 2004 f , ( ) Sankaranarayanan 2004 g , ( ) Sankaranarayanan 2004 (Mumbai) , ( ) Srivastava 2012 (Varanasi) a , ( ) Gravitt 2010 a,h >=25 2, ( ) Dutta 2012 (Eastern India) , ( ) Franceschi 2005 (Tamil Nadu) , ( ) Datta 2010 a,i , ( ) Sarkar 2011 (West Bengal) j >=15 1, ( ) Laikangbam 2007 (West Bengal) , ( ) Pandey 2012 (Lucknow) a ( ) Gupta 2009 (New Delhi) ( ) Laikangbam 2007 (Manipur) ( ) Aggarwal 2006 (Chandigarh) ( ) Kerkar 2011 (Mumbai) ( ) Bhatla 2008 (New Delhi) ( ) Laikangbam 2007 (Sikkim) ( ) Vinodhini 2012 (Tamil Nadu) ( ) Kashyap 2013 k ( ) Arora 2005 (New Delhi) ( ) Singh 2009 (North India) ( ) Indonesia Vet 2008 (Tasikmalaya) ( ) Vet 2008 (Bali) ( ) Vet 2008 (Jakarta) a ( ) 0% 10% 20% 30% 40% 50% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Women from the general population, including some with cytological cervical abnormalities (Continued on next page)

132 4 HPV RELATED STATISTICS b Shiquan County (Shaanxi Province) c Osnamabad d Kolkata (2) e Rural Uttar Pradesh f Trivandrum g Kolkata (1) h Medchal Mandal (Andhra Pradesh) i Govindpuri (New Delhi) j Few HPV types tested: 16, 18 only k Few HPV types tested: 16 only Data sources: See references in Section 9. ( Figure 56 continued from previous page)

133 4 HPV RELATED STATISTICS Figure 57: Prevalence of HPV among women with normal cervical cytology in Asia by country and study (continued) Country Study Age N % (95% CI) Indonesia de Boer 2006 (Jakarta) ( ) Rachmadi 2012 a ( ) Iran Eghbali 2012 (Bushehr Port) b ( ) Khodakarami 2012 (Tehran) ( ) Zavarei 2008 (Tehran) ( ) Safaei 2010 (Shiraz) ( ) Shahramian 2011 (Zabol) b ( ) Moradi 2011 (Gorgan) ( ) Zandi 2010 (Bushehr) b ( ) Japan Inoue 2006 (Ishikawa) , ( ) Maehama 2005 (Okinawa) , ( ) Asato 2004 (Okinawa) , ( ) Takehara 2011 c , ( ) Sasagawa 2001 d , ( ) Onuki 2009 (Ibaraki) , ( ) Chen 2013 (Nagasaki) b 1, ( ) Konno 2011 e ( ) Saito 1995 (Osaka) ( ) Sasagawa 1997 f ( ) Sasagawa 2005 (Hokuriku) ( ) Ishi 2004 (Chiba) ( ) Masumoto 2004 (Tokyo) ( ) Nishiwaki ( ) Yoshikawa 1999 <= ( ) Satoh 2013 (Tsukuba, Tokyo) ( ) Kazakhstan Buleshov 2011 (South) b , ( ) Kuwait Al Awadhi , ( ) Lebanon Mroueh 2002 (Beirut) b , ( ) Karam ( ) Malaysia Tay 2009 (Johor and Singapore) ( ) Othman 2014 g ( ) Chong 2010 (Southern Selangor) b ( ) Mongolia Dondog 2008 (Ulaanbaatar) ( ) Chimeddorj 2008 h ( ) Nepal Sherpa 2010 i ( ) Johnson 2014 j ( ) Pakistan Raza 2010 (Karachi) ( ) Philippines Ngelangel 1998 (Manila) ( ) Rep. Korea Lee 2012 b , ( ) Lee 2012 (Suwon) 26, ( ) 0% 10% 20% 30% 40% 50% 60% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Jakarta, Tasikmalaya and Bali (Continued on next page)

134 4 HPV RELATED STATISTICS ( Figure 57 continued from previous page) b Women from the general population, including some with cytological cervical abnormalities c Few HPV types tested: 16, 18, 52, 58 only d Hokuriku(Fukui, Ishikawa and Toyama) e Aomori, Tokyo, Fukui, Osaka, Hiroshima, Miyazaki and Kagoshima f Ishikawa and Toyama g North-Eastern region os West Malaysia h Few HPV types tested: 16 only i Bharatpur (Chitawan Province) j Sanphebagar Village (Achham District) Data sources: See references in Section 9.

135 4 HPV RELATED STATISTICS Figure 58: Prevalence of HPV among women with normal cervical cytology in Asia by country and study (continued) Country Study Age N % (95% CI) Rep. Korea Kim 2012 (Seoul) 11, ( ) Kim 2013 (Seoul) 6, ( ) Kim 2014 (Cheonan) a , ( ) Oh 2009 (Busan and Suwon) , ( ) Bae 2009 (Gyeonggi, Seoul) , ( ) Kim 2013 (Seoul) , ( ) Park , ( ) Bae 2009 a , ( ) Hwang , ( ) Kim , ( ) Oh 2001 (Seoul) , ( ) An 2003 (Kyonggi do) 1, ( ) Lee 2014 (Seoul, Busan, Cheonan) a ( ) Kim 2010 a ( ) Kim 2012 b ( ) Shin 2003 (Busan) ( ) Kim 2014 (Gangnam (Seoul)) a ( ) Lee 2003 (Seoul) ( ) Shin 2004 (Busan) a ( ) Cho 2011 a ( ) Bae 2014 (Seoul) ( ) Cho 2003 (Kyonggi do) ( ) Kim 2014 (Busan) a ( ) Shim 2010 (Seoul) ( ) Kim 2013 (Gwangju) ( ) Hwang 2012 a ( ) Um ( ) Lee ( ) Saudi Arabia Al Ahdal 2014 (Riyadh) ( ) Taiwan Lai 2012 (Taoyuan) , ( ) Wang 2010 a,c , ( ) Chen 2011 d , ( ) Lin 2006 (South Taiwan) a , ( ) Huang , ( ) Jeng 2005 (Taipei) , ( ) Liaw ( ) Tsai 2005 (Kaohsiung County) >= ( ) Lin 2005 (Kaohsiung) ( ) Thailand Swangvaree 2010 (Bangkok) , ( ) Laowahutanont 2014 (Bangkok) >=20 2, ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Women from the general population, including some with cytological cervical abnormalities (Continued on next page)

136 4 HPV RELATED STATISTICS b Few HPV types tested: 6, 11, 42, 43, 44 only c Taipei, Taoyuan, Chungli, Hsinchu, Keelung) d Sanchi, Chutung, Potzu,Kaoshu, Makung, Paihsa and Huhsi Data sources: See references in Section 9. ( Figure 58 continued from previous page)

137 4 HPV RELATED STATISTICS Figure 59: Prevalence of HPV among women with normal cervical cytology in Asia by country and study (continued) Country Study Age N % (95% CI) Thailand Siriaunkgul 2014 (Chiang Mai) , ( ) Paengchit 2014 a , ( ) Chansaenroj 2010 (Bangkok) 1, ( ) Marks 2011 b,c , ( ) Sukvirach 2003 (Lampang) ( ) Sukvirach 2003 (Songkla) ( ) Wongworapat 2008 (Chiang Mai) c ( ) Chandeying 2006 c,d ( ) Thomas 2001 (Bangkok) c ( ) Chichareon 1998 (Songkla) ( ) Suwannarurk 2009 (Pathumthani) e ( ) Natphopsuk 2013 (Khon Kaen) ( ) Chopjitt 2009 (Khon Kaen) ( ) Ekalaksananan 2010 (Khon Kaen) ( ) Chaiwongkot 2007 (Khon Kaen) ( ) Sriamporn 2006 (Khon Kaen) >= ( ) Siritantikorn 1997 (Bangkok) ( ) Settheetham Ishida 2005 f ( ) Turkey Inal 2007 (Izmir) , ( ) Yuce 2012 (Ankara) ( ) Ozalp 2012 (Eskisehir region) ( ) Kasap 2011 (Izmir) ( ) Demir 2012 g ( ) Sahiner ( ) Bayram 2011 (Gaziantep) ( ) Özcan ( ) Eren 2010 (Istanbul) ( ) Altun 2011 (Adana) c ( ) Akcali 2013 (Manisa) c ( ) Tezcan 2014 (Mersin Province) ( ) Sahiner 2014 (Ankara) c ( ) Dursun ( ) Oztürk ( ) Uzbekistan Inamova 2009 (Tashkent) , ( ) Viet Nam Vu 2012 (Can Tho) c , ( ) Vu 2012 (Hue) c , ( ) Vu 2012 (Thai Nguyen) , ( ) Pham 2003 (Hanoi) ( ) Pham 2003 (Ho Chi Minh City) ( ) Vu 2011 (Ho Chi Minh) c ( ) 0% 10% 20% 30% 40% 50% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Lampang Province (Continued on next page)

138 4 HPV RELATED STATISTICS ( Figure 59 continued from previous page) b Chiang Mai, Khon Kaen, Bangkok, Songkla and Hat Yai c Women from the general population, including some with cytological cervical abnormalities d Hat Yai (South Thailand) e Few HPV types tested: 16, 18, 31, 33 only f Khon Kaen g Istanbul, Ankara, Antalya, Nigde and Elazig Data sources: See references in Section 9.

139 4 HPV RELATED STATISTICS Figure 60: Prevalence of HPV among women with normal cervical cytology in Asia by country and study (continued) Country Study Age N % (95% CI) Viet Nam Vu 2011 (Hanoi) ( ) 0% 10% Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

140 4 HPV RELATED STATISTICS Figure 61: Prevalence of HPV among women with normal cervical cytology in Europe by country and study Country Study Age N % (95% CI) Belarus Rogovskaya 2013 (Minsk) ( ) Belgium Depuydt 2010 (Flanders) a , ( ) Arbyn 2009 (Antwerp) , ( ) Merckx 2014 a,b , ( ) Baay 2005 (Antwerp) , ( ) Depuydt , ( ) Schmitt 2013 (Flanders) ( ) Weyn 2013 (Brussels) >= ( ) Depuydt 2003 (Flanders) ( ) Baay 2001 (Antwerp) ( ) Bulgaria Kovachev 2013 a,c , ( ) Croatia Kaliterna 2013 (Dalmatia County) a , ( ) Kaliterna 2007 a,d ( ) Grahovac 2007 (Zagreb,Rijeka) ( ) Czech Rep. Tachezy , ( ) Denmark Kjær 2014 (Copenhagen) e , ( ) Nielsen 2008 (Copenhagen) , ( ) Bonde 2014 f , ( ) Nielsen 2008 (Copenhagen) , ( ) Svare ( ) Estonia Uusküla 2010 (Tartu) a ( ) Europe Joura , ( ) Paavonen 2008 g , ( ) Finland Malila 2013 a , ( ) Auvinen 2005 (Helsinki) a , ( ) France Clavel 2001 (Reims) , ( ) Monsonego 2011 (Paris) , ( ) Boulanger 2004 (Amiens) , ( ) Heard 2013 h , ( ) Vaucel 2011 (Nantes) ( ) Baudu 2014 (Franche Comté) ( ) Dalstein 2003 (Besançon) ( ) Haguenoer ( ) Beby Defaux 2004 (Poitiers) ( ) Riethmuller 1999 i ( ) Casalegno 2011 (Lyon) ( ) Pannier Stockman 2008 (Amiens) ( ) Monsonego 2005 (Paris) ( ) Germany Luyten 2014 (Wolfsburg) 23, ( ) Petry 2003 j , ( ) 0% 10% 20% 30% 40% 50% 60% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Women from the general population, including some with cytological cervical abnormalities (Continued on next page)

141 4 HPV RELATED STATISTICS ( Figure 61 continued from previous page) b Flanders and Brussels c Sofia, Plovdiv, Varna, Burgas, Pleven and Vidin d Split and Dalmatian County e HPV prevalence for high-risk HPV types f Copenhagen and Frederiksberg g Czech Republic, Denmark, England, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Netherlands, Norway, Poland, Portugal, Spain, and Sweden h Alsace, Auvergne, Centre - Pays de Loire, Ile-de-France and Vaucluse i Besançon, Belfort j Hannover and Tuebingen Data sources: See references in Section 9.

142 4 HPV RELATED STATISTICS Figure 62: Prevalence of HPV among women with normal cervical cytology in Europe by country and study (continued) Country Study Age N % (95% CI) Germany Schneider 2000 (East Thuringia) , ( ) Iftner , ( ) de Jonge 2013 a >=20 1, ( ) Petry 2013 (Wolfsburg) ( ) Petry 2013 (Wolfsburg) b ( ) Greece Agorastos 2014 b 5, ( ) Agorastos 2015 c , ( ) Argyri 2013 (Athens) , ( ) Tsiodras , ( ) Agorastos 2004 d , ( ) Tsiodras 2010 (Athens) , ( ) Paraskevaidis 2001 (Ioannina) ( ) Panotopoulou 2007 (Athens) ( ) Hungary Nyári ( ) Ireland Anderson 2013 (Northern Ireland) , ( ) Keegan 2007 (Dublin) ( ) Italy Del Mistro 2014 (Veneto) b , ( ) Carozzi 2014 e , ( ) Agarossi , ( ) Giorgi Rossi 2011 f , ( ) Tenti 1997 (Pavia) , ( ) Ronco 2005 (Turin) ( ) Giambi 2013 g ( ) Ammatuna 2008 (Sicily) ( ) Del Prete 2008 (Apulia) b >= ( ) Verteramo 2009 (Rome) ( ) Panatto 2013 h ( ) Centurioni 2005 (Genova) ( ) Salfa 2011 (Asti) ( ) Sammarco 2013 (Molise) ( ) Barzon 2010 (Padova) ( ) Carozzi 2000 (Florence) ( ) Masia 2009 (Sardinia) ( ) Bellaminutti 2014 b ( ) Piana 2011 (North Sardinia) ( ) Zappacosta 2009 (Molise) ( ) Astori 1997 (Udine) ( ) Tornesello 2006 (Milan, Naples) ( ) Tornesello 2008 (Naples) ( ) Latvia Silins 2004 b ( ) 0% 10% 20% 30% 40% 50% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Nordrhein-Westfalen, Niedersachsen, Schleswig-Holstein, Bremen and Hamburg (Continued on next page)

143 4 HPV RELATED STATISTICS ( Figure 62 continued from previous page) b Women from the general population, including some with cytological cervical abnormalities c Athens, Thessaloniki, Larissa, Patrasand Alexandroupolis d Thessaloniki, Thermi, Mihaniona, Corfu, Veria and Serres e Turin, Padua, Trento and Florence f Abruzzo, Campania, Lazio, Sardinia and Sicily g Abruzzo, Campania, Lazio, Tuscany, Emilia-Romagna and Piedmont h Turin, Milan and Genoa Data sources: See references in Section 9.

144 4 HPV RELATED STATISTICS Figure 63: Prevalence of HPV among women with normal cervical cytology in Europe by country and study (continued) Country Study Age N % (95% CI) Lithuania Kliucinskas 2006 a , ( ) Gudleviciene 2005 (Vilnius) ( ) Simanaviciene 2014 (Vilnius) ( ) Bumbuliene 2012 (Vilnius) a ( ) Montenegro Vujosevic 2012 (Podgorica) a ( ) Netherlands Rijkaart 2012 (Utrecht) , ( ) Bulkmans 2004 (Amsterdam) , ( ) Rijkaart , ( ) Jacobs 2000 (Amsterdam) , ( ) Rozendaal 2000 (Amsterdam) , ( ) Lenselink 2008 a,b , ( ) Boers ( ) Hesselink 2013 (Utrecht region) ( ) Zielinski 2001 (Zeeland) ( ) Norway Molden 2005 (Oslo) , ( ) Skjeldestad 2008 a,c ( ) Molden 2006 (Oslo) <= ( ) Gjøoen 1996 (Oslo) ( ) Poland Bardin 2008 (Warsaw) ( ) Portugal Pista , ( ) Vieira ( ) Pista 2011 d ( ) Dutra 2008 (Açores) a ( ) Romania Moga 2014 (Brasov County) ( ) Ursu 2011 (Northeast) ( ) Russia Bdaizieva 2010 (Moscow) a , ( ) Kubanov 2005 (Moscow) 8, ( ) Goncharevskaya 2011 (Moscow) , ( ) Rogovskaya 2013 e ( ) Shipitsyna 2011 (St Petersburg) ( ) Komarova 2010 (Moscow) ( ) Alexandrova 1999 f ( ) Shargorodskaya 2011 (Moscow) ( ) Shipulina 2011 (Moscow) ( ) Slovenia Ucakar , ( ) Ucakar ( ) Spain Castellsagué , ( ) Martorell 2010 (Valencia) a , ( ) Bernal 2008 (Zaragoza) 1, ( ) Dillner 2008 (Maresme) ( ) 0% 10% 20% 30% 40% 50% 60% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Women from the general population, including some with cytological cervical abnormalities (Continued on next page)

145 4 HPV RELATED STATISTICS b Arnhem, Nijmegen, and Den Bosch c Oslo, Trondheim, and Levanger d Lisbon area and southern region e Moscow and Novgorod f St. Petersburg Data sources: See references in Section 9. ( Figure 63 continued from previous page)

146 4 HPV RELATED STATISTICS Figure 64: Prevalence of HPV among women with normal cervical cytology in Europe by country and study (continued) Country Study Age N % (95% CI) Spain Lloveras 2013 (Barcelona) ( ) de Sanjose 2003 (Barcelona) ( ) Ortiz 2006 (Madrid and Alicante) a ( ) González 2006 (Alicante) ( ) Muñoz 1996 b ( ) Sweden Naucler 2007 c , ( ) Elfström 2014 c , ( ) Gyllensten 2012 (Uppsala County) a , ( ) Ylitalo 2000 (Uppsala) ( ) Kjellberg 1998 d ( ) Stenvall 2007 (Uppsala) a ( ) Switzerland Bigras 2005 e , ( ) UK Kitchener 2006 (Manchester) , ( ) Hibbitts 2014 (Wales) , ( ) Cuzick 2003 f , ( ) Hibbitts 2008 (South Wales) , ( ) Peto 2004 (Manchester) , ( ) Kavanagh 2014 (Scotland) a , ( ) Cuschieri 2004 (Edinburgh) , ( ) Cuzick 1999 (London) , ( ) Howell Jones 2010 g , ( ) Cuzick 1995 (London) , ( ) Geraets 2014 (Scotland) a ( ) Herbert 2007 (London) ( ) Grainge 2005 (Nottingham) ( ) 0% 10% 20% 30% 40% 50% 60% Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Women from the general population, including some with cytological cervical abnormalities b Alava, Girona, Guipuzcoa, Murcia, Navarra, Salamanca, Sevilla, Vizcaya, Zaragoza c Gothenburg, Malmö, Uppsala, Umeå, and Stockholm d Västerbotten County e Geneve, Vaud, Neuchatel, Fribourg, Valais and Tessin f Birmingham, Edinburg, London, Manchester and Mansfield g Gateshead, Birmingham, London, Gloucestershire and Norfolk Data sources: See references in Section 9.

147 4 HPV RELATED STATISTICS Figure 65: Prevalence of HPV among women with normal cervical cytology in Oceania by country and study Country Study Age N % (95% CI) Australia Tabrizi , ( ) Bowden 2005 a,b ( ) Tabrizi 2014 b,c ( ) Fiji Foliaki 2014 (Suva) b , ( ) Vanuatu Aruhuri 2012 d ( ) McAdam 2010 e ( ) 0% 10% 20% 30% 40% 50% 60% 70% Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Australian Capital Territory b Women from the general population, including some with cytological cervical abnormalities c Sydney, Melbourne, Perth d Santo Urban (Espiritu Santo Island) and Porto Vila (Efate Island) e Port Vila (Efate Island) Data sources: See references in Section 9.

148 4 HPV RELATED STATISTICS HPV type distribution among women with normal cervical cytology, precancerous cervical lesions and cervical cancer Table 13: Prevalence of HPV 16/18 in women with normal cervical cytology, precancerous cervical lesions and invasive cervical cancer by World region and sub-regions Normal cytology Low-grade lesions High-grade lesions Cervical cancer Country /Region No. HPV Prev No. HPV Prev No. HPV Prev No. HPV Prev tested (95% CI) tested (95% CI) tested (95% CI) tested (95% CI) World 514, ( ) 38, ( ) 50, ( ) 58, ( ) Less developed regions 177, ( ) 9, ( ) 13, ( ) 25, ( ) More developed regions 334, ( ) 28, ( ) 33, ( ) 25, ( ) Africa 20, ( ) ( ) ( ) 3, ( ) Eastern Africa 4, ( ) ( ) ( ) 1, ( ) Middle Africa ( ) Northern Africa 2, ( ) ( ) ( ) Southern Africa 8, ( ) ( ) ( ) ( ) Western Africa 4, ( ) ( ) ( ) ( ) Americas 110, ( ) 9, ( ) 13, ( ) 10, ( ) Caribbean ( ) ( ) ( ) ( ) Central America 18, ( ) 1, ( ) ( ) 2, ( ) Northern America 77, ( ) 6, ( ) 10, ( ) 3, ( ) South America 13, ( ) 2, ( ) 2, ( ) 6, ( ) Asia 145, ( ) 7, ( ) 13, ( ) 20, ( ) Central Asia Eastern Asia 116, ( ) 6, ( ) 10, ( ) 15, ( ) South-Eastern Asia 8, ( ) ( ) 1, ( ) 3, ( ) Southern Asia 14, ( ) ( ) ( ) 2, ( ) Western Asia 6, ( ) ( ) 1, ( ) ( ) Europe 232, ( ) 19, ( ) 21, ( ) 18, ( ) Eastern Europe 7, ( ) 1, ( ) ( ) 1, ( ) Northern Europe 119, ( ) 4, ( ) 8, ( ) 5, ( ) Southern Europe 50, ( ) 10, ( ) 5, ( ) 4, ( ) Western Europe 57, ( ) 2, ( ) 3, ( ) 3, ( ) Oceania 2, ( ) ( ) 1, ( ) ( ) Australia & New Zealand 2, ( ) ( ) 1, ( ) ( ) Melanesia ( ) ( ) ( ) Micronesia Polynesia Data updated on 19 May 2017 (data as of 30 Jun 2015 / 30 Jun 2015). 95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; Low-grade lesions: LSIL or CIN-1; Data sources: See references in Section 9.

149 4 HPV RELATED STATISTICS Figure 66: Prevalence of HPV 16 among women with normal cervical cytology in Africa by country and study Country Algeria Benin Guinea Kenya Morocco Mozambique Nigeria Senegal South Africa Tanzania Tunisia Uganda Study Hammouda 2011 Hammouda 2005 Piras 2011 Keita 2009 De Vuyst 2010 De Vuyst 2003 Alhamany 2010 Amrani 2003 Belglaiaa 2015 Chaouki 1998 Castellsagué 2001 Naucler 2011 Gage 2012 Thomas 2004 Xi 2003 Astori 1999 McDonald 2012 Allan 2008 Jones 2007 Dartell 2014 Watson Jones 2013 Guettiti 2014 Hassen 2003 Odida 2011 N , , , , % (95% CI) 0.5 ( ) 6.8 ( ) 4.3 ( ) 6.6 ( ) 7.5 ( ) 3.5 ( ) 2.2 ( ) 1.3 ( ) 2.1 ( ) 4.1 ( ) 4.8 ( ) 6.6 ( ) 1.5 ( ) 3.0 ( ) 1.0 ( ) 5.7 ( ) 2.0 ( ) 2.0 ( ) 1.6 ( ) 1.8 ( ) 12.8 ( ) 1.6 ( ) 5.2 ( ) 2.8 ( ) 0% 10% 20% 30% Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

150 4 HPV RELATED STATISTICS Figure 67: Prevalence of HPV 16 among women with normal cervical cytology in the Americas by country and study Country Argentina Belize Brazil Canada Chile Colombia Costa Rica Cuba Greenland Guatemala Honduras Mexico Paraguay Peru Trinidad & Tob. Study Matos 2003 Chouhy 2013 Abba 2003 Badano 2011 Cathro 2009 Noronha 2005 da Silva 2012 Miranda 2012 Chagas 2015 de Abreu 2012 Augusto 2014 Coser 2013 Rocha 2013 Oliveira 2010 Lorenzato 2000 Muñoz 1996 Cassel 2014 Tamegão Lopes 2014 Jiang 2013 Moore 2009 Demers 2012 Ferreccio 2004 Molano 2002 Soto De Leon 2011 Muñoz 1996 Herrero 2005 Soto 2014 Svare 1998 Vallès 2009 Ferrera 1999 Tábora 2005 Illades Aguiar 2010 Lazcano Ponce 2001 Salcedo 2014 Giuliano 2001 López Rivera 2012 Carrillo García 2014 Sánchez Anguiano 2006 Aguilar Lemarroy 2015 Monroy 2010 Giuliano 2005 Illades Aguiar 2009 Rojo Contreras 2008 Mendoza 2011 Rolón 2000 García 2004 Martorell 2012 Santos 2001 Ragin 2007 N ,379 4, ,831 1, , ,117 1,340 1, % (95% CI) 3.2 ( ) 8.3 ( ) 15.1 ( ) 6.5 ( ) 1.2 ( ) 3.8 ( ) 0.5 ( ) 1.2 ( ) 5.0 ( ) 8.5 ( ) 1.4 ( ) 1.5 ( ) 2.8 ( ) 9.6 ( ) 4.4 ( ) 7.0 ( ) 5.2 ( ) 8.9 ( ) 9.2 ( ) 3.6 ( ) 8.7 ( ) 1.9 ( ) 2.1 ( ) 3.3 ( ) 36.6 ( ) 5.5 ( ) 2.2 ( ) 35.1 ( ) 21.2 ( ) 3.3 ( ) 11.0 ( ) 6.0 ( ) 2.3 ( ) 1.7 ( ) 6.2 ( ) 1.2 ( ) 1.0 ( ) 11.2 ( ) 2.9 ( ) 3.1 ( ) 1.1 ( ) 0.8 ( ) 11.3 ( ) 9.0 ( ) 4.5 ( ) 5.5 ( ) 2.4 ( ) 12.3 ( ) 4.0 ( ) 2.4 ( ) 0% 10% 20% 30% 40% 50% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

151 4 HPV RELATED STATISTICS Figure 68: Prevalence of HPV 16 among women with normal cervical cytology in the Americas by country and study (continued) Country Study N % (95% CI) USA Wheeler , ( ) Schiffman , ( ) Goodman , ( ) Insinga , ( ) Cibas , ( ) Wideroff ( ) Giuliano ( ) Moscicki ( ) Evans ( ) Swan ( ) Hernandez ( ) Chaturvedi ( ) Uruguay Berois ( ) Ramas ( ) Venezuela Téllez ( ) 0% 10% 20% 30% 40% Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

152 4 HPV RELATED STATISTICS Figure 69: Prevalence of HPV 16 among women with normal cervical cytology in Asia by country and study Country Bahrain Bhutan China Georgia India Indonesia Iran Japan Korea, Rep. Study Hajjaj 2006 Tshomo 2014 Mai 2014 Zhao 2014 Zhao 2009 Wu 2013 Li 2013 Yuan 2011 Jin 2010 Chan 2009 Wu 2007 Li 2006 Dai 2006 Bian 2013 Wu 2010 Sun 2010 Alibegashvili 2011 Dutta 2012 Laikangbam 2007 Franceschi 2005 Gupta 2009 Aggarwal 2006 Kerkar 2011 Bhatla 2008 Vinodhini 2012 Arora 2005 Singh 2009 de Boer 2006 Khodakarami 2012 Safaei 2010 Moradi 2011 Inoue 2006 Maehama 2005 Asato 2004 Takehara 2011 Sasagawa 2001 Onuki 2009 Konno 2011 Sasagawa 1997 Nishiwaki 2008 Yoshikawa 1999 Kim 2013 Park 2014 Hwang 2004 Kim 2012 Oh 2001 An 2003 Shin 2003 Lee 2003 Cho 2003 N 91 2,272 22,114 5,416 5,284 3,737 3,115 3,112 2,847 2, ,247 2,313 2,038 1, ,260 4,078 3,249 2,068 1,562 1, ,681 1,903 1,609 1,214 1,144 1, % (95% CI) 1.1 ( ) 3.4 ( ) 3.6 ( ) 2.1 ( ) 1.7 ( ) 1.0 ( ) 2.9 ( ) 2.3 ( ) 1.0 ( ) 0.9 ( ) 1.9 ( ) 2.1 ( ) 3.5 ( ) 4.7 ( ) 3.5 ( ) 10.9 ( ) 0.5 ( ) 0.5 ( ) 4.7 ( ) 2.8 ( ) 10.1 ( ) 3.6 ( ) 1.5 ( ) 2.2 ( ) 8.9 ( ) 9.4 ( ) 8.3 ( ) 2.0 ( ) 1.8 ( ) 2.0 ( ) 4.0 ( ) 1.2 ( ) 0.3 ( ) 0.5 ( ) 1.5 ( ) 1.3 ( ) 2.6 ( ) 4.1 ( ) 1.0 ( ) 4.5 ( ) 0.8 ( ) 1.6 ( ) 0.8 ( ) 6.3 ( ) 9.9 ( ) 0.6 ( ) 22.4 ( ) 0.7 ( ) 4.3 ( ) 22.9 ( ) 0% 10% 20% 30% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

153 4 HPV RELATED STATISTICS Figure 70: Prevalence of HPV 16 among women with normal cervical cytology in Asia by country and study (continued) Country Kuwait Malaysia Mongolia Nepal Pakistan Philippines Taiwan Thailand Turkey Viet Nam Study Al Awadhi 2011 Othman 2014 Dondog 2008 Sherpa 2010 Johnson 2014 Raza 2010 Ngelangel 1998 Lai 2012 Chen 2011 Huang 2008 Tsai 2005 Lin 2005 Laowahutanont 2014 Sukvirach 2003 Chichareon 1998 Suwannarurk 2009 Natphopsuk 2013 Chopjitt 2009 Chaiwongkot 2007 Sriamporn 2006 Siritantikorn 1997 Settheetham Ishida 2005 Ozalp 2012 Demir 2012 Tezcan 2014 Dursun 2009 Bayram 2011 Pham 2003 N 3, ,724 10,067 1, ,735 1, ,897 % (95% CI) 0.2 ( ) 0.9 ( ) 4.8 ( ) 1.4 ( ) 0.9 ( ) 0.5 ( ) 1.3 ( ) 0.2 ( ) 1.4 ( ) 1.1 ( ) 2.9 ( ) 3.1 ( ) 1.2 ( ) 0.7 ( ) 4.6 ( ) 4.0 ( ) 5.6 ( ) 5.6 ( ) 12.9 ( ) 7.1 ( ) 1.0 ( ) 8.0 ( ) 1.4 ( ) 3.6 ( ) 4.2 ( ) 7.1 ( ) 2.6 ( ) 1.5 ( ) 0% 10% 20% Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

154 4 HPV RELATED STATISTICS Figure 71: Prevalence of HPV 16 among women with normal cervical cytology in Europe by country and study Country Belarus Belgium Croatia Czech Rep. Denmark France Germany Greece Ireland Italy Lithuania Netherlands Norway Study Rogovskaya 2013 Arbyn 2009 Baay 2005 Depuydt 2012 Schmitt 2013 Weyn 2013 Depuydt 2003 Baay 2001 Grahovac 2007 Tachezy 2013 Kjær 2014 Nielsen 2008 Bonde 2014 Svare 1998 Heard 2013 Vaucel 2011 Casalegno 2011 Pannier Stockman 2008 Beby Defaux 2004 Klug 2007 Iftner 2010 de Jonge 2013 Agorastos 2015 Argyri 2013 Tsiodras 2011 Agorastos 2004 Tsiodras 2010 Panotopoulou 2007 Anderson 2013 Keegan 2007 Carozzi 2014 Agarossi 2009 Giorgi Rossi 2011 Ronco 2005 Panatto 2013 Centurioni 2005 Salfa 2011 Barzon 2010 Sammarco 2013 Astori 1997 Tornesello 2006 Tornesello 2008 Gudleviciene 2005 Simanaviciene 2014 Bulkmans 2007 Jacobs 2000 Rozendaal 2000 Zielinski 2001 Molden 2005 Gjøoen 1996 N 322 8,729 2,293 1, ,302 37,958 11,663 4, , ,833 1,692 1,463 3,783 2,218 1,348 1,272 1, , ,660 9,148 3, ,245 3,299 2, , % (95% CI) 7.1 ( ) 2.3 ( ) 2.1 ( ) 1.4 ( ) 5.6 ( ) 2.1 ( ) 4.2 ( ) 2.8 ( ) 15.6 ( ) 4.8 ( ) 4.2 ( ) 4.0 ( ) 5.4 ( ) 8.4 ( ) 3.0 ( ) 3.6 ( ) 10.6 ( ) 9.3 ( ) 1.8 ( ) 1.1 ( ) 6.6 ( ) 4.9 ( ) 2.1 ( ) 2.6 ( ) 4.0 ( ) 0.4 ( ) 0.0 ( ) 0.5 ( ) 3.2 ( ) 1.7 ( ) 1.8 ( ) 3.0 ( ) 2.1 ( ) 2.7 ( ) 2.8 ( ) 8.8 ( ) 0.9 ( ) 6.0 ( ) 6.6 ( ) 5.1 ( ) 8.7 ( ) 2.8 ( ) 6.9 ( ) 4.3 ( ) 1.0 ( ) 0.9 ( ) 2.7 ( ) 1.8 ( ) 1.3 ( ) 6.3 ( ) 0% 10% 20% 30% (Continued on next page) Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

155 4 HPV RELATED STATISTICS Figure 72: Prevalence of HPV 16 among women with normal cervical cytology in Europe by country and study (continued) Country Poland Portugal Romania Russia Slovenia Spain Sweden UK Study Bardin 2008 Pista 2011 Moga 2014 Rogovskaya 2013 Shipitsyna 2011 Alexandrova 1999 Komarova 2010 Ucakar 2012 Castellsagué 2012 de Sanjose 2003 Dillner 2008 González 2006 Muñoz 1996 Naucler 2007 Elfström 2014 Ylitalo 2000 Kjellberg 1998 Sargent 2008 Hibbitts 2014 Cuschieri 2004 Cuzick 1999 Cuzick 1995 Hibbitts 2006 Grainge 2005 N ,199 3, ,877 5, ,364 10,890 3,089 2,855 1,818 1, % (95% CI) 2.8 ( ) 5.2 ( ) 7.5 ( ) 7.1 ( ) 2.7 ( ) 7.4 ( ) 24.1 ( ) 2.5 ( ) 2.5 ( ) 0.4 ( ) 3.1 ( ) 1.3 ( ) 1.8 ( ) 1.7 ( ) 2.0 ( ) 5.8 ( ) 1.0 ( ) 1.5 ( ) 4.3 ( ) 4.4 ( ) 0.1 ( ) 1.3 ( ) 1.4 ( ) 1.4 ( ) 0% 10% 20% 30% Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

156 4 HPV RELATED STATISTICS Figure 73: Prevalence of HPV 16 among women with normal cervical cytology in Oceania by country and study Country Study N % (95% CI) Australia Tabrizi , ( ) Vanuatu Aruhuri ( ) 0% 10% Data updated on 15 Dec 2016 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

157 4 HPV RELATED STATISTICS Figure 74: Prevalence of HPV 16 among women with low-grade cervical lesions in Africa by country and study Country Study N % (95% CI) DR Congo Hovland ( ) Ethiopia Abate ( ) Guinea Keita ( ) Kenya De Vuyst ( ) De Vuyst ( ) Morocco Alhamany ( ) Nigeria Thomas ( ) Gage ( ) Senegal Xi ( ) Chabaud ( ) South Africa Allan ( ) Zimbabwe Sawaya ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; Low-grade lesions: LSIL or CIN-1; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

158 4 HPV RELATED STATISTICS Figure 75: Prevalence of HPV 16 among women with low-grade cervical lesions in the Americas by country and study Country Argentina Belize Brazil Canada Chile Colombia Cuba Ecuador Honduras Jamaica Mexico Nicaragua Paraguay Peru USA Study Abba 2003 Venezuela 2012 Tonon 1999 Eiguchi 2008 Deluca 2004 Chouhy 2006 Cathro 2009 Tomita 2010 Fernandes 2009 Resende 2014 Ribeiro 2011 Lorenzato 2000 Carestiato 2006 Franco 1999 Pitta 2010 Freitas 2007 Coutlée 2011 Moore 2009 Antonishyn 2008 Jiang 2011 Tran Thanh 2003 Koushik 2005 Richardson 2003 Sellors 2000 Sellors 2000 López M 2010 Ili 2011 Molano 2002 Del Río Ospina 2015 García 2011 Soto 2007 Tornesello 2008 Ferreira 2008 Strickler 1999 Rattray 1996 Illades Aguiar 2010 Velázquez Márquez 2009 González Losa 2004 Piña Sánchez 2006 Giuliano 2001 Carrillo 2004 Torroella Kouri 1998 Hindryckx 2006 Mendoza 2011 Tonon 1999 Martorell 2012 Wheeler 2006 Wentzensen 2009 Vidal 2014 Einstein 2007 N , % (95% CI) 26.5 ( ) 14.2 ( ) 74.5 ( ) 18.9 ( ) 8.3 ( ) 18.2 ( ) 10.0 ( ) 28.7 ( ) 18.3 ( ) 23.2 ( ) 27.3 ( ) 19.4 ( ) 29.1 ( ) 25.9 ( ) 0.0 ( ) 20.0 ( ) 27.6 ( ) 35.2 ( ) 14.2 ( ) 19.4 ( ) 15.0 ( ) 26.4 ( ) 18.2 ( ) 37.5 ( ) 50.0 ( ) 22.4 ( ) 55.6 ( ) 10.0 ( ) 42.4 ( ) 80.4 ( ) 6.7 ( ) 34.5 ( ) 11.4 ( ) 4.3 ( ) 6.5 ( ) 10.6 ( ) 12.9 ( ) 5.8 ( ) 25.3 ( ) 15.2 ( ) 19.0 ( ) 4.8 ( ) 7.6 ( ) 19.5 ( ) 74.5 ( ) 22.7 ( ) 21.3 ( ) 22.5 ( ) 10.0 ( ) 6.3 ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; Low-grade lesions: LSIL or CIN-1; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

159 4 HPV RELATED STATISTICS Figure 76: Prevalence of HPV 16 among women with low-grade cervical lesions in the Americas by country and study (continued) Country USA Uruguay Venezuela Study Evans 2006 Schiff 2000 Tortolero Luna 1998 Liaw 1999 Kulasingam 2002 Adam 2000 Stoler 2011 Moscicki 2008 Swan 1999 Castle 2011 Jarboe 2004 Lee 2009 Wheeler 2009 Zuna 2007 Voss 2009 Hu 2005 Park 2007 Evans 2002 Guo 2007 Brown 2002 Bell 2007 Kong 2007 Ramas 2013 Correnti 2011 N % (95% CI) 15.5 ( ) 5.8 ( ) 12.6 ( ) 7.5 ( ) 15.7 ( ) 45.3 ( ) 10.8 ( ) 19.7 ( ) 10.1 ( ) 8.5 ( ) 7.4 ( ) 3.9 ( ) 26.9 ( ) 14.9 ( ) 18.6 ( ) 8.9 ( ) 16.7 ( ) 7.1 ( ) 0.0 ( ) 40.0 ( ) 8.3 ( ) 27.3 ( ) 23.8 ( ) 21.0 ( ) 0% 10% 20% 30% 40% 50% 60% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; Low-grade lesions: LSIL or CIN-1; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

160 4 HPV RELATED STATISTICS Figure 77: Prevalence of HPV 16 among women with low-grade cervical lesions in Asia by country and study Country Bangladesh China India Iran Japan Kuwait Malaysia Myanmar Rep. Korea Taiwan Study Banik 2013 Chan 2006 Chan 2012 Yuan 2011 Zhao 2014 Guo 2010 Liu 2010 Li 2013 Ding 2014 Li 2012 Wu 2010 Hong 2008 Tao 2006 Zhang 2013 Liu 2008 Sun 2014 Wu 2013 Zhao 2008 Chan 1999 Jin 2010 Singh 2009 Nair 1999 Franceschi 2005 Berlin Grace 2009 Nagpal 2002 Esmaeili 2008 Ghaffari 2006 Matsumoto 2011 Takehara 2011 Onuki 2009 Saito 2001 Sasagawa 2001 Inoue 2006 Yamasaki 2011 Nishiwaki 2008 Konno 2011 Yoshida 2004 Al Awadhi 2011 Al Awadhi 2013 Sharifah 2009 Mu Mu Shwe 2014 An 2003 Lee 2007 Cho 2003 Kang 2009 Oh 2001 Hwang 2003 Ding 2008 Chao 2008 Huang 2008 N % (95% CI) 15.4 ( ) 14.0 ( ) 14.0 ( ) 15.9 ( ) 20.8 ( ) 20.4 ( ) 34.4 ( ) 12.7 ( ) 7.9 ( ) 16.1 ( ) 11.6 ( ) 13.3 ( ) 21.8 ( ) 17.0 ( ) 5.6 ( ) 21.0 ( ) 18.2 ( ) 12.5 ( ) 21.6 ( ) 9.1 ( ) 23.8 ( ) 18.9 ( ) 30.8 ( ) 0.0 ( ) 35.7 ( ) 39.1 ( ) 41.7 ( ) 9.2 ( ) 11.4 ( ) 8.5 ( ) 2.6 ( ) 9.0 ( ) 17.2 ( ) 19.2 ( ) 13.3 ( ) 20.0 ( ) 8.3 ( ) 18.3 ( ) 18.3 ( ) 26.1 ( ) 60.0 ( ) 36.5 ( ) 19.2 ( ) 26.7 ( ) 17.8 ( ) 17.9 ( ) 16.7 ( ) 6.1 ( ) 3.9 ( ) 0.0 ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; Low-grade lesions: LSIL or CIN-1; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

161 4 HPV RELATED STATISTICS Figure 78: Prevalence of HPV 16 among women with low-grade cervical lesions in Asia by country and study (continued) Country Study N % (95% CI) Thailand Chansaenroj ( ) Chaiwongkot ( ) Ekalaksananan ( ) Bhattarakosol ( ) Chansaenroj ( ) Suwannarurk ( ) Turkey Yuce ( ) Sahiner ( ) Ergünay ( ) Tezcan ( ) Ozgul ( ) 0% 10% 20% 30% 40% 50% 60% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; Low-grade lesions: LSIL or CIN-1; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

162 4 HPV RELATED STATISTICS Figure 79: Prevalence of HPV 16 among women with low-grade cervical lesions in Europe by country and study Country Belarus Belgium Croatia Czech Rep. Denmark France Germany Greece Ireland Italy Latvia Study Kulmala 2007 Depuydt 2003 Beerens 2005 Arbyn 2009 Weyn 2013 Baay 2001 Grce 2001 Grce 1997 Grce 2004 Tachezy 2011 Kjær 2014 Kjaer 2008 Hording 1995 Prétet 2008 Vaucel 2011 Bergeron 1992 Humbey 2002 Monsonego 2008 de Jonge 2013 Meyer 2001 Klug 2007 Nindl 1999 Merkelbach Bruse 1999 Argyri 2013 Panotopoulou 2007 Tsiodras 2011 Kroupis 2007 Labropoulou 1997 Mammas 2008 Keegan 2014 Murphy 2003 Butler 2000 Voglino 2000 Spinillo 2014 Chironna 2010 Agarossi 2009 Spinillo 2009 Capra 2008 Astori 1997 Tornesello 2006 Agodi 2009 Gargiulo 2007 Giorgi Rossi 2010 Sandri 2009 Zerbini 2001 Venturoli 2002 Laconi 2000 Menegazzi 2009 Venturoli 2008 Kulmala 2007 N , ,499 1, % (95% CI) 35.1 ( ) 20.3 ( ) 18.5 ( ) 23.5 ( ) 10.0 ( ) 24.1 ( ) 11.6 ( ) 6.0 ( ) 8.3 ( ) 28.4 ( ) 17.1 ( ) 12.8 ( ) 31.7 ( ) 21.4 ( ) 14.5 ( ) 20.8 ( ) 30.0 ( ) 5.4 ( ) 17.5 ( ) 13.1 ( ) 11.5 ( ) 12.2 ( ) 68.8 ( ) 14.5 ( ) 6.8 ( ) 17.8 ( ) 23.4 ( ) 11.8 ( ) 21.7 ( ) 40.8 ( ) 72.4 ( ) 0.0 ( ) 24.7 ( ) 25.6 ( ) 13.0 ( ) 19.8 ( ) 36.7 ( ) 11.4 ( ) 24.3 ( ) 36.6 ( ) 32.3 ( ) 15.7 ( ) 21.1 ( ) 21.3 ( ) 14.0 ( ) 7.5 ( ) 30.0 ( ) 16.7 ( ) 20.0 ( ) 35.1 ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; Low-grade lesions: LSIL or CIN-1; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

163 4 HPV RELATED STATISTICS Figure 80: Prevalence of HPV 16 among women with low-grade cervical lesions in Europe by country and study (continued) Country Lithuania Netherlands Norway Portugal Romania Russia Spain Sweden Switzerland UK Study Gudleviciene 2005 Bollen 1997 Prinsen 2007 Reesink Peters 2001 Roberts 2006 Molden 2005 Medeiros 2005 Nobre 2010 Ursu 2011 Anton 2011 Kulmala 2007 de Oña 2010 Martín 2011 Herraez Hernandez 2013 García Sierra 2009 Conesa Zamora 2009 Doménech Peris 2010 Söderlund Strand 2011 Brismar Wendel 2009 Kalantari 1997 Andersson 2005 Zehbe 1996 Dobec 2011 Sargent 2008 Howell Jones 2010 Anderson 2013 Cuschieri 2004 Hibbitts 2008 Giannoudis 1999 Jamison 2009 Woo 2010 Cuzick 1999 Southern 2001 Arends 1993 Cuzick 1994 N , , % (95% CI) 6.7 ( ) 12.7 ( ) 7.9 ( ) 28.6 ( ) 5.0 ( ) 25.0 ( ) 44.2 ( ) 10.7 ( ) 5.6 ( ) 11.5 ( ) 35.1 ( ) 12.2 ( ) 24.8 ( ) 39.8 ( ) 17.6 ( ) 29.3 ( ) 23.8 ( ) 24.2 ( ) 20.6 ( ) 17.7 ( ) 20.0 ( ) 40.0 ( ) 25.0 ( ) 17.3 ( ) 20.5 ( ) 24.0 ( ) 28.0 ( ) 27.8 ( ) 12.7 ( ) 27.8 ( ) 41.7 ( ) 12.0 ( ) 10.2 ( ) 15.0 ( ) 23.1 ( ) 0% 10% 20% 30% 40% 50% 60% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; Low-grade lesions: LSIL or CIN-1; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

164 4 HPV RELATED STATISTICS Figure 81: Prevalence of HPV 16 among women with low-grade cervical lesions in Oceania by country and study Country Australia Study Garland 2011 N 239 % (95% CI) 24.3 ( ) Stevens ( ) Brestovac ( ) 0% 10% 20% 30% 40% 50% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; Low-grade lesions: LSIL or CIN-1; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

165 4 HPV RELATED STATISTICS Figure 82: Prevalence of HPV 16 among women with high-grade cervical lesions in Africa by country and study Country Study N % (95% CI) Ethiopia Abate ( ) Guinea Keita ( ) Kenya De Vuyst ( ) Nigeria Haghshenas ( ) Gage ( ) Senegal Xi ( ) Chabaud ( ) South Africa Allan ( ) van Aardt Unpublished ( ) Tanzania Dartell ( ) Zimbabwe Sawaya ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

166 4 HPV RELATED STATISTICS Figure 83: Prevalence of HPV 16 among women with high-grade cervical lesions in the Americas by country and study Country Argentina Belize Brazil Canada Chile Colombia Costa Rica Cuba Ecuador Honduras Jamaica Mexico Nicaragua Paraguay Peru USA Study Abba 2003 Alonio 2003 Venezuela 2012 Chouhy 2006 Cathro 2009 Resende 2014 Tomita 2010 Chagas 2015 Fernandes 2010 Camara 2003 Pitta 2010 Ribeiro 2011 Lorenzato 2000 Fernandes 2009 Terra 2007 Krambeck 2008 Freitas 2007 Coutlée 2011 Antonishyn 2008 Moore 2009 Jiang 2011 Ili 2011 Muñoz 1992 Bosch 1993 García 2011 Herrero 2005 Soto 2007 Mejía 2016 Ferreira 2008 Strickler 1999 Rattray 1996 Illades Aguiar 2010 Piña Sánchez 2006 Velázquez Márquez 2009 Torroella Kouri 1998 Giuliano 2001 Hindryckx 2006 Mendoza 2011 Martorell 2012 Hariri 2012 Joste 2015 Wheeler 2009 Wentzensen 2009 Castle 2010 Castle 2011 Wheeler 2006 Adam 1998 Evans 2006 Hariri 2012 Moscicki 2008 N ,058 1,880 1, % (95% CI) 48.8 ( ) 54.0 ( ) 21.4 ( ) 58.3 ( ) 46.7 ( ) 49.2 ( ) 59.9 ( ) 35.4 ( ) 61.8 ( ) 30.5 ( ) 51.8 ( ) 48.2 ( ) 56.7 ( ) 53.6 ( ) 69.7 ( ) 25.0 ( ) 40.0 ( ) 65.5 ( ) 46.9 ( ) 52.4 ( ) 38.1 ( ) 55.5 ( ) 34.8 ( ) 32.8 ( ) 91.8 ( ) 45.4 ( ) 27.8 ( ) 33.9 ( ) 35.8 ( ) 23.5 ( ) 24.2 ( ) 27.5 ( ) 42.4 ( ) 13.7 ( ) 58.3 ( ) 27.3 ( ) 26.9 ( ) 41.9 ( ) 50.0 ( ) 47.2 ( ) 54.1 ( ) 56.3 ( ) 58.8 ( ) 59.9 ( ) 44.4 ( ) 47.7 ( ) 51.0 ( ) 49.2 ( ) 48.9 ( ) 47.5 ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

167 4 HPV RELATED STATISTICS Figure 84: Prevalence of HPV 16 among women with high-grade cervical lesions in the Americas by country and study (continued) Country Study N % (95% CI) USA Zuna ( ) Einstein ( ) Hu ( ) Vidal ( ) Stoler ( ) Guo ( ) Voss ( ) Kong ( ) Evans ( ) Bell ( ) Lee ( ) Venezuela Sánchez Lander ( ) 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

168 4 HPV RELATED STATISTICS Figure 85: Prevalence of HPV 16 among women with high-grade cervical lesions in Asia by country and study Country China India Iran Israel Japan Kuwait Malaysia Rep. Korea Study Chan 2006 Chan 2012 Yuan 2011 Li 2012 Singh 2015 Ding 2014 Guo 2010 Tao 2006 Li 2013 Zhao 2008 Liu 2008 Chan 1999 Wu 2013 Zhang 2013 Li 2011 Sun 2014 Zhao 2014 Chan 1996 Wu 1994 Jin 2010 Deodhar 2012 Singh 2009 Nagpal 2002 Franceschi 2005 Esmaeili 2008 Bassal 2015 Laskov 2013 Azuma 2014 Takehara 2011 Onuki 2009 Sasagawa 2001 Yamasaki 2011 Okadome 2014 Nakamura 2015 Matsumoto 2011 Inoue 2006 Nishiwaki 2008 Nagai 2000 Yoshida 2004 Ichimura 2003 Tsuda 2003 Niwa 2003 Al Awadhi 2011 Al Awadhi 2013 Quek 2013 Kang 2009 Kahng 2014 Quek 2013 Hwang 2003 Cho 2003 N 1,577 1, % (95% CI) 35.7 ( ) 35.8 ( ) 47.5 ( ) 44.6 ( ) 10.5 ( ) 49.2 ( ) 35.3 ( ) 39.9 ( ) 42.9 ( ) 32.1 ( ) 36.4 ( ) 25.8 ( ) 59.7 ( ) 64.7 ( ) 34.9 ( ) 44.0 ( ) 63.0 ( ) 24.4 ( ) 35.3 ( ) 15.2 ( ) 65.1 ( ) 45.2 ( ) 48.0 ( ) 35.0 ( ) 64.7 ( ) 65.9 ( ) 71.9 ( ) 41.8 ( ) 28.1 ( ) 22.8 ( ) 35.8 ( ) 43.8 ( ) 27.0 ( ) 38.4 ( ) 15.4 ( ) 33.7 ( ) 28.8 ( ) 37.9 ( ) 33.3 ( ) 41.4 ( ) 11.5 ( ) 38.9 ( ) 33.3 ( ) 33.3 ( ) 41.1 ( ) 39.7 ( ) 45.0 ( ) 36.0 ( ) 24.7 ( ) 51.4 ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

169 4 HPV RELATED STATISTICS Figure 86: Prevalence of HPV 16 among women with high-grade cervical lesions in Asia by country and study (continued) Country Study N % (95% CI) Rep. Korea Oh ( ) Singapore Quek ( ) Taiwan Chao , ( ) Lai ( ) Ho ( ) Chao ( ) Lin ( ) Thailand Swangvaree ( ) Chansaenroj ( ) Sukasem ( ) Limpaiboon ( ) Turkey Baser ( ) Sahiner ( ) Yuce ( ) Viet Nam Quek ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

170 4 HPV RELATED STATISTICS Figure 87: Prevalence of HPV 16 among women with high-grade cervical lesions in Europe by country and study Country Austria Belarus Belgium Croatia Czech Rep. Denmark Europe France Germany Greece Hungary Iceland Ireland Italy Study Rössler 2013 Kulmala 2007 Depuydt 2003 Beerens 2005 Arbyn 2009 Baay 2001 Grce 2001 Grce 2004 Tachezy 2011 Kjær 2014 Thomsen 2015 Kirschner 2013 Kjaer 2008 Bonde 2014 Sebbelov 1994 Hording 1995 Tjalma 2013 Prétet 2008 Vaucel 2011 Monsonego 2008 Meyer 2001 de Jonge 2013 Merkelbach Bruse 1999 Nindl 1997 Nindl 1999 Klug 2007 Argyri 2013 Panotopoulou 2007 Tsiodras 2011 Labropoulou 1997 Agorastos 2005 Daponte 2006 Paraskevaidis 2001 Kroupis 2007 Szoke 2003 Sigurdsson 2007 Keegan 2014 Murphy 2003 Butler 2000 O'Leary 1998 Spinillo 2014 Carozzi 2010 Carozzi 2014 Zerbini 2001 Sandri 2009 Agarossi 2009 Gargiulo 2007 Tornesello 2006 Venturoli 2008 Laconi 2000 N , , , % (95% CI) 55.9 ( ) 56.0 ( ) 50.0 ( ) 43.1 ( ) 34.9 ( ) 56.7 ( ) 17.1 ( ) 20.3 ( ) 58.2 ( ) 52.1 ( ) 35.8 ( ) 46.2 ( ) 48.0 ( ) 34.9 ( ) 85.3 ( ) 50.0 ( ) 47.2 ( ) 62.3 ( ) 42.6 ( ) 33.3 ( ) 46.2 ( ) 34.4 ( ) 61.4 ( ) 36.5 ( ) 56.9 ( ) 54.3 ( ) 37.2 ( ) 36.7 ( ) 50.0 ( ) 36.0 ( ) 58.1 ( ) 51.7 ( ) 35.7 ( ) 50.0 ( ) 57.3 ( ) 51.2 ( ) 69.4 ( ) 78.1 ( ) 70.4 ( ) 95.0 ( ) 48.4 ( ) 62.9 ( ) 53.9 ( ) 50.6 ( ) 73.7 ( ) 53.4 ( ) 38.8 ( ) 47.7 ( ) 60.7 ( ) 50.0 ( ) 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

171 4 HPV RELATED STATISTICS Figure 88: Prevalence of HPV 16 among women with high-grade cervical lesions in Europe by country and study (continued) Country Italy Latvia Lithuania Netherlands Norway Portugal Romania Russia Slovenia Spain Sweden Switzerland UK Study Capra 2008 Kulmala 2007 Simanaviciene 2014 Gudleviciene 2005 Tang 2009 Bulkmans 2005 Reesink Peters 2001 Cornelissen 1992 Prinsen 2007 van Duin 2003 Roberts 2006 Sjoeborg 2010 Kraus 2004 Molden 2005 Pista 2013 Pista 2011 Medeiros 2005 Nobre 2010 Anton 2011 Ursu 2011 Kulmala 2007 Kovanda 2009 de Oña 2010 Bosch 1993 Muñoz 1992 Martín 2011 Herraez Hernandez 2013 Conesa Zamora 2009 Darwich 2011 García Sierra 2009 Kalantari 1997 Andersson 2005 Zehbe 1996 Dobec 2011 Howell Jones 2010 Sargent 2008 Cuzick 2014 Geraets 2014 Cuschieri 2004 Hibbitts 2008 Cuzick 1994 Anderson 2013 Jamison 2009 Arends 1993 Herrington 1995 Southern 1998 N , % (95% CI) 42.9 ( ) 56.0 ( ) 51.6 ( ) 48.3 ( ) 70.8 ( ) 60.6 ( ) 56.9 ( ) 52.8 ( ) 51.2 ( ) 65.0 ( ) 44.1 ( ) 20.6 ( ) 49.3 ( ) 28.0 ( ) 55.6 ( ) 27.7 ( ) 74.2 ( ) 32.4 ( ) 48.1 ( ) 31.7 ( ) 56.0 ( ) 62.5 ( ) 28.8 ( ) 49.0 ( ) 51.0 ( ) 48.8 ( ) 69.1 ( ) 33.3 ( ) 61.8 ( ) 36.0 ( ) 35.4 ( ) 37.1 ( ) 50.5 ( ) 57.6 ( ) 54.1 ( ) 46.8 ( ) 31.1 ( ) 43.4 ( ) 48.9 ( ) 40.9 ( ) 63.0 ( ) 56.9 ( ) 49.0 ( ) 50.0 ( ) 57.9 ( ) 61.5 ( ) 10% 20% 30% 40% 50% 60% 70% 80% 90% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

172 4 HPV RELATED STATISTICS Figure 89: Prevalence of HPV 16 among women with high-grade cervical lesions in Oceania by country and study Country Australia Study Stevens 2009 N 533 % (95% CI) 51.4 ( ) Stevens ( ) Callegari ( ) Brestovac ( ) Garland ( ) Fiji Tabrizi ( ) New Zealand Kang ( ) 20% 30% 40% 50% 60% 70% 80% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

173 4 HPV RELATED STATISTICS Figure 90: Prevalence of HPV 16 among women with invasive cervical cancer in Africa by country and study Country Africa Algeria Botswana Ethiopia Ghana Guinea Kenya Mali Morocco Mozambique Nigeria Senegal South Africa Sudan Tanzania Tunisia Uganda Zimbabwe Study de Sanjose 2010 Hammouda 2005 Bosch 1995 Ermel 2014 Fanta 2005 Abate 2013 Awua 2016 Denny 2014 Keita 2009 Bosch 1995 De Vuyst 2008 De Vuyst 2012 Bayo 2002 Bosch 1995 Chaouki 1998 El khair 2010 Naucler 2004 Denny 2014 Lin 2001 Xi 2003 Pegoraro 2002 Denny 2014 van Aardt 2015 Williamson 1994 Kay 2003 De Vuyst 2012 Abate 2013 ter Meulen 1992 Bosch 1995 KrennHrubec 2011 Odida 2008 Bosch 1995 Stanczuk 2003 N % (95% CI) 38.4 ( ) 61.4 ( ) 40.0 ( ) 32.5 ( ) 71.8 ( ) 86.7 ( ) 7.5 ( ) 55.4 ( ) 45.0 ( ) 41.2 ( ) 43.8 ( ) 56.3 ( ) 47.7 ( ) 35.1 ( ) 58.6 ( ) 58.4 ( ) 55.6 ( ) 52.4 ( ) 37.3 ( ) 35.0 ( ) 46.8 ( ) 47.5 ( ) 51.0 ( ) 44.1 ( ) 82.0 ( ) 53.1 ( ) 79.5 ( ) 37.7 ( ) 47.7 ( ) 61.0 ( ) 48.2 ( ) 55.0 ( ) 62.1 ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Includes cases from Algeria, Mozambique, Nigeria, and Uganda Data sources: See references in Section 9.

174 4 HPV RELATED STATISTICS Figure 91: Prevalence of HPV 16 among women with invasive cervical cancer in the Americas by country and study Country Argentina Bolivia Brazil Canada Chile Colombia Costa Rica Cuba Ecuador Greenland Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Suriname Trinidad & Tob. USA Study Turazza 1997 Bosch 1995 Alonio 2003 Golijow 2005 Bosch 1995 Serrano 2014 Cambruzzi 2005 Eluf Neto 1994 de Oliveira 2013 Tomita 2010 Lorenzato 2000 Rabelo Santos 2003 Bosch 1995 Duggan 1995 Tran Thanh 2003 Bosch 1995 Roa 2009 Valdivia L 2010 Bosch 1995 Murillo 2009 Muñoz 1992 Moreno Acosta 2008 Bosch 1995 Herrero 2005 Bosch 1995 Mejía 2016 Sebbelov 2000 Ferreira 2008 Strickler 1999 Guardado Estrada 2014 Serrano 2014 Carrillo García 2014 Illades Aguiar 2009 Aguilar Lemarroy 2015 Piña Sánchez 2006 Flores Miramontes 2015 Torroella Kouri 1998 Meyer 1998 Alarcón Romero 2009 González Losa 2004 Hindryckx 2006 Bosch 1995 Kasamatsu 2012 Rolón 2000 Santos 2001 Martorell 2012 De Boer 2005 Hosein 2013 Wheeler 2009 Hopenhayn 2014 N % (95% CI) 61.9 ( ) 59.3 ( ) 56.4 ( ) 68.6 ( ) 35.6 ( ) 51.7 ( ) 27.1 ( ) 58.6 ( ) 76.7 ( ) 60.0 ( ) 59.3 ( ) 56.3 ( ) 52.3 ( ) 35.5 ( ) 54.0 ( ) 62.8 ( ) 76.8 ( ) 61.1 ( ) 47.3 ( ) 51.2 ( ) 54.1 ( ) 57.6 ( ) 52.6 ( ) 45.7 ( ) 56.1 ( ) 37.9 ( ) 81.3 ( ) 43.4 ( ) 21.4 ( ) 51.3 ( ) 47.9 ( ) 56.4 ( ) 66.9 ( ) 62.8 ( ) 72.2 ( ) 48.3 ( ) 43.9 ( ) 43.3 ( ) 66.7 ( ) 26.7 ( ) 52.6 ( ) 48.5 ( ) 48.0 ( ) 60.4 ( ) 56.1 ( ) 50.9 ( ) 35.3 ( ) 47.4 ( ) 53.2 ( ) 50.8 ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

175 4 HPV RELATED STATISTICS Figure 92: Prevalence of HPV 16 among women with invasive cervical cancer in the Americas by country and study (continued) Country USA Venezuela Study Schwartz 2001 Burger 1996 de Sanjose 2010 Joste 2015 Wentzensen 2009 Zuna 2007 Hariri 2012 Pirog 2000 Patel 2009 Sebbelov 2000 Paquette 1993 Quint 2009 Guo 2007 Resnick 1990 Ferguson 1998 Bryan 2006 Wistuba 1997 Burnett 1992 Bosch 1995 Sánchez Lander 2012 N % (95% CI) 59.1 ( ) 51.4 ( ) 65.3 ( ) 49.1 ( ) 55.1 ( ) 55.9 ( ) 57.0 ( ) 36.6 ( ) 59.7 ( ) 77.4 ( ) 48.9 ( ) 60.0 ( ) 69.0 ( ) 75.9 ( ) 25.9 ( ) 58.3 ( ) 60.0 ( ) 66.7 ( ) 60.0 ( ) 67.7 ( ) 10% 20% 30% 40% 50% 60% 70% 80% 90% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

176 4 HPV RELATED STATISTICS Figure 93: Prevalence of HPV 16 among women with invasive cervical cancer in Asia by country and study Country Asia China Georgia India Indonesia Study de Sanjose 2010 Wang 2015 Lo 2002 Chen 2009 Chan 2012 Chan 2009 Wu 2008 Yuan 2011 Wu 2008 Hong 2008 Qiu 2007 Liu 2010 Lo 2001 Ding 2014 Cai 2009 Cai 2008 Shah 2009 Liu 2004 Zhao 2008 Liu 2008 Peng 1991 Li 2013 Lin 1998 Wu 2009 Gao 2003 Liu 2005 Yu 2003 Huang 1997 Tao 2006 Stephen 2000 Alibegashvili 2011 Basu 2009 Munjal 2014 Franceschi 2003 Gheit 2009 Nambaru 2009 Peedicayil 2006 Deodhar 2012 Nair 1999 Bhatla 2006 Nagpal 2002 Neyaz 2008 Munagala 2009 Munirajan 1998 Sowjanya 2005 Peedicayil 2009 De Boer 2005 Schellekens 2004 Bosch 1995 Tobing 2014 N 940 1, % (95% CI) 58.0 ( ) 38.3 ( ) 66.9 ( ) 76.7 ( ) 59.0 ( ) 56.1 ( ) 68.7 ( ) 65.2 ( ) 73.7 ( ) 65.2 ( ) 78.6 ( ) 73.1 ( ) 48.8 ( ) 56.9 ( ) 81.3 ( ) 81.8 ( ) 66.7 ( ) 50.0 ( ) 52.0 ( ) 45.8 ( ) 34.8 ( ) 53.8 ( ) 48.1 ( ) 83.1 ( ) 40.0 ( ) 66.0 ( ) 70.0 ( ) 25.7 ( ) 55.6 ( ) 72.7 ( ) 58.2 ( ) 65.9 ( ) 73.7 ( ) 62.8 ( ) 81.7 ( ) 72.7 ( ) 60.5 ( ) 76.1 ( ) 69.1 ( ) 73.6 ( ) 60.6 ( ) 86.7 ( ) 65.1 ( ) 53.5 ( ) 58.5 ( ) 78.6 ( ) 33.8 ( ) 43.2 ( ) 35.7 ( ) 90.0 ( ) 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Includes cases from Bangladesh, India, Israel, Kuwait, Lebanon and Turkey Data sources: See references in Section 9.

177 4 HPV RELATED STATISTICS Figure 94: Prevalence of HPV 16 among women with invasive cervical cancer in Asia by country and study (continued) Country Iran Israel Japan Jordan Malaysia Mongolia Nepal Pakistan Philippines Rep. Korea Study Salehi Vaziri 2015 Mortazavi 2002 Esmaeili 2008 Khodakarami 2012 Hamkar 2002 Bassal 2015 Laskov 2013 Maehama 2005 Asato 2004 Azuma 2014 Nakagawa 1996 Onuki 2009 Takehara 2011 Kashiwabara 1992 Harima 2002 Sasagawa 2001 Yamasaki 2011 Saito 2000 Imajoh 2012 Yamakawa 1994 Watari 2011 Tsuda 2003 Ishikawa 2001 Fujinaga 1991 Maki 1991 Kanao 2004 Nawa 1995 Yoshida 2009 Nakagawa 2002 Inoue 2006 Yoshida 2004 Sughayer 2010 Hamzi Abdul Raub 2014 Quek 2013 Yadav 1995 Cheah 2008 Sharifah 2009 Chimeddorj 2008 Sherpa 2010 Raza 2010 Khan 2007 Ngelangel 1998 de Sanjose 2010 Quek 2013 Bosch 1995 Kim 2009 Lee 2007 An 2005 Quek 2013 Tong 2007 N % (95% CI) 27.7 ( ) 73.9 ( ) 55.4 ( ) 60.0 ( ) 28.6 ( ) 66.7 ( ) 60.5 ( ) 29.0 ( ) 37.1 ( ) 48.0 ( ) 37.7 ( ) 37.9 ( ) 41.9 ( ) 42.9 ( ) 26.2 ( ) 42.9 ( ) 42.3 ( ) 34.8 ( ) 12.5 ( ) 32.8 ( ) 83.3 ( ) 28.3 ( ) 53.8 ( ) 48.7 ( ) 44.8 ( ) 32.0 ( ) 73.9 ( ) 35.0 ( ) 57.9 ( ) 33.3 ( ) 41.7 ( ) 68.3 ( ) 57.5 ( ) 36.6 ( ) 73.9 ( ) 72.7 ( ) 18.2 ( ) 48.3 ( ) 60.7 ( ) 75.8 ( ) 95.0 ( ) 38.8 ( ) 33.5 ( ) 31.1 ( ) 43.5 ( ) 65.7 ( ) 51.9 ( ) 44.4 ( ) 58.8 ( ) 51.5 ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

178 4 HPV RELATED STATISTICS Figure 95: Prevalence of HPV 16 among women with invasive cervical cancer in Asia by country and study (continued) Country Rep. Korea Saudi Arabia Singapore Sri Lanka Syria Taiwan Thailand Turkey Viet Nam Study Hwang 2003 Cho 2003 An 2003 Hwang 1999 Kim 1995 Song 2007 Alsbeih 2011 Quek 2013 Samarawickrema 2011 Karunaratne 2014 Darnel 2010 Lai 2007 Chen 1994 Ding 2008 Huang 2004 Huang 2004 Su 2007 Yang 1997 Lai 1999 Ho 2005 Chen 1993 Lin 2005 Chao 2009 Yang 2004 Chansaenroj 2014 Chichareon 1998 Natphopsuk 2013 Bhattarakosol 1996 Siriaunkgul 2008 Settheetham Ishida 2005 Chopjitt 2009 Bosch 1995 Siritantikorn 1997 Usubütün 2009 Ozgul 2008 Quek 2013 N , % (95% CI) 52.8 ( ) 64.4 ( ) 63.6 ( ) 39.5 ( ) 53.3 ( ) 65.5 ( ) 67.0 ( ) 36.9 ( ) 77.8 ( ) 67.3 ( ) 47.7 ( ) 50.3 ( ) 46.0 ( ) 43.7 ( ) 65.8 ( ) 98.7 ( ) 58.4 ( ) 64.2 ( ) 53.5 ( ) 30.9 ( ) 50.0 ( ) 53.6 ( ) 72.0 ( ) 36.0 ( ) 51.0 ( ) 54.6 ( ) 48.0 ( ) 35.0 ( ) 77.8 ( ) 61.1 ( ) 75.0 ( ) 61.5 ( ) 61.9 ( ) 58.7 ( ) 52.2 ( ) 48.5 ( ) 20% 30% 40% 50% 60% 70% 80% 90% 100% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

179 4 HPV RELATED STATISTICS Figure 96: Prevalence of HPV 16 among women with invasive cervical cancer in Europe by country and study Country Austria Belarus Belgium Bulgaria Croatia Czech Rep. Denmark Europe Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Study Bachtiary 2002 Widschwendter 2003 Kulmala 2007 Baay 2001 Todorova 2010 Hadzisejdic 2006 Dabic 2008 Tachezy 2011 Slama 2009 Tachezy 1999 Kirschner 2013 Hording 1997 Sebbelov 2000 Kjær 2014 Tjalma 2013 de Sanjose 2010 Iwasawa 1996 Prétet 2008 de Cremoux 2009 Lombard 1998 Riou 1990 Milde Langosch 1995 Bosch 1995 Panotopoulou 2007 Dokianakis 1999 Koffa 1994 Labropoulou 1997 Adamopoulou 2009 Kónya 1995 Sigurdsson 2007 Skyldberg 1999 Butler 2000 O'Leary 1998 Fay 2009 Sideri 2009 Carozzi 2010 Spinillo 2014 Tornesello 2011 Voglino 2000 Ciotti 2006 Tornesello 2006 Del Mistro 2006 Garzetti 1998 Gargiulo 2007 Rolla 2009 Silins 2004 Kulmala 2007 Gudleviciene 2005 Simanaviciene 2014 Ressler 2007 N ,881 2, % (95% CI) 65.1 ( ) 75.5 ( ) 65.4 ( ) 68.5 ( ) 70.9 ( ) 30.3 ( ) 62.7 ( ) 73.3 ( ) 61.2 ( ) 59.2 ( ) 60.8 ( ) 18.0 ( ) 70.6 ( ) 57.9 ( ) 55.9 ( ) 57.4 ( ) 63.5 ( ) 72.9 ( ) 55.5 ( ) 50.5 ( ) 54.7 ( ) 51.0 ( ) 76.5 ( ) 24.2 ( ) 2.7 ( ) 35.9 ( ) 54.3 ( ) 47.1 ( ) 63.2 ( ) 57.1 ( ) 23.7 ( ) 93.1 ( ) 80.0 ( ) 80.0 ( ) 63.4 ( ) 67.9 ( ) 54.5 ( ) 58.5 ( ) 71.0 ( ) 57.8 ( ) 60.0 ( ) 75.0 ( ) 50.0 ( ) 61.3 ( ) 66.7 ( ) 60.6 ( ) 65.4 ( ) 56.5 ( ) 50.7 ( ) 79.3 ( ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. a Includes cases from Bosnia-Herzegovina, Croatia, Czech Republic, France, Greece, Italy, Netherlands, Poland, Portugal, and Spain Data sources: See references in Section 9.

180 4 HPV RELATED STATISTICS Figure 97: Prevalence of HPV 16 among women with invasive cervical cancer in Europe by country and study (continued) Country Netherlands Norway Poland Portugal Russia Slovenia Spain Sweden UK Study Tang 2009 Baay 1996 Bulk 2006 Krul 1999 Baalbergen 2013 De Boer 2005 Zielinski 2003 Van Den Brule 1991 Resnick 1990 Karlsen 1996 Bertelsen 2006 Kwasniewska 2009 Baay 2009 Biesaga 2012 Bardin 2008 Pirog 2000 Dybikowska 2002 Bosch 1995 Pista 2013 Medeiros 2005 Nobre 2010 Kleter 1999 Kulmala 2007 Jancar 2009 Muñoz 1992 Martró 2012 Darwich 2011 Rodriguez 1998 Bosch 1995 Mazarico 2012 González Bosquet 2008 Herraez Hernandez 2013 Du 2011 Andersson 2001 Graflund 2004 Wallin 1999 Andersson 2003 Hagmar 1992 Andersson 2005 Skyldberg 1999 Zehbe 1997 Mesher 2015 Howell Jones 2010 Cuschieri 2014 Cuschieri 2010 Powell 2009 Tawfik El Mansi 2006 Cuzick 2000 Arends 1993 Giannoudis 1999 N , % (95% CI) 63.5 ( ) 61.7 ( ) 54.2 ( ) 58.6 ( ) 32.7 ( ) 43.8 ( ) 32.5 ( ) 84.0 ( ) 75.9 ( ) 68.4 ( ) 52.8 ( ) 58.4 ( ) 85.8 ( ) 80.0 ( ) 75.0 ( ) 36.6 ( ) 47.2 ( ) 78.3 ( ) 70.3 ( ) 80.0 ( ) 61.4 ( ) 64.4 ( ) 65.4 ( ) 65.2 ( ) 54.1 ( ) 47.9 ( ) 79.2 ( ) 61.1 ( ) 54.3 ( ) 43.2 ( ) 52.4 ( ) 78.6 ( ) 58.4 ( ) 23.7 ( ) 79.1 ( ) 47.1 ( ) 34.1 ( ) 38.0 ( ) 66.7 ( ) 23.7 ( ) 63.2 ( ) 63.0 ( ) 62.5 ( ) 55.9 ( ) 56.5 ( ) 67.7 ( ) 46.2 ( ) 65.5 ( ) 53.2 ( ) 81.4 ( ) 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% (Continued on next page) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

181 4 HPV RELATED STATISTICS Figure 98: Prevalence of HPV 16 among women with invasive cervical cancer in Europe by country and study (continued) Country Study N % (95% CI) UK Crook ( ) 50% 60% 70% 80% 90% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

182 4 HPV RELATED STATISTICS Figure 99: Prevalence of HPV 16 among women with invasive cervical cancer in Oceania by country and study Country Australia Study Stevens 2006 N 191 % (95% CI) 52.9 ( ) Chen ( ) de Sanjose ( ) Thompson ( ) Liu ( ) Plunkett ( ) Brestovac ( ) Papua N. Guinea Tabone ( ) 10% 20% 30% 40% 50% 60% 70% 80% 90% Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; N: number of women tested; The samples for HPV testing come from cervical specimens (fresh/fixed biopsies or exfoliated cells). The line represents the 95% confidence interval and the shadowed square is proportional to the sample size. Data sources: See references in Section 9.

183 4 HPV RELATED STATISTICS Figure 100: Comparison of the ten most frequent HPV oncogenic types among women with and without cervical lesions by World compared to developing and developed regions World Less developed regions More developed regions Normal cytology HPV type Low grade lesions HPV type High grade lesions HPV type Cervical Cancer HPV type Prevalence (%) Prevalence (%) Prevalence (%) Data updated on 19 May 2017 (data as of 30 Jun 2015). High-grade lesions: CIN-2, CIN-3, CIS or HSIL; Low-grade lesions: LSIL or CIN-1; The samples for HPV testing come from cervical specimens (fresh / fixed biopsies or exfoliated cells). Data sources: See references in Section 9.

184 4 HPV RELATED STATISTICS Figure 101: Comparison of the ten most frequent HPV types among women with invasive cervical cancer by histology by World, developing and developed regions World Less developed regions More developed regions Any Histology HPV type Squamous cell carcinoma HPV type Adenocarcinoma HPV type Unespecified HPV type Prevalence (%) Prevalence (%) Prevalence (%) Data updated on 19 May 2017 (data as of 30 Jun 2015). The samples for HPV testing come from cervical specimens (fresh / fixed biopsies or exfoliated cells). Data sources: See references in Section 9.

185 4 HPV RELATED STATISTICS Table 14: Type-specific HPV prevalence in women with normal cervical cytology, precancerous cervical lesions and invasive cervical cancer Normal cytology Low-grade lesions High-grade lesions Cervical cancer HPV Type No. HPV Prev No. HPV Prev No. HPV Prev No. HPV Prev tested % (95% CI) tested % (95% CI) tested % (95% CI) tested % (95% CI) ONCOGENIC HPV TYPES High-risk HPV types , ( ) 38, ( ) 50, ( ) 58, ( ) , ( ) 37, ( ) 49, ( ) 58, ( ) , ( ) 36, ( ) 48, ( ) 52, ( ) , ( ) 35, ( ) 48, ( ) 53, ( ) , ( ) 31, ( ) 44, ( ) 47, ( ) , ( ) 28, ( ) 43, ( ) 46, ( ) , ( ) 31, ( ) 44, ( ) 47, ( ) , ( ) 27, ( ) 43, ( ) 44, ( ) , ( ) 29, ( ) 44, ( ) 49, ( ) , ( ) 28, ( ) 43, ( ) 46, ( ) , ( ) 30, ( ) 44, ( ) 50, ( ) , ( ) 27, ( ) 41, ( ) 46, ( ) Probable/possible carcinogen , ( ) 13, ( ) 22, ( ) 29, ( ) 30 58, ( ) 3, ( ) 2, ( ) 14, ( ) , ( ) 8, ( ) 12, ( ) 21, ( ) , ( ) 23, ( ) 33, ( ) 33, ( ) , ( ) 26, ( ) 39, ( ) 40, ( ) , ( ) 11, ( ) 18, ( ) 22, ( ) , ( ) 25, ( ) 37, ( ) 40, ( ) , ( ) 11, ( ) 19, ( ) 20, ( ) , ( ) 17, ( ) 25, ( ) 33, ( ) , ( ) 16, ( ) 23, ( ) 28, ( ) , ( ) 16, ( ) 25, ( ) 30, ( ) 85 81, ( ) 3, ( ) 7, ( ) , ( ) ( ) NON-ONCOGENIC HPV TYPES 6 429, ( ) 26, ( ) 34, ( ) 38, ( ) , ( ) 26, ( ) 33, ( ) 38, ( ) 32 77, ( ) ( ) - - 2, ( ) , ( ) 4, ( ) 11, ( ) 23, ( ) , ( ) 4, ( ) 9, ( ) 25, ( ) , ( ) 3, ( ) 5, ( ) 21, ( ) , ( ) 5, ( ) 11, ( ) 24, ( ) , ( ) 3, ( ) 11, ( ) 25, ( ) , ( ) 1, ( ) 2, ( ) 6, ( ) , ( ) 3, ( ) 9, ( ) 23, ( ) , ( ) 2, ( ) 8, ( ) 7, ( ) , ( ) 2, ( ) 8, ( ) 9, ( ) , ( ) 2, ( ) 8, ( ) 10, ( ) , ( ) 1, ( ) 2, ( ) 16, ( ) , ( ) 2, ( ) 8, ( ) 9, ( ) , ( ) 2, ( ) 9, ( ) 9, ( ) , ( ) 2, ( ) 9, ( ) 8, ( ) 86 33, ( ) , ( ) ( ) , ( ) 1, ( ) 7, ( ) 7, ( ) 90 40, ( ) ( ) - - 2, ( ) 91 21, ( ) ( ) , ( ) Data updated on 19 May 2017 (data as of 30 Jun 2015 / 30 Jun 2015). 95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; Low-grade lesions: LSIL or CIN-1; a Kahng 2014 includes lesions CIN2 or worse Data sources: See references in Section 9.

186 4 HPV RELATED STATISTICS Table 15: Type-specific HPV prevalence among invasive cervical cancer cases by histology Any Histology Squamous cell carcinoma Adenocarcinoma Unespecified HPV Type No. HPV Prev No. HPV Prev No. HPV Prev No. HPV Prev tested % (95% CI) tested % (95% CI) tested % (95% CI) tested % (95% CI) ONCOGENIC HPV TYPES High-risk HPV types 16 58, ( ) 43, ( ) 5, ( ) 11, ( ) 18 58, ( ) 42, ( ) 5, ( ) 11, ( ) 31 52, ( ) 39, ( ) 4, ( ) 9, ( ) 33 53, ( ) 40, ( ) 4, ( ) 9, ( ) 35 47, ( ) 36, ( ) 4, ( ) 8, ( ) 39 46, ( ) 36, ( ) 4, ( ) 6, ( ) 45 47, ( ) 36, ( ) 4, ( ) 7, ( ) 51 44, ( ) 34, ( ) 4, ( ) 7, ( ) 52 49, ( ) 38, ( ) 4, ( ) 8, ( ) 56 46, ( ) 35, ( ) 4, ( ) 7, ( ) 58 50, ( ) 39, ( ) 4, ( ) 9, ( ) 59 46, ( ) 36, ( ) 4, ( ) 7, ( ) Probable/possible carcinogen 26 29, ( ) , ( ) 12, ( ) 1, ( ) 1, ( ) 34 21, ( ) 17, ( ) 1, ( ) 2, ( ) 53 33, ( ) , ( ) 31, ( ) 3, ( ) 6, ( ) 67 22, ( ) 18, ( ) 1, ( ) 3, ( ) 68 40, ( ) 30, ( ) 3, ( ) 5, ( ) 69 20, ( ) , ( ) , ( ) , ( ) 22, ( ) 2, ( ) 4, ( ) ( ) ( ) NON-ONCOGENIC HPV TYPES 6 38, ( ) , ( ) , ( ) , ( ) , ( ) 20, ( ) 1, ( ) 3, ( ) 43 21, ( ) , ( ) 20, ( ) 1, ( ) 3, ( ) 54 25, ( ) , ( ) , ( ) , ( ) , ( ) , ( ) , ( ) , ( ) , ( ) , ( ) , ( ) , ( ) , ( ) Data updated on 19 May 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; Data sources: See references in Section 9.

187 4 HPV RELATED STATISTICS Terminology Cytologically normal women No abnormal cells are observed on the surface of their cervix upon cytology. Cervical Intraepithelial Neoplasia (CIN) / Squamous Intraepithelial Lesions (SIL) SIL and CIN are two commonly used terms to describe precancerous lesions or the abnormal growth of squamous cells observed in the cervix. SIL is an abnormal result derived from cervical cytological screening or Pap smear testing. CIN is a histological diagnosis made upon analysis of cervical tissue obtained by biopsy or surgical excision. The condition is graded as CIN 1, 2 or 3, according to the thickness of the abnormal epithelium (1/3, 2/3 or the entire thickness). Low-grade cervical lesions (LSIL/CIN-1) Low-grade cervical lesions are defined by early changes in size, shape, and number of abnormal cells formed on the surface of the cervix and may be referred to as mild dysplasia, LSIL, or CIN-1. High-grade cervical lesions (HSIL/ CIN-2 / CIN-3 / CIS) High-grade cervical lesions are defined by a large number of precancerous cells on the surface of the cervix that are distinctly different from normal cells. They have the potential to become cancerous cells and invade deeper tissues of the cervix. These lesions may be referred to as moderate or severe dysplasia, HSIL, CIN-2, CIN-3 or cervical carcinoma in situ (CIS). Carcinoma in situ (CIS) Preinvasive malignancy limited to the epithelium without invasion of the basement membrane. CIN 3 encompasses the squamous carcinoma in situ. Invasive cervical cancer (ICC) / Cervical cancer If the high-grade precancerous cells invade the basement membrane is called ICC. ICC stages range from stage I (cancer is in the cervix or uterus only) to stage IV (the cancer has spread to distant organs, such as the liver). Invasive squamous cell carcinoma Invasive carcinoma composed of cells resembling those of squamous epithelium. Adenocarcinoma Invasive tumour with glandular and squamous elements intermingled.

188 4 HPV RELATED STATISTICS HPV burden in anogenital cancers other than the cervix Methods: Prevalence and type distribution of human papillomavirus in carcinoma of the vulva, vagina, anus and penis: systematic review and meta-analysis A systematic review of the literature was conducted regarding the worldwide HPV-prevalence and type distribution for anogenital carcinomas other than cervix from January 1986 to data as of indicated in each section. The search terms for the review were HPV AND (anus OR anal) OR (penile) OR vagin* OR vulv* using Pubmed. There were no limits in publication language. References cited in selected articles were also investigated. Inclusion criteria were: HPV DNA detection by means of PCR, a minimum of 10 cases by lesion and a detailed description of HPV DNA detection and genotyping techniques used. The number of cases tested and HPV positive cases were extracted for each study to estimate the prevalence of HPV DNA and the HPV type distribution. Binomial 95% confidence intervals were calculated for each HPV prevalence Anal cancer and precancerous anal lesions Anal cancer is similar to cervical cancer with respect to overall HPV DNA positivity, with approximately 88% of cases associated with HPV infection worldwide (de Martel C et al. Lancet Oncol 2012;13(6):607-15). HPV16 is the most common type detected, representing 73% of all HPV-positive tumours. HPV18 is the second most common type detected and is found in approximately 5% of cases. HPV DNA is also detected in the majority of precancerous anal lesions (AIN) (91.5% in AIN1 and 93.9% in AIN2/3) (De Vuyst H et al. Int J Cancer 2009; 124: ). In this section, the HPV prevalence among anal cancer cases and precancerous anal lesions in the World are presented. Alemany (Asia) Table 16: Studies on HPV prevalence among anal cancer cases (male and female) HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) 2015 a Hillman 2014 (Australia) Ouhoummane 2013 (Canada) Tachezy 2011 (Czech Rep.) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) PCR L1-Consensus primer, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 82) PCR L1-Consensus primer, LBA (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, 89) PCR L1-Consensus primer,, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) ( ) HPV 16 (67.3%) HPV 18 (3.8%) HPV 35 (3.8%) HPV 56 (1.9%) HPV 58 (1.9%) ( ) HPV 16 (77.1%) HPV 52 (13.3%) HPV 6 (10.5%) HPV 54 (9.5%) HPV 11 (5.7%) ( ) HPV 16 (82.3%) HPV 6 (3.1%) HPV 33 (3.1%) HPV 18 (2.1%) HPV 58 (2.1%) ( ) HPV 16 (73.1%) (Continued on next page)

189 4 HPV RELATED STATISTICS HPV detection ( Table 16 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Serup-Hansen 2014 (Denmark) Alemany (Europe) 2015 b Abramowitz 2011 (France) Valmary-Degano 2013 (France) Vincent-Salomon 1996 (France) Rödel 2015 (Germany) Varnai 2006 (Germany) PCR-E6, PCR-E7, PCR- MULTIPLEX (HPV 16, 18, 31, 33, 45, 52, 58) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) PCR-SPF10, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 82) PCR-E6, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 82) PCR L1-Consensus primer, PCR-E6, TS (HPV 6, 11, 16, 18, 33) PCR-SPF10, PCR- MULTIPLEX, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 81, 82) PCR-MY09/11, TS, Sequencing (HPV 6, 11, 16, 18, 31, 33, 45, 58) ( ) HPV 16 (81.0%) HPV 33 (5.1%) HPV 18 (2.2%) HPV 58 (0.7%) ( ) HPV 16 (73.4%) HPV 6 (3.6%) HPV 18 (3.6%) HPV 11 (3.0%) HPV 33 (2.4%) ( ) HPV 16 (75.5%) HPV 18 (5.9%) HPV 11 (3.7%) HPV 6 (3.0%) HPV 52 (2.6%) ( ) HPV 16 (89.0%) HPV 39 (4.1%) HPV 33 (2.7%) HPV 6 (1.4%) HPV 11 (1.4%) ( ) HPV 16 (63.0%) HPV 18 (7.4%) ( ) HPV 16 (94.5%) HPV 11 (2.2%) HPV 31 (2.2%) HPV 35 (2.2%) HPV 18 (1.1%) ( ) HPV 16 (74.5%) HPV 33 (6.4%) HPV 18 (2.1%) HPV 31 (2.1%) HPV 45 (2.1%) Indinnimeo 1999 PCR, TS (HPV 6, 11, 16, 18) ( ) HPV 16 (42.9%) (Italy) Alemany 2015 (Latin America & Caribbean) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) ( ) - Yhim 2011 (Rep. Korea) Youk 2001 (Rep. Korea) Laytragoon-Lewin 2007 (Sweden) Baricevic 2015 (UK) PCR, TS (HPV 6, 11, 16, 18, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 56, 58, 59, 66, 68, 69) PCR-MY09/11, PCR-L1C1/C2, PCR-E6, PCR-E7, TS (HPV 16, 18) PCR-MY09/11, Sequencing (HPV 16, 18, 33) PCR-L1C1/C2, PCR L1-Consensus primer, PCR-E6, PCR-E7, PCR- MULTIPLEX (HPV 6, 11, 16, 18, 31, 33, 45, 52, 58) ( ) HPV 16 (66.0%) HPV 58 (6.4%) HPV 35 (2.1%) ( ) HPV 16 (100.0%) ( ) HPV 16 (69.4%) HPV 18 (34.7%) HPV 33 (2.8%) ( ) HPV 16 (88.7%) HPV 6 (11.9%) HPV 33 (6.6%) HPV 18 (4.6%) HPV 58 (4.6%) (Continued on next page)

190 4 HPV RELATED STATISTICS HPV detection ( Table 16 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Alemany 2015 (USA) Daling 2004 (USA) Palefsky 1991 (USA) Zaki 1992 (USA) Alemany 2015 c (Western Africa) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) PCR-MY09/11, PCR L1-Consensus primer, RFLP, TS (HPV 16, 18) PCR-E6, TS (HPV 06/11, 16, 18, 31, 33) PCR L1-Consensus primer, TS (HPV 6, 11, 16, 18, 16/18) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) ( ) HPV 16 (81.3%) HPV 18 (7.3%) HPV 31 (4.2%) HPV 39 (3.1%) HPV 52 (3.1%) ( ) HPV 16 (69.8%) HPV 18 (8.5%) ( ) HPV 16 (76.9%) HPV 31 (23.1%) HPV 6/11 (15.4%) HPV 33 (7.7%) ( ) HPV 16 (18.2%) HPV 6 (9.1%) HPV 11 (9.1%) HPV 16/18 (9.1%) ( ) HPV 16 (28.6%) HPV 6 (9.5%) HPV 18 (9.5%) HPV 31 (4.8%) HPV 35 (4.8%) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; EIA: Enzyme ImmunoAssay; LBA: Line-Blot Assay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; SPF: Short Primer Fragment; TS: Type Specific; a Includes cases from Bangladesh, India and South Korea b Includes cases from Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom c Includes cases from Mali, Nigeria and Senegal Data sources: See references in Section 9. Table 17: Studies on HPV prevalence among AIN 2/3 cases (male and female) HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Hillman 2012 (Australia) Gohy (Canada) Salit (Canada) Alemany (Europe) 2008 a 2009 a 2015 b Hampl 2006 (Germany) HC2, LBA (HPV 16, 18, 31, 33) ( ) HPV 16 (33.3%) HPV 31 (19.0%) HPV 18 (4.8%) PCR-MY09/11, (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, 89) PCR-PGMY09/11, PCR L1-Consensus primer, LBA (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 66, 68) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91), PCR-MY09/11, Sequencing (HPV 6, 11, 20, 21, 22, 23, 26, 30, 32) ( ) HPV 16 (35.5%) HPV 18 (16.1%) HPV 58 (16.1%) HPV 42 (9.7%) HPV 45 (9.7%) ( ) HPV 16 (52.7%) HPV 18 (32.4%) HPV 31 (31.1%) HPV 6 (28.4%) HPV 52 (27.0%) ( ) HPV 16 (65.2%) HPV 6 (8.7%) HPV 18 (8.7%) HPV 51 (8.7%) HPV 74 (8.7%) ( ) - (Continued on next page)

191 4 HPV RELATED STATISTICS HPV detection ( Table 17 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Silling 2012 a PCR- MULTIPLEX (HPV 6, 11, ( ) HPV 16 (69.0%) (Germany) 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 61, 66, 67, 68, 70, 71, 72, 73, 81, 82, 83, 84, 89) HPV 11 (23.8%) HPV 18 (23.8%) HPV 6 (19.0%) HPV 67 (19.0%) Varnai 2006 (Germany) Wieland 2006 a (Germany) Tanzi (Italy) 2009 a, PCR-MY09/11, TS, Sequencing (HPV 6, 11, 16, 18, 31, 33, 45, 58) PCR, EIA (HPV 6, 11, 16, 18, 31, 33, 34, 35, 42, 44, 45, 52, 53, 54, 56, 58, 59, 66, 68, 70, 72, 73, 81, 82, 83, 84, 89) PCR-MY09/11, PCR L1-Consensus primer, RFLP (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 81, 83, 84) Alemany 2015 c (Latin America & Caribbean) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) Richel 2014 a PCR L1-Consensus primer, (Netherlands) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 67, 68, 69, 70, 73, 74) García-Espinosa 2013 a (Spain) Sirera (Spain) Torres (Spain) 2013 a 2013 a Phanuphak 2013 (Thailand) PCR-GP5/6, PCR L1-Consensus primer, DBH (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 61, 66, 68, 70, 71, 72, 73, 81, 82, 84) PCR- MULTIPLEX (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) LBA (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84) PCR L1-Consensus primer, PCR-E6, PCR-E7, LBA (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84) ( ) HPV 16 (70.8%) HPV 11 (12.5%) HPV 6 (8.3%) HPV 58 (4.2%) ( ) HPV 16 (88.9%) HPV 18 (44.4%) HPV 83 (38.9%) HPV 52 (33.3%) HPV 58 (27.8%) ( ) HPV 6 (38.7%) HPV 16 (37.1%) HPV 11 (27.4%) HPV 58 (8.1%) HPV 18 (4.8%) ( ) HPV 16 (91.7%) HPV 6 (8.3%) HPV 11 (8.3%) ( ) HPV 16 (58.8%) HPV 31 (17.6%) HPV 18 (11.8%) HPV 53 (11.8%) HPV 58 (11.8%) ( ) HPV 16 (50.0%) HPV 44 (35.0%) HPV 58 (35.0%) HPV 6 (30.0%) HPV 31 (30.0%) ( ) HPV 16 (55.1%) HPV 58 (34.8%) HPV 33 (29.0%) HPV 51 (23.2%) HPV 18 (21.7%) ( ) HPV 16 (59.1%) HPV 6 (34.1%) HPV 66 (31.8%) HPV 52 (29.5%) HPV 53 (29.5%) ( ) HPV 40 (51.2%) HPV 53 (26.8%) HPV 16 (24.4%) HPV 11 (19.5%) HPV 58 (17.1%) (Continued on next page)

192 4 HPV RELATED STATISTICS HPV detection ( Table 17 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Fox 2005 a (UK), PCR-MY09/11, (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) Sahasrabuddhe 2013 a (USA) PCR-PGMY09/11, LBA (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84) ( ) HPV 16 (64.9%) HPV 18 (25.7%) HPV 33 (24.3%) HPV 58 (21.6%) HPV 31 (18.9%) ( ) HPV 16 (54.8%) HPV 6 (26.0%) HPV 31 (22.1%) HPV 42 (22.1%) HPV 66 (21.2%) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; DBH: Dot Blot Hybridization; EIA: Enzyme ImmunoAssay; HC2: Hybrid Capture 2; LBA: Line-Blot Assay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; SPF: Short Primer Fragment; TS: Type Specific; a HIV positive cases b Includes cases from Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom c Includes cases from Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico and Paraguay Data sources: See references in Section 9. Figure 102: Comparison of the ten most frequent HPV types in anal cancer cases in Africa and the World Africa (a) World (b) th* th* th* Type specific HPV prevalence (%) of anal cancer cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; a Includes cases from Mali, Nigeria and Senegal. b Includes cases from Europe (Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom); America (Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay and United States); Africa (Mali, Nigeria and Senegal); Asia (Bangladesh,India and South Korea) Data sources: See references in Section 9.

193 4 HPV RELATED STATISTICS Figure 103: Comparison of the ten most frequent HPV types in anal cancer cases in the Americas and the World Americas (a) World (b) Type specific HPV prevalence (%) of anal cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; a Includes cases from Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay and United States b Includes cases from Europe (Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom); America (Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay and United States); Africa (Mali, Nigeria and Senegal); Asia (Bangladesh,India and South Korea) Data sources: See references in Section 9. Figure 104: Comparison of the ten most frequent HPV types in anal cancer cases in Asia and the World Asia (a) World (b) Type specific HPV prevalence (%) of anal cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; a Includes cases from Bangladesh,India and South Korea b Includes cases from Europe (Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom); America (Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay and United States); Africa (Mali, Nigeria and Senegal); Asia (Bangladesh,India and South Korea) Data sources: See references in Section 9.

194 4 HPV RELATED STATISTICS Figure 105: Comparison of the ten most frequent HPV types in anal cancer cases in Europe and the World Europe (a) World (b) Type specific HPV prevalence (%) of anal cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; a Includes cases from Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom. b Includes cases from Europe (Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom); America (Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay and United States); Africa (Mali, Nigeria and Senegal); Asia (Bangladesh,India and South Korea) Data sources: See references in Section 9. Figure 106: Comparison of the ten most frequent HPV types in anal cancer cases in Oceania and the World Oceania World (a) 1st* nd* rd* th* th* 6th* No data available th* th* th* th* Type specific HPV prevalence (%) of anal cancer cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; a Includes cases from Europe (Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom); America (Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay and United States); Africa (Mali, Nigeria and Senegal); Asia (Bangladesh,India and South Korea) Data sources: See references in Section 9.

195 4 HPV RELATED STATISTICS Figure 107: Comparison of the ten most frequent HPV types in AIN 2/3 cases in Africa and the World Africa World (a) 1st* nd* rd* th* th* 6th* No data available th* th* th* th* Type specific HPV prevalence (%) of AIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; a Includes cases from Europe (Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom); America (Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay) Data sources: See references in Section 9. Figure 108: Comparison of the ten most frequent HPV types in AIN 2/3 cases in the Americas and the World Americas (a) World (b) th* th* th* th* th* th* th* Type specific HPV prevalence (%) of AIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; a Includes cases from Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay b Includes cases from Europe (Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom); America (Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay) Data sources: See references in Section 9.

196 4 HPV RELATED STATISTICS Figure 109: Comparison of the ten most frequent HPV types in AIN 2/3 cases in Asia and the World Asia World (a) 1st* nd* rd* th* th* 6th* No data available th* th* th* th* Type specific HPV prevalence (%) of AIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; a Includes cases from Europe (Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom); America (Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay) Data sources: See references in Section 9. Figure 110: Comparison of the ten most frequent HPV types in AIN 2/3 cases in Europe and the World Europe (a) World (b) Type specific HPV prevalence (%) of AIN 2/3 cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; a Includes cases from Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom b Includes cases from Europe (Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom); America (Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay) Data sources: See references in Section 9.

197 4 HPV RELATED STATISTICS Figure 111: Comparison of the ten most frequent HPV types in AIN 2/3 cases in Oceania and the World Oceania World (a) 1st* nd* rd* th* th* 6th* No data available th* th* th* th* Type specific HPV prevalence (%) of AIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). AIN 2/3: Anal intraepithelial neoplasia of grade 2/3; a Includes cases from Europe (Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom); America (Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay) Data sources: See references in Section 9.

198 4 HPV RELATED STATISTICS Vulvar cancer and precancerous vulvar lesions HPV attribution for vulvar cancer is 43% worldwide (de Martel C et al. Lancet Oncol 2012;13(6):607-15). Vulvar cancer has two distinct histological patterns with two different risk factor profiles: (1) basaloid/warty types (2) keratinising types. Basaloid/warty lesions are more common in young women, are frequently found adjacent to VIN, are very often associated with HPV DNA detection (86%), and have a similar risk factor profile as cervical cancer. Keratinising vulvar carcinomas represent the majority of the vulvar lesions (>60%). These lesions develop from non HPV-related chronic vulvar dermatoses, especially lichen sclerosus and/or squamous hyperplasia, their immediate cancer precursor lesion is differentiated VIN, they occur more often in older women, and are rarely associated with HPV (6%) or with any of the other risk factors typical of cervical cancer. HPV prevalence is frequently detected among cases of high-grade VIN (VIN2/3) (85.3%). HPV 16 is the most common type detected followed by HPV 33 (De Vuyst H et al. Int J Cancer 2009; 124: ). In this section, the HPV prevalence among vulvar cancer cases and precancerous vulvar lesions in the World are presented. Table 18: Studies on HPV prevalence among vulvar cancer cases HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) de Sanjosé 2013 a (Africa) de Sanjosé 2013 b (Asia) Tan 2013 (Australia) Pinto 1999 (Brazil) Tachezy 2011 (Czech Rep.) Bryndorf 2004 (Denmark) Hørding 1993 (Denmark) Hørding 1994 (Denmark) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) PCR L1-Consensus primer, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 82) PCR L1-Consensus primer, PCR-E6, TS (HPV 06/11, 16, 18, 40, 42, 43, 44, 45, 51, 52, 54, 56, 58) PCR L1-Consensus primer,, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) PCR-SPF10, (HPV 6, 11, 16, 18, 31, 33, 35, 42, 44, 45, 51, 52, 56, 58) PCR-E6, PCR-E7, TS (HPV 6, 11, 16, 18, 33) PCR-E6, PCR-E7, TS (HPV 6, 11, 16, 18, 33) ( ) HPV 16 (58.3%) HPV 18 (4.2%) HPV 45 (4.2%) HPV 52 (4.2%) ( ) HPV 16 (18.1%) HPV 18 (1.6%) HPV 44 (1.6%) HPV 45 (1.1%) HPV 52 (1.1%) ( ) HPV 16 (80.0%) HPV 33 (5.0%) HPV 35 (5.0%) HPV 52 (5.0%) HPV 54 (5.0%) ( ) HPV 16 (16.5%) HPV 18 (9.5%) HPV 6/11 (1.3%) HPV 45 (0.6%) ( ) HPV 16 (23.9%) HPV 33 (8.7%) HPV 6 (2.2%) HPV 42 (2.2%) HPV 45 (2.2%) ( ) HPV 16 (40.0%) HPV 33 (20.0%) HPV 56 (10.0%) ( ) HPV 16 (21.0%) HPV 18 (4.8%) HPV 33 (4.8%) ( ) HPV 16 (28.2%) HPV 33 (3.8%) (Continued on next page)

199 4 HPV RELATED STATISTICS HPV detection ( Table 18 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Madsen 2008 (Denmark) de Sanjosé 2013 c (Europe) Iwasawa 1997 (Finland) Choschzick 2011 (Germany) Hampl 2006 (Germany) Milde-Langosch 1995 (Germany) Reuschenbach 2013 (Germany) Bonvicini 2005 (Italy) Nagano 1996 (Japan) Osakabe 2007 (Japan) EIA, (HPV 6, 11, 16, 18, 31, 33, 35, 42, 44, 45, 51, 52, 56, 58, 61, 67, 73) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) PCR-MY09/11, PCR L1-Consensus primer, PCR-E6, TS (HPV 6, 11, 16, 18, 33) PCR-MY09/11, Sequencing (HPV 6, 11, 16, 18, 33) PCR-MY09/11, Sequencing (HPV 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 35, 42, 44, 45, 51, 52, 56, 58, 61, 67, 73, 91) PCR-MY09/11, TS (HPV 6, 11, 16, 18, 31, 33, 35) PCR- MULTIPLEX (HPV 6, 11, 16, 18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56, 58, 59, 68, 70, 71, 73, 82) PCR-MY09/11 (HPV 16, 18, 31, 33, 35, 45, 52, 58) PCR-L1C1/C2, RFLP (HPV 6, 11, 16, 18, 30, 31, 33, 34, 35, 39, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 68, 70) PCR-L1C1/C2, RFLP (HPV 6, 11, 16, 18, 31, 33, 42, 52, 58) de Sanjosé 2013 d (Latin America & Caribbean) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) Kagie 1997 (Netherlands) Trietsch 2013 (Netherlands) van de Nieuwenhof 2009 (Netherlands) PCR-CPI/CPIIG, Sequencing (HPV 6, 11, 16, 31, 33, 45) PCR, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 82) PCR L1-Consensus primer, (HPV 6, 11, 16, 18, 31, 33, 35, 42, 45, 51, 52, 53, 54, 56, 58, 66, 73) ( ) HPV 16 (36.7%) HPV 33 (11.7%) HPV 73 (3.3%) HPV 6 (1.7%) HPV 51 (1.7%) ( ) HPV 16 (13.8%) HPV 33 (1.2%) HPV 18 (0.6%) HPV 31 (0.6%) HPV 44 (0.4%) ( ) HPV 16 (25.7%) HPV 18 (12.2%) HPV 33 (1.4%) ( ) HPV 16 (43.6%) HPV 33 (2.6%) ( ) HPV 16 (39.6%) HPV 33 (8.3%) HPV 31 (4.2%) HPV 18 (2.1%) ( ) HPV 16 (25.0%) ( ) HPV 16 (36.1%) HPV 18 (2.7%) HPV 33 (1.1%) HPV 6 (0.5%) HPV 11 (0.5%) ( ) ( ) HPV 16 (36.4%) HPV 6 (9.1%) HPV 18 (9.1%) HPV 51 (9.1%) HPV 56 (9.1%) ( ) HPV 16 (14.3%) HPV 6 (4.8%) HPV 52 (4.8%) ( ) ( ) HPV 16 (16.7%) HPV 33 (1.5%) HPV 45 (1.5%) ( ) HPV 16 (10.2%) HPV 33 (5.6%) HPV 18 (1.9%) ( ) HPV 16 (15.4%) HPV 33 (5.4%) HPV 18 (2.3%) HPV 52 (1.5%) HPV 54 (1.5%) (Continued on next page)

200 4 HPV RELATED STATISTICS HPV detection ( Table 18 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) van der Avoort 2006 (Netherlands) de Sanjosé 2013 e (Oceania) Bujko 2012 (Poland) Liss 1998 (Poland) Alonso 2011 (Spain) Guerrero 2011 (Spain) Lerma 1999 (Spain) Larsson 2012 (Sweden) Lindell 2010 (Sweden) Ngamkham 2013 (Thailand) Abdel-Hady 2001 (UK) de Sanjosé 2013 (USA) Gargano 2012 (USA) PCR L1-Consensus primer, PCR-SPF10, (HPV 6, 11, 16, 18, 31, 33, 35, 42, 44, 45, 51, 52, 56, 58) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) PCR, LBA (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 61, 66, 68, 70, 71, 72, 73, 81, 82, 83, 84) PCR-MY09/11, PCR L1-Consensus primer, PCR-E6, PCR-E7, RFLP (HPV 6, 11, 16, 18, 31, 33, 35, 45, 52, 58) PCR-SPF10, (HPV 6, 11, 16, 18, 31, 33, 35, 42, 45, 51, 52, 53, 54, 56, 58, 66) PCR L1-Consensus primer, (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 61, 66, 68, 70, 71, 72, 73, 81, 82, 83, 84) PCR L1-Consensus primer, TS (HPV 16, 18) PCR-E6, (HPV 6, 11, 16, 18, 31, 33, 39, 45, 51, 52, 56, 58, 59) PCR-CPI/CPIIG, TS, Sequencing (HPV 6, 11, 16, 18, 33, 52) EIA (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 66, 68, 70, 71, 72, 73, 81, 82, 83, 84, 89) ( ) ( ) HPV 16 (27.3%) HPV 33 (3.6%) HPV 18 (2.7%) HPV 6 (1.4%) HPV 39 (1.4%) ( ) HPV 16 (20.5%) HPV 11 (11.4%) HPV 44 (4.5%) HPV 52 (4.5%) HPV 58 (4.5%) ( ) HPV 16 (16.7%) ( ) HPV 16 (14.3%) HPV 33 (2.0%) HPV 31 (1.0%) HPV 51 (1.0%) HPV 52 (1.0%) ( ) HPV 59 (10.0%) HPV 6 (3.3%) HPV 16 (3.3%) HPV 18 (3.3%) ( ) HPV 16 (12.3%) ( ) HPV 16 (23.8%) HPV 33 (3.8%) HPV 18 (1.5%) HPV 56 (0.8%) HPV 59 (0.8%) ( ) HPV 16 (21.3%) HPV 18 (2.7%) HPV 33 (2.7%) HPV 52 (1.3%) ( ) HPV 16 (36.0%) HPV 33 (8.0%) HPV 35 (8.0%) HPV 18 (4.0%) HPV 58 (4.0%) TS (HPV 6, 11, 16, 18, 31, 33) ( ) HPV 16 (27.3%) HPV 33 (18.2%) HPV 18 (9.1%) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) PCR-SPF10, LBA, (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 81, 82, 83, 84) ( ) HPV 16 (34.0%) HPV 33 (8.0%) HPV 6 (2.0%) HPV 18 (2.0%) HPV 44 (2.0%) ( ) HPV 16 (48.3%) HPV 33 (10.2%) HPV 52 (2.8%) HPV 18 (1.7%) HPV 31 (1.1%) (Continued on next page)

201 4 HPV RELATED STATISTICS HPV detection ( Table 18 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Kim 1996 (USA) Madeleine 1997 (USA) Sutton 2008 (USA) Tate 1994 (USA) PCR-MY09/11, PCR L1-Consensus primer, TS, Sequencing (HPV 16, 18) PCR-MY09/11, PCR L1-Consensus primer, PCR-E6, RFLP (HPV 16) PCR L1-Consensus primer, LBA (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 70, 71, 72, 73, 81, 82, 83, 84) PCR-MY09/11, PCR L1-Consensus primer, RFLP (HPV 16, 33) PCR L1-Consensus primer, TS (HPV 16) ( ) HPV 16 (27.8%) HPV 18 (5.6%) ( ) HPV 16 (43.6%) ( ) HPV 16 (56.0%) HPV 33 (10.3%) HPV 45 (3.4%) HPV 6 (2.6%) HPV 52 (2.6%) ( ) HPV 16 (46.2%) HPV 33 (7.7%) Riethdorf 2004 f ( ) HPV 16 (87.3%) (World) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; EIA: Enzyme ImmunoAssay; LBA: Line-Blot Assay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; SPF: Short Primer Fragment; TS: Type Specific; a Includes cases from Mali, Mozambique, Nigeria, and Senegal b Includes cases from Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey c Includes cases from Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom d Includes cases from Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay, and Venezuela e Includes cases from Australia and New Zealand f Includes cases from Germany and United States of America Data sources: See references in Section 9. Table 19: Studies on HPV prevalence among VIN 2/3 cases HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) de Sanjosé 2013 a (Asia) Tan 2013 (Australia) Tachezy 2011 (Czech Rep.) Junge 1995 (Denmark) de Sanjosé 2013 b (Europe) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) PCR L1-Consensus primer, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 82) PCR L1-Consensus primer,, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) PCR-E6, PCR-E7, TS (HPV 6, 11, 16, 18, 31, 33) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) ( ) HPV 16 (80.0%) HPV 6 (5.0%) HPV 18 (5.0%) HPV 33 (5.0%) HPV 35 (5.0%) ( ) HPV 16 (68.2%) HPV 26 (4.5%) HPV 33 (4.5%) HPV 52 (4.5%) HPV 82 (4.5%) ( ) HPV 16 (71.3%) HPV 33 (8.5%) HPV 18 (5.3%) HPV 6 (4.3%) HPV 11 (2.1%) ( ) HPV 16 (77.6%) HPV 33 (10.3%) ( ) HPV 16 (69.6%) HPV 33 (11.2%) HPV 18 (2.2%) HPV 6 (1.6%) HPV 52 (1.3%) (Continued on next page)

202 4 HPV RELATED STATISTICS HPV detection ( Table 19 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Hampl 2006 (Germany) Tsimplaki 2012 (Greece) Bonvicini 2005 (Italy) PCR-MY09/11, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 35, 42, 44, 45, 51, 52, 56, 58, 61, 67, 73, 74, 91) (HPV 6, 11, 16, 18, 31, 33, 35, 40, 42, 43, 44, 45, 51, 52, 53, 56, 58, 59, 66, 73) PCR-MY09/11 (HPV 16, 18, 31, 33, 35, 45, 52, 58) de Sanjosé 2013 c (Latin America & Caribbean) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) van Beurden 1995 (Netherlands) van der Avoort 2006 (Netherlands) van Esch 2014 (Netherlands) de Sanjosé 2013 d (Oceania) Lerma 1999 (Spain) Abdel-Hady 2001 (UK) Baldwin 2003 (UK) PCR-CPI/CPIIG, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 45) PCR L1-Consensus primer, PCR-SPF10, (HPV 6, 11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, 56, 58, 59, 74) ( ) HPV 16 (79.8%) HPV 33 (10.7%) HPV 31 (4.2%) HPV 18 (3.0%) ( ) HPV 16 (64.3%) HPV 18 (7.1%) HPV 51 (7.1%) HPV 52 (7.1%) HPV 53 (7.1%) ( ) HPV 16 (36.0%) HPV 35 (8.0%) HPV 33 (4.0%) HPV 52 (4.0%) ( ) ( ) HPV 16 (89.1%) HPV 33 (2.2%) HPV 45 (2.2%) ( ) HPV 16 (40.6%) HPV 6 (6.3%) HPV 31 (6.3%) HPV 33 (3.1%) TS (HPV 16, 18, 33, 73) ( ) HPV 16 (81.4%) HPV 33 (14.0%) HPV 73 (2.3%) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 91) PCR L1-Consensus primer, TS (HPV 16, 18) ( ) HPV 16 (71.2%) HPV 33 (10.4%) HPV 18 (4.0%) HPV 31 (3.2%) HPV 6 (1.6%) ( ) HPV 16 (27.8%) TS (HPV 06/11, 16, 18, 31, 33) ( ) HPV 16 (62.5%) HPV 6/11 (18.8%) HPV 31 (3.1%) HPV 33 (3.1%) PCR L1-Consensus primer, Sequencing (HPV 6, 11, 16, 18, 31, 33) Bryant 2011 (UK) PCR- MULTIPLEX (HPV 6, 11, 16, 18, 31, 33, 35, 40, 42, 43, 44, 45, 51, 52, 53, 56, 58, 59, 66, 73) Daayana 2010 (UK) EIA, (HPV 6, 11, 16, 26, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 61, 66, 68, 70, 71, 72, 73, 81, 82, 83, 84) ( ) HPV 16 (90.9%) HPV 33 (9.1%) ( ) HPV 16 (67.3%) HPV 33 (16.3%) HPV 6 (10.2%) HPV 18 (2.0%) HPV 31 (2.0%) ( ) HPV 16 (73.7%) HPV 33 (5.3%) HPV 42 (5.3%) HPV 84 (5.3%) (Continued on next page)

203 4 HPV RELATED STATISTICS HPV detection ( Table 19 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Winters 2008 (UK) Gargano 2012 (USA) Madeleine 1997 (USA) Srodon 2006 (USA) EIA, (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 61, 66, 68, 70, 71, 72, 73, 81, 82, 83, 84) PCR-SPF10, LBA, (HPV 16, 18, 33, 52, 59) PCR-MY09/11, PCR L1-Consensus primer, PCR-E6, RFLP (HPV 16) PCR-MY09/11, PCR-SPF10,, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) PCR L1-Consensus primer, TS (HPV 16) ( ) HPV 16 (75.0%) HPV 18 (5.0%) HPV 33 (5.0%) ( ) HPV 16 (80.9%) HPV 33 (8.8%) HPV 59 (2.9%) HPV 18 (1.5%) ( ) HPV 16 (61.7%) ( ) HPV 16 (91.2%) HPV 18 (5.9%) HPV 35 (5.9%) HPV 11 (2.9%) HPV 33 (2.9%) Riethdorf 2004 e ( ) HPV 16 (68.3%) (World) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; EIA: Enzyme ImmunoAssay; LBA: Line-Blot Assay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; SPF: Short Primer Fragment; TS: Type Specific; a Includes cases from Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey b Includes cases from Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom c Includes cases from Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay, and Venezuela d Includes cases from Australia and New Zealand e Includes cases from Germany and United States of America Data sources: See references in Section 9. Figure 112: Comparison of the ten most frequent HPV types in vulvar cancer cases in Africa and the World Africa (a) World (b) th* th* th* th* th* th* Type specific HPV prevalence (%) of vulvar cancer cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; a Includes cases from Mali, Mozambique, Nigeria, and Senegal. (Continued on next page)

204 4 HPV RELATED STATISTICS ( Figure 116 continued from previous page) b Includes cases from America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay, United States of America and Venezuela); Africa (Mali, Mozambique, Nigeria, and Senegal); Oceania (Australia and New Zealand); Europe (Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom); and in Asia (Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey) Data sources: See references in Section 9. Figure 113: Comparison of the ten most frequent HPV types in vulvar cancer cases in the Americas and the World Americas (a) World (b) Type specific HPV prevalence (%) of vulvar cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; a Includes cases from Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay, United States of America and Venezuela b Includes cases from America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay, United States of America and Venezuela); Africa (Mali, Mozambique, Nigeria, and Senegal); Oceania (Australia and New Zealand); Europe (Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom); and in Asia (Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey) Data sources: See references in Section 9. Figure 114: Comparison of the ten most frequent HPV types in vulvar cancer cases in Asia and the World Asia (a) World (b) Type specific HPV prevalence (%) of vulvar cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; (Continued on next page)

205 4 HPV RELATED STATISTICS ( Figure 116 continued from previous page) a Includes cases from Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey. b Includes cases from America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay, United States of America and Venezuela); Africa (Mali, Mozambique, Nigeria, and Senegal); Oceania (Australia and New Zealand); Europe (Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom); and in Asia (Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey) Data sources: See references in Section 9. Figure 115: Comparison of the ten most frequent HPV types in vulvar cancer cases in Europe and the World Europe (a) World (b) Type specific HPV prevalence (%) of vulvar cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; a Includes cases from Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom. b Includes cases from America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay, United States of America and Venezuela); Africa (Mali, Mozambique, Nigeria, and Senegal); Oceania (Australia and New Zealand); Europe (Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom); and in Asia (Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey) Data sources: See references in Section 9. Figure 116: Comparison of the ten most frequent HPV types in vulvar cancer cases in Oceania and the World Oceania (a) World (b) Type specific HPV prevalence (%) of vulvar cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). (Continued on next page)

206 4 HPV RELATED STATISTICS ( Figure 116 continued from previous page) VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; a Includes cases from Australia and New Zealand. b Includes cases from America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay, United States of America and Venezuela); Africa (Mali, Mozambique, Nigeria, and Senegal); Oceania (Australia and New Zealand); Europe (Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom); and in Asia (Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey) Data sources: See references in Section 9. Figure 117: Comparison of the ten most frequent HPV types in VIN 2/3 cases in Africa and the World Africa World (a) 1st* nd* rd* th* th* 6th* No data available th* th* th* th* Type specific HPV prevalence (%) of VIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; a Includes cases from America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay and Venezuela); Oceania (Australia and New Zealand); Europe (Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom); and in Asia (Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey) Data sources: See references in Section 9. Figure 118: Comparison of the ten most frequent HPV types in VIN 2/3 cases in the Americas and the World Americas (a) World (b) Type specific HPV prevalence (%) of VIN 2/3 cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; (Continued on next page)

207 4 HPV RELATED STATISTICS ( Figure 121 continued from previous page) a Includes cases from Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay, and Venezuela. b Includes cases from America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay and Venezuela); Oceania (Australia and New Zealand); Europe (Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom); and in Asia (Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey) Data sources: See references in Section 9. Figure 119: Comparison of the ten most frequent HPV types in VIN 2/3 cases in Asia and the World Asia (a) World (b) th* th* th* th* Type specific HPV prevalence (%) of VIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; a Includes cases from Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey. b Includes cases from America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay and Venezuela); Oceania (Australia and New Zealand); Europe (Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom); and in Asia (Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey) Data sources: See references in Section 9. Figure 120: Comparison of the ten most frequent HPV types in VIN 2/3 cases in Europe and the World Europe (a) World (b) Type specific HPV prevalence (%) of VIN 2/3 cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; a Includes cases from Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom. (Continued on next page)

208 4 HPV RELATED STATISTICS ( Figure 121 continued from previous page) b Includes cases from America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay and Venezuela); Oceania (Australia and New Zealand); Europe (Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom); and in Asia (Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey) Data sources: See references in Section 9. Figure 121: Comparison of the ten most frequent HPV types in VIN 2/3 cases in Oceania and the World Oceania (a) World (b) Type specific HPV prevalence (%) of VIN 2/3 cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VIN 2/3: Vulvar intraepithelial neoplasia of grade 2/3; a Includes cases from Australia and New Zealand. b Includes cases from America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Uruguay and Venezuela); Oceania (Australia and New Zealand); Europe (Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom); and in Asia (Bangladesh, India, Israel, South Korea, Kuwait, Lebanon, Philippines, Taiwan and Turkey) Data sources: See references in Section 9.

209 4 HPV RELATED STATISTICS Vaginal cancer and precancerous vaginal lesions Vaginal and cervical cancers share similar risk factors and it is generally accepted that both carcinomas share the same aetiology of HPV infection although there is limited evidence available. Women with vaginal cancer are more likely to have a history of other anogenital cancers, particularly of the cervix, and these two carcinomas are frequently diagnosed simultaneously. HPV DNA is detected among 70% of invasive vaginal carcinomas and 91% of high-grade vaginal neoplasias (VaIN2/3). HPV16 is the most common type in high-grade vaginal neoplasias and it is detected in at least 70% of HPV-positive carcinomas (de Martel C et al. Lancet Oncol 2012;13(6):607-15; De Vuyst H et al. Int J Cancer 2009; 124: ). In this section, the HPV prevalence among vaginal cancer cases and precancerous vaginal lesions in the World are presented. Alemany (Africa) Table 20: Studies on HPV prevalence among vaginal cancer cases HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) 2014 a Alemany 2014 b (Americas) Alemany 2014 c (Asia-Pacific) Madsen 2008 (Denmark) Alemany (Europe) 2014 d Ferreira 2008 (Portugal) Fuste 2010 (Spain) Larsson 2013 (Sweden) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 35, 39, 42, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 73, 82) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 35, 39, 42, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 73, 82) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 35, 39, 42, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 73, 82) EIA, (HPV 6, 11, 16, 18, 31, 33, 35, 39, 40, 42, 44, 45, 51, 52, 56, 58) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 35, 39, 42, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 73, 82) PCR, (HPV 6, 11, 16, 18, 31, 33, 35, 40, 42, 44, 45, 51, 52, 56, 58) PCR-SPF10, (HPV 6, 11, 16, 18, 31, 33, 35, 39, 40, 42, 45, 51, 52, 56, 58, 59, 68) PCR-E6, (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; (Continued on next page) ( ) HPV 16 (31.6%) HPV 45 (10.5%) HPV 18 (5.3%) HPV 31 (5.3%) HPV 33 (5.3%) ( ) HPV 16 (42.4%) HPV 31 (5.8%) HPV 18 (4.2%) HPV 33 (4.2%) HPV 52 (3.1%) ( ) HPV 16 (41.3%) HPV 33 (4.3%) HPV 68 (4.3%) HPV 18 (2.2%) HPV 26 (2.2%) ( ) HPV 16 (77.8%) HPV 33 (7.4%) HPV 18 (3.7%) HPV 39 (3.7%) HPV 45 (3.7%) ( ) HPV 16 (47.4%) HPV 18 (3.3%) HPV 73 (3.3%) HPV 33 (2.6%) HPV 56 (2.6%) ( ) HPV 16 (33.3%) HPV 31 (28.6%) HPV 40 (14.3%) HPV 6 (9.5%) HPV 18 (9.5%) ( ) HPV 16 (56.3%) HPV 52 (6.3%) HPV 35 (3.1%) HPV 51 (3.1%) HPV 58 (3.1%) ( ) HPV 16 (37.7%) HPV 18 (2.9%) HPV 31 (2.9%) HPV 33 (2.9%) HPV 52 (2.9%)

210 4 HPV RELATED STATISTICS ( Table 20 continued from previous page) EIA: Enzyme ImmunoAssay; PCR: Polymerase Chain Reaction; SPF: Short Primer Fragment; a Includes cases from Mozambique, Nigeria b Includes cases from Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United States of America and Venezuela c Includes cases from Australia, Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey d Includes cases from Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom Data sources: See references in Section 9. Table 21: Studies on HPV prevalence among VaIN 2/3 cases HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Alemany 2014 (Americas) Alemany 2014 (Asia-Pacific) Alemany 2014 (Europe) Hampl 2006 (Germany) Tsimplaki 2012 (Greece) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 35, 39, 42, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 73, 82, 89) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 35, 39, 42, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 73, 82, 89) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 33, 35, 39, 42, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 73, 82) PCR-MY09/11, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 35, 40, 44, 52, 56, 58) (HPV 6, 11, 16, 18, 31, 33, 35, 39, 40, 42, 44, 45, 51, 52, 53, 56, 58, 66, 70) ( ) HPV 16 (46.3%) HPV 18 (6.3%) HPV 52 (6.3%) HPV 73 (6.3%) HPV 6 (3.8%) ( ) HPV 16 (53.8%) HPV 52 (15.4%) HPV 59 (15.4%) HPV 45 (7.7%) HPV 73 (7.7%) ( ) HPV 16 (65.6%) HPV 33 (7.3%) HPV 18 (5.2%) HPV 52 (3.1%) HPV 73 (3.1%) ( ) HPV 16 (63.6%) ( ) HPV 16 (20.0%) HPV 33 (20.0%) Frega 2007 (Italy) PCR, TS (HPV 16, 18) ( ) HPV 16 (86.7%) HPV 18 (13.3%) Sugase 1997 (Japan) Daling 2002 (USA) Srodon 2006 (USA) PCR, TS, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) PCR-MY09/11, PCR L1-Consensus primer, RFLP, TS (HPV 16, 31, 33, 35, 58, 66, 73) PCR-MY09/11, PCR-SPF10,, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) ( ) HPV 16 (16.7%) HPV 58 (16.7%) HPV 53 (11.1%) HPV 67 (11.1%) HPV 35 (5.6%) ( ) HPV 16 (54.5%) HPV 58 (1.0%) HPV 66 (1.0%) HPV 73 (1.0%) ( ) HPV 16 (50.0%) HPV 58 (18.8%) HPV 31 (12.5%) HPV 35 (6.3%) HPV 51 (6.3%) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; VAIN 2/3: Vaginal intraepithelial neoplasia of grade 2/3; EIA: Enzyme ImmunoAssay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; SPF: Short Primer Fragment; TS: Type Specific; Based on systematic reviews (up to 2008) performed by ICO for the IARC Monograph on the Evaluation of Carcinogenic Risks to Humans volume 100B and IARC s Infections and Cancer Epidemiology Group. The has updated data until June Reference publications: 1) Bouvard V, Lancet Oncol 2009;10:321 2) De Vuyst H, Int J Cancer 2009;124:1626 Alemany L, Eur J Cancer 2014; 50: 2846 Daling JR, Gynecol Oncol 2002; 84: 263 Frega A, Cancer Lett 2007; 249: 235 Hampl M, Obstet Gynecol 2006; 108: 1361 Srodon M, Am J Surg Pathol 2006; 30: 1513 Sugase M, Int J Cancer 1997; 72: 412 Tsimplaki E, J Oncol 2012; 2012: Data sources: See references in Section 9.

211 4 HPV RELATED STATISTICS Figure 122: Comparison of the ten most frequent HPV types in vaginal cancer cases in Africa and the World Africa (a) World (b) th* th* th* th* Type specific HPV prevalence (%) of vaginal cancer cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VAIN 2/3: Vaginal intraepithelial neoplasia of grade 2/3; a Includes cases from Mozambique, Nigeria. b Includes cases from Europe (Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom); America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United states of America and Venezuela); Africa (Mozambique, Nigeria); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania (Australia) Data sources: See references in Section 9. Figure 123: Comparison of the ten most frequent HPV types in vaginal cancer cases in the Americas and the World Americas (a) World (b) Type specific HPV prevalence (%) of vaginal cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VAIN 2/3: Vaginal intraepithelial neoplasia of grade 2/3; a Includes cases from Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United States of America and Venezuela. b Includes cases from Europe (Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom); America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United states of America and Venezuela); Africa (Mozambique, Nigeria); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania (Australia) Data sources: See references in Section 9.

212 4 HPV RELATED STATISTICS Figure 124: Comparison of the ten most frequent HPV types in vaginal cancer cases in Asia and the World Asia (a) World (b) Type specific HPV prevalence (%) of vaginal cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VAIN 2/3: Vaginal intraepithelial neoplasia of grade 2/3; a Includes cases from Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey b Includes cases from Europe (Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom); America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United states of America and Venezuela); Africa (Mozambique, Nigeria); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania (Australia) Data sources: See references in Section 9. Figure 125: Comparison of the ten most frequent HPV types in vaginal cancer cases in Europe and the World Europe (a) World (b) Type specific HPV prevalence (%) of vaginal cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VAIN 2/3: Vaginal intraepithelial neoplasia of grade 2/3; a Includes cases from Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom. b Includes cases from Europe (Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom); America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United states of America and Venezuela); Africa (Mozambique, Nigeria); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania (Australia) Data sources: See references in Section 9.

213 4 HPV RELATED STATISTICS Figure 126: Comparison of the ten most frequent HPV types in vaginal cancer cases in Oceania and the World Oceania (a) World (b) th* th* th* th* th* Type specific HPV prevalence (%) of vaginal cancer cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). VAIN 2/3: Vaginal intraepithelial neoplasia of grade 2/3; a Includes cases from Australia b Includes cases from Europe (Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom); America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United states of America and Venezuela); Africa (Mozambique, Nigeria); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania (Australia) Data sources: See references in Section 9. Figure 127: Comparison of the ten most frequent HPV types in VaIN 2/3 cases in Africa and the World Africa World (a) 1st* nd* rd* th* th* 6th* No data available th* th* th* th* Type specific HPV prevalence (%) of VaIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). a Includes cases from Europe (Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom); America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United states of America and Venezuela); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania (Australia) Data sources: See references in Section 9.

214 4 HPV RELATED STATISTICS Figure 128: Comparison of the ten most frequent HPV types in VaIN 2/3 cases in the Americas and the World Americas (a) World (b) Type specific HPV prevalence (%) of VaIN 2/3 cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). a Includes cases from Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United States of America and Venezuela. b Includes cases from Europe (Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom); America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United states of America and Venezuela); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania (Australia) Data sources: See references in Section 9. Figure 129: Comparison of the ten most frequent HPV types in VaIN 2/3 cases in Asia and the World Asia (a) World (b) th* th* th* th* th* Type specific HPV prevalence (%) of VaIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). a Includes cases from Australia, Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey. b Includes cases from Europe (Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom); America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United states of America and Venezuela); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania (Australia) Data sources: See references in Section 9.

215 4 HPV RELATED STATISTICS Figure 130: Comparison of the ten most frequent HPV types in VaIN 2/3 cases in Europe and the World Europe (a) World (b) Type specific HPV prevalence (%) of VaIN 2/3 cases Data updated on 09 Feb 2017 (data as of 30 Jun 2014). a Includes cases from Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom. b Includes cases from Europe (Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom); America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United states of America and Venezuela); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania (Australia) Data sources: See references in Section 9. Figure 131: Comparison of the ten most frequent HPV types in VaIN 2/3 cases in Oceania and the World Oceania (a) World (b) th* th* th* th* th* Type specific HPV prevalence (%) of VaIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2014). a Includes cases from Australia, Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey. b Includes cases from Europe (Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom); America (Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Uruguay, United states of America and Venezuela); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania (Australia) Data sources: See references in Section 9.

216 4 HPV RELATED STATISTICS Penile cancer and precancerous penile lesions HPV DNA is detectable in approximately 50% of all penile cancers (de Martel C et al. Lancet Oncol 2012;13(6):607-15). Among HPV-related penile tumours, HPV16 is the most common type detected, followed by HPV18 and HPV types 6/11 (Miralles C et al. J Clin Pathol 2009;62:870-8). Over 95% of invasive penile cancers are SCC and the most common penile SCC histologic sub-types are keratinising (49%), mixed warty-basaloid (17%), verrucous (8%), warty (6%), and basaloid (4%). HPV is commonly detected in basaloid and warty tumours but is less common in keratinising and verrucous tumours. In this section, the HPV prevalence among penile cancer cases and precancerous penile lesions in the World are presented. Table 22: Studies on HPV prevalence among penile cancer cases HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Alemany 2016 (Africa) Rubin 2001 (Americas) Picconi 2000 (Argentina) Alemany 2016 (Asia) Mannweiler 2013 (Austria) D Hauwers 2012 (Belgium) Afonso 2012 (Brazil) Calmon 2013 (Brazil) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 32, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 90, 91) PCR L1-Consensus primer, PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 35, 45, 52, 53, 68) PCR L1-Consensus primer, TS (HPV 6, 16, 18, 31, 33) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 32, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 90, 91) PCR L1-Consensus primer, PCR-SPF10, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 72, 73, 74, 82) PCR-E6, PCR-E7, qpcr (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68) PCR-MY09/11, PCR L1-Consensus primer, PCR-E6, RFLP (HPV 6, 11, 16, 18, 26, 31, 33, 35, 45, 53, 62, 70, 71, 73) PCR L1-Consensus primer, qpcr, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 82) ( ) HPV 16 (26.3%) HPV 30 (5.3%) HPV 33 (5.3%) HPV 52 (5.3%) ( ) HPV 16 (25.4%) HPV 6 (3.5%) HPV 45 (2.8%) HPV 52 (2.8%) HPV 35 (2.1%) ( ) HPV 18 (28.9%) HPV 16 (21.1%) HPV 6 (5.3%) ( ) HPV 16 (9.0%) HPV 33 (1.5%) HPV 35 (1.5%) HPV 45 (1.5%) ( ) HPV 16 (45.5%) HPV 33 (4.9%) HPV 18 (4.1%) HPV 45 (3.3%) HPV 6 (0.8%) ( ) HPV 16 (47.2%) HPV 59 (5.6%) HPV 6 (2.8%) HPV 11 (2.8%) HPV 33 (2.8%) ( ) HPV 16 (17.3%) HPV 45 (12.8%) HPV 6 (6.8%) HPV 18 (3.8%) HPV 31 (3.0%) ( ) HPV 16 (40.4%) HPV 11 (10.6%) HPV 35 (2.1%) (Continued on next page)

217 4 HPV RELATED STATISTICS HPV detection ( Table 22 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) de Sousa 2015 (Brazil) Fonseca 2013 (Brazil) Scheiner 2008 (Brazil) Maden 1993 (Canada) Chan 1994 (China) Alemany 2016 (Europe) Humbey 2003 (France) Perceau 2003 (France) Poetsch 2011 (Germany) Barzon 2014 (Italy) Gentile 2006 (Italy) Tornesello 2008 (Italy) Iwasawa 1993 (Japan) Suzuki 1994 (Japan) Yanagawa 2008 (Japan) Alemany 2016 (Latin America & Caribbean) PCR-PGMY09/11, PCR- MULTIPLEX, Sequencing (HPV 11, 16, 18, 45, 69) Sequencing (HPV 6, 11, 16, 18, 33, 45, 51, 52, 53, 58, 68) PCR-MY09/11, RFLP (HPV 6, 16, 18, 31, 33, 45, 71) PCR L1-Consensus primer, PCR-E6, PCR-E7, TS (HPV 16) ( ) HPV 16 (13.2%) HPV 11 (7.9%) HPV 18 (5.3%) HPV 69 (2.6%) HPV 45 (1.3%) ( ) HPV 11 (39.0%) HPV 6 (19.5%) HPV 16 (18.3%) HPV 53 (11.0%) HPV 33 (2.4%) ( ) HPV 16 (15.0%) HPV 6 (5.0%) HPV 18 (1.3%) HPV 31 (1.3%) HPV 33 (1.3%) ( ) HPV 16 (34.3%) PCR-E6, TS (HPV 16, 18) ( ) HPV 16 (9.8%) HPV 18 (9.8%) PCR-SPF10, EIA, (HPV 6, 11, ( ) HPV 16 (23.4%) 16, 18, 26, 31, 32, 33, 34, 35, 39, HPV 52 (1.2%) 40, 42, 43, 44, 45, 51, 52, 53, 54, HPV 6 (1.0%) 56, 58, 59, 61, 66, 67, 68, 69, 70, HPV 33 (1.0%) 73, 74, 82, 83, 87, 89, 90, 91) HPV 45 (0.7%) PCR-MY09/11, PCR ( ) HPV 16 (25.0%) L1-Consensus primer, TS (HPV 6, 11, 16, 18, 31, 33, 35, 45, 51, 52, 58, 68) TS (HPV 16, 18, 31, 33) ( ) HPV 16 (17.6%) PCR- MULTIPLEX, TS (HPV 06/11, 16, 18) qpcr,, TS (HPV 16, 18, 26, 31, 33, 35, 39, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 82) PCR-MY09/11, PCR L1-Consensus primer, Sequencing (HPV 16, 18, 53) PCR-MY09/11, PCR-L1C1/C2, PCR-E6, PCR-E7, Sequencing (HPV 6, 16, 18, 33, 35) ( ) HPV 16 (32.7%) HPV 6/11 (3.8%) HPV 18 (1.9%) ( ) HPV 16 (25.9%) HPV 45 (1.9%) HPV 68 (1.9%) ( ) HPV 16 (45.5%) HPV 18 (18.2%) HPV 53 (9.1%) ( ) HPV 16 (42.6%) HPV 18 (3.3%) HPV 35 (1.6%) PCR-E6, TS (HPV 16, 18, 33) ( ) HPV 16 (61.3%) HPV 18 (1.8%) PCR L1-Consensus primer, PCR-E6, RFLP (HPV 6, 11, 16, 18, 31, 33, 42, 52, 58) PCR-L1C1/C2, RFLP (HPV 6, 11, 16, 18, 31, 33, 42, 52, 58) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 32, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 90, 91) ( ) HPV 16 (30.8%) HPV 33 (15.4%) HPV 31 (7.7%) ( ) HPV 16 (11.5%) ( ) HPV 16 (23.8%) HPV 6 (2.5%) HPV 11 (1.5%) HPV 33 (1.3%) HPV 35 (1.3%) (Continued on next page)

218 4 HPV RELATED STATISTICS HPV detection ( Table 22 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) López-Romero 2013 (Mexico) Heideman 2007 (Netherlands) Cubilla 2010 (Paraguay) Lebelo 2014 (South Africa) Ferrándiz-Pulido 2013 (Spain) Guerrero 2008 (Spain) Pascual 2007 (Spain) Senba 2006 (Thailand) Tornesello 2008 (Uganda) Stankiewicz 2011 (UK) Alemany 2016 (USA) Cupp 1995 (USA) PCR-E6,, Sequencing (HPV 11, 16, 18, 31, 33, 58, 59) PCR-E6, PCR-E7, EIA, (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 61, 66, 68, 70, 71, 72, 73, 81, 82, 83, 84) PCR-SPF10, (HPV 6, 11, 16, 18, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 70, 73, 74) PCR L1-Consensus primer, PCR-E6, PCR-E7, qpcr (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 70, 73, 74) (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 61, 66, 68, 70, 71, 72, 73, 81, 82, 83, 84) PCR-MY09/11, PCR L1-Consensus primer, Sequencing (HPV 6, 11, 16, 18) PCR L1-Consensus primer, PCR-SPF10, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) PCR-MY09/11, PCR-L1C1/C2, PCR-E6, PCR-E7, Sequencing (HPV 6, 16, 18, 33, 35) PCR L1-Consensus primer, PCR-SPF10 (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 82) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 32, 33, 34, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 90, 91) PCR L1-Consensus primer, PCR-E6, TS (HPV 16, 18) ( ) HPV 16 (61.8%) HPV 11 (3.9%) HPV 31 (3.9%) HPV 18 (1.3%) HPV 33 (1.3%) ( ) HPV 16 (22.8%) HPV 18 (2.3%) HPV 45 (1.8%) HPV 33 (1.2%) HPV 56 (0.6%) ( ) HPV 16 (22.8%) HPV 6 (3.0%) HPV 18 (2.0%) HPV 11 (1.5%) HPV 35 (1.5%) ( ) HPV 16 (55.0%) HPV 11 (30.0%) HPV 18 (10.0%) HPV 45 (5.0%) HPV 6 (2.5%) ( ) HPV 16 (26.9%) HPV 58 (3.8%) HPV 6 (2.6%) HPV 33 (1.3%) HPV 45 (1.3%) ( ) HPV 16 (45.8%) HPV 39 (4.2%) ( ) HPV 16 (65.3%) HPV 18 (8.2%) ( ) HPV 18 (55.4%) HPV 6 (40.0%) HPV 34 (3.1%) HPV 11 (1.5%) HPV 22 (1.5%) ( ) HPV 16 (58.8%) HPV 6 (11.8%) HPV 18 (11.8%) HPV 33 (5.9%) ( ) HPV 16 (45.1%) HPV 11 (9.8%) HPV 6 (5.9%) HPV 45 (5.9%) HPV 31 (4.9%) ( ) HPV 16 (18.8%) ( ) HPV 16 (40.5%) HPV 18 (4.8%) (Continued on next page)

219 4 HPV RELATED STATISTICS HPV detection ( Table 22 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Daling 2005 (USA) Hernandez 2014 (USA) Do 2013 (Viet Nam) PCR-MY09/11, PCR L1-Consensus primer, PCR-E6, RFLP, Sequencing (HPV 6, 16, 18, 31, 33, 45, 53) PCR, LBA, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, 89) PCR-SPF10, PCR-E6, qpcr, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 82) ( ) HPV 16 (69.1%) HPV 6 (4.3%) HPV 33 (2.1%) HPV 18 (1.1%) HPV 31 (1.1%) ( ) HPV 16 (44.3%) HPV 18 (5.1%) HPV 33 (5.1%) HPV 45 (3.8%) HPV 6 (2.5%) ( ) HPV 16 (20.0%) HPV 11 (0.8%) HPV 18 (0.8%) HPV 33 (0.8%) HPV 58 (0.8%) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; EIA: Enzyme ImmunoAssay; LBA: Line-Blot Assay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; SPF: Short Primer Fragment; TS: Type Specific; Data sources: See references in Section 9. Table 23: Studies on HPV prevalence among PeIN 2/3 cases HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study Method No. Tested % (95% CI) HPV type (%) Mannweiler 2013 (Austria) D Hauwers 2012 (Belgium) Alemany 2016 (Europe) Alemany 2016 (Latin America & Caribbean) López-Romero 2013 (Mexico) Wikström 2012 (Sweden) Cupp 1995 (USA) PCR L1-Consensus primer, PCR-SPF10, (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 72, 73, 74, 82) PCR-E6, PCR-E7, qpcr (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 32, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 90, 91) PCR-SPF10, EIA, (HPV 6, 11, 16, 18, 26, 30, 31, 32, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 67, 68, 69, 70, 73, 74, 82, 83, 87, 89, 90, 91) PCR-E6,, Sequencing (HPV 16, 18, 31, 33, 58, 59) PCR-MY09/11, PCR L1-Consensus primer (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 53, 56, 58, 59, 66, 68, 70, 73, 82) PCR L1-Consensus primer, PCR-E6, TS (HPV 16, 18) Data updated on 28 Jun 2017 (data as of 30 Jun 2015). 95% CI: 95% Confidence Interval; PeIN 2/3: Penile intraepithelial neoplasia of grade 2/3; EIA: Enzyme ImmunoAssay; PCR: Polymerase Chain Reaction; SPF: Short Primer Fragment; TS: Type Specific; Data sources: See references in Section ( ) HPV 16 (62.8%) HPV 18 (9.3%) HPV 33 (2.3%) HPV 73 (2.3%) ( ) HPV 16 (61.5%) HPV 18 (23.1%) HPV 11 (15.4%) HPV 53 (15.4%) HPV 56 (15.4%) ( ) HPV 16 (73.4%) HPV 33 (6.3%) HPV 6 (3.1%) HPV 18 (3.1%) HPV 31 (3.1%) ( ) HPV 16 (36.4%) HPV 66 (18.2%) HPV 11 (9.1%) HPV 31 (9.1%) HPV 51 (9.1%) ( ) HPV 16 (100.0%) ( ) HPV 16 (39.3%) HPV 6 (21.4%) HPV 31 (7.1%) HPV 33 (7.1%) HPV 45 (7.1%) ( ) HPV 16 (80.0%) HPV 18 (8.0%)

220 4 HPV RELATED STATISTICS Figure 132: Comparison of the ten most frequent HPV types in penile cancer cases in Africa and the World Africa (a) World (b) th* th* th* th* th* th* Type specific HPV prevalence (%) of penile cancer cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2015). a Includes cases from Mozambique, Nigeria, Senegal b Includes cases from Australia, Bangladesh, India, South Korea, Lebanon, Philippines, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela and United States, Mozambique, Nigeria, Senegal, Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom. Data sources: See references in Section 9. Figure 133: Comparison of the ten most frequent HPV types in penile cancer cases in the Americas and the World Americas (a) World (b) Type specific HPV prevalence (%) of penile cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2015). a Includes cases from Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela and United States b Includes cases from Australia, Bangladesh, India, South Korea, Lebanon, Philippines, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela and United States, Mozambique, Nigeria, Senegal, Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom. Data sources: See references in Section 9.

221 4 HPV RELATED STATISTICS Figure 134: Comparison of the ten most frequent HPV types in penile cancer cases in Asia and the World Asia (a) World (b) th* th* th* th* th* th* Type specific HPV prevalence (%) of penile cancer cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2015). a Includes cases from Bangladesh, India, South Korea, Lebanon, Philippinesy b Includes cases from Australia, Bangladesh, India, South Korea, Lebanon, Philippines, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela and United States, Mozambique, Nigeria, Senegal, Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom. Data sources: See references in Section 9. Figure 135: Comparison of the ten most frequent HPV types in penile cancer cases in Europe and the World Europe (a) World (b) Type specific HPV prevalence (%) of penile cancer cases Data updated on 09 Feb 2017 (data as of 30 Jun 2015). a Includes cases from Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom b Includes cases from Australia, Bangladesh, India, South Korea, Lebanon, Philippines, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela and United States, Mozambique, Nigeria, Senegal, Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom. Data sources: See references in Section 9.

222 4 HPV RELATED STATISTICS Figure 136: Comparison of the ten most frequent HPV types in penile cancer cases in Oceania and the World Oceania World (a) 1st* nd* rd* th* th* 6th* No data available th* th* th* th* Type specific HPV prevalence (%) of penile cancer cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2015). a Includes cases from Australia, Bangladesh, India, South Korea, Lebanon, Philippines, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela and United States, Mozambique, Nigeria, Senegal, Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom. Data sources: See references in Section 9. Figure 137: Comparison of the ten most frequent HPV types in PeIN 2/3 cases in Africa and the World Africa World (a) 1st* nd* rd* th* th* 6th* No data available th* th* th* th* Type specific HPV prevalence (%) of PeIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2015). a Includes cases from Australia, Bangladesh, India, South Korea, Lebanon, Philippines, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela, Mozambique, Nigeria, Senegal, Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom. Data sources: See references in Section 9.

223 4 HPV RELATED STATISTICS Figure 138: Comparison of the ten most frequent HPV types in PeIN 2/3 cases in the Americas and the World Americas (a) World (b) Type specific HPV prevalence (%) of PeIN 2/3 cases Data updated on 09 Feb 2017 (data as of 30 Jun 2015). a Includes cases from Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela. b Includes cases from Australia, Bangladesh, India, South Korea, Lebanon, Philippines, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela, Mozambique, Nigeria, Senegal, Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom. Data sources: See references in Section 9. Figure 139: Comparison of the ten most frequent HPV types in PeIN 2/3 cases in Asia and the World Asia World (a) 1st* nd* rd* th* th* 6th* No data available th* th* th* th* Type specific HPV prevalence (%) of PeIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2015). a Includes cases from Australia, Bangladesh, India, South Korea, Lebanon, Philippines, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela, Mozambique, Nigeria, Senegal, Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom. Data sources: See references in Section 9.

224 4 HPV RELATED STATISTICS Figure 140: Comparison of the ten most frequent HPV types in PeIN 2/3 cases in Europe and the World Europe (a) World (b) Type specific HPV prevalence (%) of PeIN 2/3 cases Data updated on 09 Feb 2017 (data as of 30 Jun 2015). a Includes cases from Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom b Includes cases from Australia, Bangladesh, India, South Korea, Lebanon, Philippines, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela, Mozambique, Nigeria, Senegal, Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom. Data sources: See references in Section 9. Figure 141: Comparison of the ten most frequent HPV types in PeIN 2/3 cases in Oceania and the World Oceania World (a) 1st* nd* rd* th* th* 6th* No data available th* th* th* th* Type specific HPV prevalence (%) of PeIN 2/3 cases *No data available. No more types than shown were tested or were positive. Data updated on 09 Feb 2017 (data as of 30 Jun 2015). a Includes cases from Australia, Bangladesh, India, South Korea, Lebanon, Philippines, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Venezuela, Mozambique, Nigeria, Senegal, Czech Republic, France, Greece, Poland, Portugal, Spain and United Kingdom. Data sources: See references in Section 9.

225 4 HPV RELATED STATISTICS HPV burden in men The information to date regarding anogenital HPV infection is primarily derived from cross-sectional studies of selected populations such as general population, university students, military recruits, and studies that examined husbands of control women, as well as from prospective studies. Special subgroups include mainly studies that examined STD (sexually transmitted diseases) clinic attendees, MSM (men who have sex with men), HIV positive men, and partners of women with HPV lesions, CIN (cervical intraepithelial neoplasia), cervical cancer or cervical carcinoma in situ. Globally, prevalence of external genital HPV infection in men is higher than cervical HPV infection in women, but persistence is less likely. As with genital HPV prevalence, high numbers of sexual partners increase the acquisition of oncogenic HPV infections (Vaccine 2012, Vol. 30, Suppl 5). In this section, the HPV burden among men in the World is presented. Methods HPV burden in men was based on published systematic reviews and meta-analyses (Dunne EF, J Infect Dis 2006; 194: 1044, Smith JS, J Adolesc Health 2011; 48: 540, Olesen TB, Sex Transm Infect 2014; 90: 455, and Hebnes JB, J Sex Med 2014; 11: 2630) up to October 31, The search terms for the review were human papillomavirus, men, polymerase chain reaction (PCR), hybrid capture (HC), and viral DNA. References cited in selected articles were also investigated. Inclusion criteria were: HPV DNA detection by means of PCR or HC (ISH if data are not available for the country), and a detailed description of HPV DNA detection and genotyping techniques used. The number of cases tested and HPV positive cases were extracted for each study to estimate the anogenital prevalence of HPV DNA. Binomial 95% confidence intervals were calculated for each anogenital HPV prevalence.

226 4 HPV RELATED STATISTICS Table 24: Studies on anogenital HPV prevalence among men Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Australia Brazil Canada Chile Vardas Penis RT-PCR-Multiplex 2011 a or Biplex Franceschi 2002 Glans, corona, urethra Giuliano Corona sulcus, 2008 b glans, shaft and scrotum Nyitray 2011 Rosenblatt 2004 PCR-GP5+/6+ PCR-PGMY09/11 and GP5/6+ Heterosexual men enrolled in a HPV vaccine trial Husbands of control women Anal canal PCR-PGMY09/11 HIV- MSM from general population and population from a STD clinic Shaft, dorsal and prebalanic area, prepuce, urethral meatus HC2 HR Vardas Penis RT-PCR-Multiplex 2011 a or Biplex Vardas Penis RT-PCR-Multiplex 2011 a or Biplex Guzmán 2008 Corona and shaft China Liu 2015 Coronal sulcus, shaft, glans, and scrotum Colombia Franceschi 2002 Glans, corona, urethra PCR-GP5+/6+ PCR-SPF1/GP6+ PCR-GP5+/6+ Croatia Grce 1996 Urethra Filter hybridization (slot-blot, TS 6,11,16,18) Denmark Finland Vardas Penis RT-PCR-Multiplex 2011 a or Biplex Hebnes 2015 Kjaer 2005 Hippeläinen 1993 Coronal sulcus, glans, preputial cavity, scrotum, shaft and perineum Glans and corona sulcus Glans, prepuce, corona sulcus, urethral meatus HC2 PCR-LIPAv2 PCR-GP5+/6+ TS oligoprobes PCR-MY09/11 TS 6,11,16,18,31,33 Median 20 (15-24) ( ) ( ) General population ( ) HIV- MSW from general population and population from a STD clinic Partners of women without CIN Heterosexual men enrolled in a HPV vaccine trial Heterosexual men enrolled in a HPV vaccine trial University students Population-based esophageal cancer cohort study Husbands of control women Family planning clinic attendees Heterosexual men enrolled in a HPV vaccine trial Male employees and conscripts at military barracks Male employees and conscripts at military barracks ( ) ( ) ( ) Median 20 (15-24) Median 20 (15-24) ( ) ( ) ( ) ( ) ( ) ( ) Median 20 (15-24) Mean 23 (18-65) Mean 23 (18-65) ( ) ( ) ( ) Military conscripts ( ) Voluntary conscripts Mean ( ) ( Table 24 continued from previous page)

227 4 HPV RELATED STATISTICS ( Table 24 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Germany India Italy Japan Kenya Kero 2011 Urethra PCR-MY09/11 and GP5+/6+ Grussendorf- Conen 1987 Coronal sulcus and glans ISH Vardas Penis RT-PCR-Multiplex 2011 a or Biplex Gupta 2006 Lorenzon 2014 Nasca 2006 Takahashi 2003 Ng ayo 2008 Smith 2010 Korea, Rep. Shin 2004 Mexico Coronal sulcus, distal and intrameatal urethra and glans Coronal sulcus, shaft, prepuce, and urethral Penis Glans, corona, prepuce Glans, corona sulcus, shaft of the penis, scrotum and the perianal region Shaft, glans, coronal sulcus, and inner and external foreskin tissue Glans, corona, scrotum, prepuce, urethra Giuliano Corona sulcus, 2008 b glans, shaft and scrotum Lajous 2005 Lazcano- Ponce 2001 Corona, shaft, upper third of the scrotum, urethral meatus, urethra PCR-L1 and TS 16,18 PCR-Roche Linear Array HPV Genotyping test PCR-MY09/11 and GP5+/6+ HC2 HR, LR PCR- PGMY09/MY11 and HMB01 PCR-GP5+/6+ Sexual partners of pregnant women Blood donors or patients from department of dermatology Heterosexual men enrolled in a HPV vaccine trial Partners of women with normal cytology Heterosexual men for routine HPV testing Hospital based controls attending clinic for nongenital complaints University students Men working in the fishing industry Men screened to participate in an RCT of male circumcision ( ) ( ) Median 20 (15-24) Mean 46.9 PCR-SPF10 Male students Median 22 PCR-PGMY09/11 and GP5/6+ PCR-BGH 20 and BPCO4 General population and organized health care systems Corona, urethra PCR-GP5+/6+ Sexually active college students and industry workers ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Military conscripts ( ) ( ) ( Table 24 continued from previous page)

228 4 HPV RELATED STATISTICS ( Table 24 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Nyitray 2011 Sánchez- Alemán 2002 Vaccarella 2006 Philippines Franceschi 2002 Rwanda South Africa Spain Sweden Anal canal PCR-PGMY09/11 HIV- MSM from organized health care systems, factories and military Glans and prepuce Scrotum, coronal sulcus, the glans and the opening of the meatus HC2 HR PCR-PGMY09/11 Vardas Penis RT-PCR-Multiplex 2011 a or Biplex Veldhuijzen 2012 Auvert 2010 Mbulawa 2010 Franceschi 2002 Glans, corona, urethra Shaft, scrotum, glans/sulcus corona, and foreskin in uncircumcised men Urethra Shaft and glans, and the foreskin in uncircumcised men Glans, corona, urethra PCR-GP5+/6+ PCR-Roche Linear Array HPV Genotyping test (HR-HPV types) PCR-Roche Linear Array HPV Genotyping test (LR-HPV types) PCR-Roche Amplicor HPV test PCR-Roche Linear Array HPV Genotyping test PCR-GP5+/6+ Vardas Penis RT-PCR-Multiplex 2011 a or Biplex Forslund 1993 Urethra PCR-TS (6,11,16,18,31,33,35) and unespecified consensus primer HIV- MSW from organized health care systems, factories and military University students Men who requested a vasectomy Heterosexual men enrolled in a HPV vaccine trial Husbands of control women Men participating in a case control study assessing risk factors for infertility Men participating in a case control study assessing risk factors for infertility Men recruited from the general population for an RCT of male circumcision HIV- heterosexual men recruited for investigations of genital HPV transmission Husbands of control women Heterosexual men enrolled in a HPV vaccine trial ( ) ( ) >= ( ) Mean ( ) Median 20 (15-24) ( ) ( ) Median 31 (IQR=27-38) Median 31 (IQR=27-38) IQR= ( ) ( ) ( ) ( ) ( ) Median 20 (15-24) ( ) Military conscripts ( ) ( Table 24 continued from previous page)

229 4 HPV RELATED STATISTICS ( Table 24 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Tanzania Thailand Uganda USA Kataoka 1991 Olesen 2013 Franceschi 2002 Tobian 2013 Urethra Glans, preputial cavity (uncircumcised men), coronal sulcus (circumcised men), shaft, corpus Glans, corona, urethra Coronal sulcus and glans Giuliano Corona sulcus, 2008 c glans, shaft and scrotum Giuliano Corona sulcus, 2008 b glans, shaft and scrotum Hernandez 2008 Nielson 2007 Nyitray 2011 Partridge 2007 Glans, corona sulcus, penile shaft, scrotum Glans, corona sulcus, penile shaft and scrotum, perianal area, anus PCR-TS 6,11,16,18,33 PCR-LIPA and HC2 PCR-GP5+/6+ PCR-PGMY09/11 Army conscripts with normal epithelium Men from the general population Husbands of control women HIV- heterosexual men ( ) Mean ( ) ( ) ( ) PCR-PGMY09/11 General population ( ) PCR-PGMY09/11 and GP5/6+ PCR-PGMY09/11 PCR-PGMY09/11 General population and population from University University population General population volunteers and STD clinic attendees Anal canal PCR-PGMY09/11 HIV- MSM from general population and population from University Glans, urethral meatus, penile shaft and scrotum PCR-MY09/11 HMB 01 Vardas Penis RT-PCR-Multiplex 2011 a or Biplex Weaver 2004 Glans, prepuce, shaft, scrotum PCR-MY09/11 HMB 01 HIV- MSW from general population and population from University Heterosexual university students Heterosexual men enrolled in a HPV vaccine trial University students ( ) Mean ( ) ( ) ( ) ( ) ( ) Median 20 (15-24) ( ) ( ) Data updated on 28 Jun 2017 (data as of 31 Oct 2015). 95% CI: 95% Confidence Interval; HC2: Hybrid Capture 2; ISH: In Situ Hybridization; PCR: Polymerase Chain Reaction; RT-PCR: Real Time Polymerase Chain Reaction; SPF: Short Primer Fragment; TS: Type Specific; MSM: Men who have sex with men; MSW:Men who have sex with women; STD: sexually transmitted diseases; a Includes cases from Australia, Brazil, Canada, Croatia, Germany, Mexico, Spain, and USA. b Giuliano AR, Cancer Epidemiol Biomarkers Prev 2008; 17: 2036 c Giuliano AR, J Infect Dis 2008; 198: 827 Data sources: See references in Section 9.

230 4 HPV RELATED STATISTICS Table 25: Studies on anogenital HPV prevalence among men from special subgroups Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Argentina Australia Pando 2012 Anderson 2008 Goldstone 2011 Anus GP-PCR Reverse line blot hybridization HIV- MSM HIV+ MSM Anal canal HC2 HR HIV+ MSM Median 45 (28-59) Anus Penis RT-PCR-Multiplex or Biplex RT-PCR-Multiplex or Biplex HIV- MSM HIV- MSM Mean/Median ( ) 31 years Mean/Median ( ) 31 years Median 22 (16-27) Median 22 (16-27) Ong 2016 Anus PCR-Linear Array HIV+ MSM Mean 51 (35-82) Vajdic 2009 Brazil de Lima Rocha 2012 Franceschi 2002 Freire 2014 Goldstone 2011 Guimarães 2011 Nicolau 2005 Nyitray 2011 Rombaldi 2006 Anal canal HC2 HIV- MSM IQR=36-48 Coronal sulcus, glans, and prepuce Glans, corona, urethra Shaft, glans, balanopreputial sulcus and urethral Anus Penis PCR-GP5+/6+ PCR-GP5+/6+ PCR-Papillocheck RT-PCR-Multiplex or Biplex RT-PCR-Multiplex or Biplex HIV+ MSM Sexual partners of women with cervical HPV infection Husbands of women with invasive cervical cancer Men referred to the Urological Division HIV- MSM HIV- MSM IQR= ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Median 22 (16-27) Median 22 (16-27) ( ) ( ) Anus PCR-DBH HIV+ >= ( ) Glans, urethra, internal and external prepuce, scrotum, anus HC2 HR, LR Partners of women with HPV Anal canal PCR-PGMY09/11 HIV- MSM from general population and population from a STD clinic Prepuce, preglans, shaft, urethral canal PCR-L1, MY09/11 Partners of women with CIN ( ) ( ) ( ) ( Table 25 continued from previous page)

231 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Rosenblatt 2004 Canada de Pokomandy 2009 Goldstone 2011 Ogilvie 2009 Shaft, dorsal and prebalanic area, prepuce, urethral meatus HC2 HR Partners of women with CIN Anal canal PCR-PGMY09/11 HIV+ MSM Median 43 (21-66) Anus Penis Shaft, scrotum RT-PCR-Multiplex or Biplex RT-PCR-Multiplex or Biplex PCR-Roche Amplicor HPV test HIV- MSM HIV- MSM Heterosexual men attending provincial STD clinic Salit 2009 Anus PCR-PGMY09/11 HIV+ MSM participants in TRACE study ( ) Median 22 (16-27) Median 22 (16-27) Salit 2010 Anal canal HC2 HIV+ MSM Median 44.4 (IQR= ) China Gao 2010 Anal canal PCR- TellgenplexTM HPV DNA Test Colombia Croatia HIV- MSM >=18 (70% <30 years) HIV+ MSM >=18 (70% <30 years) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Li 2015 Anus PCR-GenoArray HIV+ MSM ( ) Tang 2006 Urethral meatus PCR-MY09/11 Yang 2012 Anus PCR- TellgenplexTM HPV DNA Test Zhang 2014 Franceschi 2002 Goldstone 2011 STD clinic attendees Anus PCR-GenoArray HIV- MSM, STD clinic attendees Glans, corona, urethra Anus Penis PCR-GP5+/6+ RT-PCR-Multiplex or Biplex RT-PCR-Multiplex or Biplex ( ) HIV+ MSM >= ( ) HIV+ MSM STD clinic attendees Husbands of women with cervical carcinoma in situ Husbands of women with invasive cervical cancer HIV- MSM HIV- MSM IQR= IQR= ( ) ( ) ( ) ( ) Median 22 (16-27) Median 22 (16-27) ( ) ( ) ( Table 25 continued from previous page)

232 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Denmark France Germany Greece India Ireland Svare 2002 Aynaud 2003 Damay 2010 Philibert 2014 Piketty 2004 Goldstone 2011 Schneider 1988 Wieland 2015 Hadjivassiliou 2007 Gupta 2006 Sadlier 2014 Coronal sulcus, glans, perianal area, scrotum, and shaft Meatal urethra Anal canal Anus PCR-GP5+/6+ and TS 6,11,16,18,31,33 PCR-TS 6,11,42,16,18,33 PCR- PapilloCheck PCR-Cobas HR-HPV STD clinic attendees Men with normal peniscopy whose female partners have genital HPV lesions Men with penile and urethral lesions whose female partners have genital HPV lesions HIV+ MSM HIV- MSM HIV+ MSM >= ( ) Mean ( ) Mean ( ) Median 45 ( ) Mean 46.4 (SD=9.4) Mean 46.4 (SD=9.4) ( ) ( ) ( ) Anal canal PCR-MY09/11 HIV+ MSM ( ) Anus Penis Glans, prepuce, fossa navicularis, shaft Anus RT-PCR-Multiplex or Biplex RT-PCR-Multiplex or Biplex Filter hybridization DNA/DNA PCR-Multiplex and hybridization HIV- MSM HIV- MSM Sexual partners of women with HPV associated lesions of the cervix Urethra HC2 HR, LR HIV- STD clinic attendees without genital warts and sexual partners of women with genital warts Coronal sulcus, distal and intrameatal urethra and glans PCR-L1 and TS 16,18 Median 22 (16-27) Median 22 (16-27) Mean ( ) ( ) ( ) HIV+ MSM ( ) Partners of women with cervical cancer ( ) Mean 46.4 Anus PCR-TS 16,18,31 HIV- MSM Mean 32 (SD=8) HIV+ MSM Mean 40 (SD=10) ( ) ( ) ( ) ( Table 25 continued from previous page)

233 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Italy Japan Barzon 2010 Benevolo 2008 Chiarini 1998 Della Torre 1992 Glans, corona, shaft, perianal area, urethra, and semen Coronal sulcus, urethra, prepuce, shaft Urethra Urethra PCR-General primers for L1 (MY09/11, GP5 + /6+) PCR-L1 PCR-Generic primers in E1 PCR-TS 6,11,16,18 Men referred for HPV testing. Indications for testing: STD screening, HPV suspected lesions, HPV-positive partners Male partners of women with CIN and/or positive HPV Men with symptoms of nongonococcal urethritis Partners of women with HPV Dona 2015 Anus PCR-Linear Array HIV- MSM Median 32 (IQR=27-39) Garbuglia 2015 Giovannelli 2007 Orlando 2008 Pierangeli 2008 Sammarco 2016 Nagata 2015 HIV+ MSM ( ) ( ) ( ) ( ) Median 41 (IQR=33-47) Anus PCR-MY09/11 HIV+ MSM Median 39 (IQR=33-44) Coronal sulcus, frenulum, glans, prepuce, shaft PCR-LiPA, GP5+/6+ and MY09/11 Partners of women with HPV Anus HC2 HIV+ Median 34 (IQR=30-42) ( ) ( ) ( ) ( ) ( ) Anal canal PCR-MY09/11 HIV- MSM ( ) Anus Coronal sulcus Urethra PCR-Multiplex and RFLP and sequencing PCR-Multiplex and RFLP and sequencing PCR-Multiplex and RFLP and sequencing HIV+ MSM ( ) HIV+ MSM Mean 38 (IQR=20-53) HIV+ MSM Mean 38 (IQR=20-53) HIV+ MSM Mean 38 (IQR=20-53) Anus PCR-Invader HIV+ heterosexual men Median 44 (IQR=39-55) ( ) ( ) ( ) ( ) ( Table 25 continued from previous page)

234 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Mexico Netherlands Shigehara 2010 Takahashi 2003 Takahashi 2005 Goldstone 2011 Leyva- López 2003 Mendez- Martinez 2014 Nyitray 2011 Torres- Ibarra 2014 Bleeker 2002 Coronal sulcus, glans, prepuce, urethra, and urine Coronal sulcus, glans, prepuce Glans, corona, inner surface of prepuce Anus Penis Urethral meatus PCR-HPV GenoArray HC2 HR, LR HC2 HR, LR RT-PCR-Multiplex or Biplex RT-PCR-Multiplex or Biplex PCR-L1 HIV+ MSM Men with urethritis Patients with urethritis STD clinic attendees HIV- MSM HIV- MSM Partners of women with CIN Median 44 (IQR=39-55) Mean 35.2 (19-62) ( ) ( ) ( ) ( ) Median 22 (16-27) Median 22 (16-27) Anus PCR-INNO-LIPA HIV+ MSM Median 39 (IQR=33-45) Anal canal PCR-PGMY09/11 HIV- MSM from organized health care systems, factories and military ( ) ( ) ( ) ( ) ( ) Anus PCR-PGMY09/11 HIV+ MSM ( ) Glans, corona, frenulum, prepuce Bleeker Corona, 2005 a frenulum, glans, inner prepuce Bleeker Corona, 2005 b frenulum, glans, inner prepuce van der Snoek 2003 Coronal sulcus Perianal area PCR-GP5+/6+ PCR-GP5+/6+ PCR-GP5+/6+ PCR-TS primers and LiPA PCR-TS primers and LiPA Partners of women with CIN Men visiting department of dermatology for non-sti complaints Partners of women with dyskaryosis and/or CIN ( ) ( ) ( ) HIV- MSM ( ) HIV+ MSM ( ) HIV- MSM ( ) HIV+ MSM ( ) ( Table 25 continued from previous page)

235 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Van Doornum 1994 van 2014 Vriend 2013 Welling 2015 Rijn Corona, urethra, anus, rectum Anal canal Penile shaft PCR-TS 6/11,16,18,33 PCR-LIPA TS 16,18,31,33,45,52,58 PCR-LIPA TS 16,18,31,33,45,52,58 STD clinic attendees HIV- MSM HIV+ MSM HIV- MSM HIV+ MSM Anal canal PCR-LIPA MSM STD clinic attendees MSW STD clinic attendees Penis PCR-LIPA MSM STD clinic attendees Anus Penis PCR-SPF DEIA LIPA PCR-SPF DEIA LIPA MSW STD clinic attendees HIV- MSM HIV+ MSM HIV- MSM HIV+ MSM Mean ( ) Median 37.6 (IQR= ) Median 45.6 (IQR= ) Median 37.6 (IQR= ) Median 45.6 (IQR= ) Median 22 (16-24) Median 22 (16-24) Median 22 (16-24) Median 22 (16-24) Median 38 (IQR=33-42) Median 46 (IQR=39-53) Median 38 (IQR=33-42) Median 46 (IQR=39-53) Peru Blas 2015 Anal canal PCR-Linear Array HIV- MSM Mean 34 (18-59) Coronal sulcus, glans, penis shaft, and scrotum PCR-Linear Array HIV- MSM Mean 34 (18-59) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( Table 25 continued from previous page)

236 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Quinn 2012 Philippines Franceschi 2002 Anus PCR-Line blot MSM Mean 33 (SD=10.1) Glans, corona, urethra PCR-GP5+/6+ Russia Wirtz 2015 Anus PCR-TS 6,11,16,18,31,33 Husbands of women with invasive cervical cancer HIV- MSM HIV+ MSM Slovenia Golob 2014 Penis PCR-Linear Array Men from infertile couples South Africa Spain Milosevic 2010 Firnhaber 2011 Mbulawa 2010 Müller 2010 Vogt 2013 Álvarez- Argüelles ( ) ( ) Median 29 (19-50) Median 29 (19-50) ( ) ( ) Mean ( ) Anal canal PCR-Linear Array HIV- MSM ( ) Prepuce, penile shaft and genital wart areas of the penis Shaft and glans, and the foreskin in uncircumcised men Glans penis, coronal sulcus and penile shaft Glans penis, coronal sulcus, penile shaft and anogenital warts Coronal sulcus, glans and shaft Anus PCR-Roche Linear Array HPV Genotyping test PCR-Roche Linear Array HPV Genotyping test PCR-Roche Linear Array HPV Genotyping test PCR-Roche Linear Array HPV Genotyping test PCR-PGMY09/11 PCR-General primers in L1 (MY09/11, GP5 + /6+), PCR with TS primers in E6/E7 for typing HIV+ MSM ( ) Men with penile warts attending a public sector antiretroviral treatment clinic HIV+ heterosexual men recruited for investigations of genital HPV transmission Asymptomatic men attending for HIV voluntary counselling and testing a sexual health clinic Men with urethritis syndrome attending a sexual health clinic Men with anogenital wart attending a sexual health clinic Heterosexual men attending an HIV testing centre STD clinic attendees Mean ( ) ( ) Mean 29.8 Mean 29.8 Mean 29.8 IQR= ( ) ( ) ( ) ( ) ( ) ( Table 25 continued from previous page)

237 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Sweden Franceschi 2002 Goldstone 2011 Hidalgo- Tenorio 2015 Sendagorta 2014 Sendagorta 2015 Torres 2013 Videla 2013 Kataoka 1991 Balanopreputial Glans, corona, urethra Anus Penis Anus Anus Anus Anus Anus Coronal sulcus, glans, urethra, shaft Urethra PCR-General primers in L1 (MY09/11, GP5 + /6+), PCR with TS primers in E6/E7 for typing PCR-GP5+/6+ RT-PCR-Multiplex or Biplex RT-PCR-Multiplex or Biplex PCR-GeneAmp HR-HPV PCR-Genomic amplification PCR-HR Clart HPV2 PCR-Roche Linear Array HPV Genotyping test PCR-TS primers in E6/E7 F-HPVTM typing (Molgentix SL, Spain) PCR-TS primers in E6/E7 F-HPVTM typing (Molgentix SL, Spain) PCR-TS 6,11,16,18,33 STD clinic attendees Husbands of women with cervical carcinoma in situ Husbands of women with invasive cervical cancer HIV- MSM HIV- MSM HIV+ MSM HIV+ MSM/bisexual men HIV+ MSM HIV+ MSM HIV+ Heterosexual men attending an outpatient HIV clinic HIV+ MSM attending an outpatient HIV clinic HIV+ Heterosexual men attending an outpatient HIV clinic HIV+ MSM attending an outpatient HIV clinic Army conscripts with aceto-white epithelium ( ) ( ) ( ) Median 22 (16-27) Median 22 (16-27) Mean 37.4 (SD=9.5) ( ) ( ) ( ) >= ( ) Median 42 (IQR=33-50) IQR= ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( Table 25 continued from previous page)

238 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Thailand Löwhagen 1999 Strand 1993 Voog 1997 Wikström 1991 Wikström 2000 Franceschi 2002 Leaungwutiwong 2015 Phanuphak 2013 Supindham 2015 Anus PCR-MY09/11 HIV- MSM ( ) Coronal sulcus, glans, preputium, and shaft Glans and prepuce Coronal sulcus, inner part of the prepuce, urethra Corona, glans, and prepuce Glans, corona, urethra Anus Anus PCR-MY09/11 and GP5+/6+ PCR-MY09/11 and GP5+/6+ PCR-TS primers followed by dot blot PCR-GP5+/6+ PCR-GP5+/6+ Nested-PCR and sequencing PCR-Roche Linear Array HPV Genotyping test HIV+ MSM ( ) STD clinic attendees STD clinic attendees STD clinic attendees STD clinic attendees Husbands of women with invasive cervical cancer HIV- MSM HIV- MSM sex worker Anus PCR-Linear Array MSM-Bisexual men who self-identify as men and engage in insertive and/or receptive anal sex with men and women ( ) ( ) ( ) ( ) ( ) Median 33 Median ( ) ( ) HIV- MSM >= ( ) HIV+ MSM >= ( ) MSM-Gay men who self-identify as men and prefer insertive and/or receptive anal sex with other men MSM-Transgender women who are born as anatomical males (and who may or may not have undergone genital surgery), but who self-identify as women and prefer receptive anal sex with men ( ) ( ) ( ) ( Table 25 continued from previous page)

239 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Uganda UK USA Tobian 2013 Bissett 2011 Cuschieri 2011 Hillman 1993 Coronal sulcus and glans Glans, prepuce, shaft, scrotum PCR-PGMY09/11 PCR-General primers (GP5 + /6+), Bio-Plex array technology for typing HIV+ heterosexual men Genitourinary clinic attendees with multiple sexual partners or diagnosis of genital warts within 6 months Shaft PCR-INNO-LiPA Drop-in sexual health service attendees Urethra PCR-GP5+/6+ Men infected with gonorrhea Jalal 2007 Urethra PCR-General primers for L1 (MY09/11, GP5 + /6+) and RLH King 2015 Anus PCR-Multiplex and Bio-Plex Any nonavalent vaccine HPV types Lacey 1999 Baken 1995 Baldwin 2003 Coronal sulcus, glans, penis shaft, scrotum and perianal area PCR-Multiplex and Bio-Plex Any nonavalent vaccine HPV types Genitourinary clinic attendees MSM MSM ( ) ( ) ( ) ( ) ( ) Median 30 (IQR=25-35) Median 30 (IQR=25-35) ( ) ( ) Anal canal PCR-GP5+/6+ HIV+ MSM ( ) Penis PCR-MY09/11 Heterosexual partners of STD clinic attendees Glans, corona, urethra PCR-PGMY09/11 STD clinic attendees > ( ) ( ) Berry 2009 Anal canal PCR-MY09/11 HIV- MSM ( ) Caussy 1990 Chin-Hong 2004 Chin-Hong 2008 Colón- López 2014 Conley 2010 Anus PCR-TS 6,11,16,18,31,33,35 HIV+ MSM ( ) HIV± homosexual men Anus PCR-MY09/11 HIV- MSM in EXPLORE cohort Anus PCR- generic probe set by DBH HIV- homosexual or bisexual men HIV+ homosexual or bisexual men Anus PCR-MY09/11 STD clinic attendees (29.8% MSM) Mean 40.6 Anal canal PCR-Linear Array HIV + MSM Median 42 (IQR=36-48) ( ) ( ) ( ) ( ) >= ( ) ( ) ( Table 25 continued from previous page)

240 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Critchlow 1998 Fife 2003 Friedman 1998 Gandra 2015 Goldstone 2011 HIV+ MSW Anus PCR-MY09/11 HIV- homosexual men Glans, corona, shaft, inguinal skin, scrotum, perineum, perianal, urine Anal canal PCR-TS 6,11 PCR-MY09/11, HMB01, and HC HIV+ homosexual men STD clinic attendees Median 42 (IQR=38-48) HIV- MSM <40 years HIV+ MSM <40 years Anus HC2 HIV+ heterosexual men Anus Penis RT-PCR-Multiplex or Biplex RT-PCR-Multiplex or Biplex HIV+ MSM HIV- MSM HIV- MSM ( ) Mean ( ) Mean ( ) ( ) Median 55 (IQR=49-60) Median 49 (IQR=41-57) Median 22 (16-27) Median 22 (16-27) Hood 2016 Anus PCR-MY09/11 HIV+ MSM Mean 39.5 (SD=7.8) Kiviat 1993 Moscicki 2003 Nyitray 2011 Palefsky 1997 Palefsky 1998 Anal canal PCR-MY09/11 HIV- MSM/bisexual men Anus PCR-MY09/11 and HMB01 HIV+ MSM/bisexual men High-risk adolescent boys in REACH cohort Anal canal PCR-PGMY09/11 HIV- MSM from general population and population from University Anus PCR-MY09/11 HIV+ homosexual or bisexual men Anus PCR-MY09/11 HIV- homosexual or bisexual men HIV+ homosexual or bisexual men HIV± homosexual or bisexual men ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( Table 25 continued from previous page)

241 4 HPV RELATED STATISTICS ( Table 25 continued from previous page) Anatomic sites HPV detection Age HPV prevalence Country Study samples method Population (years) No % (95% CI) Palefsky 2005 Anal canal PCR-L1 consensus primers HIV+ MSM ( ) Wiley 2013 Anus PCR-PGMY09/11 HIV- MSM Mean ( ) Wilkin 2004 HIV+ MSM Mean ( ) Anal canal HC2 HIV+ MSM 90% > 30 years ( ) Data updated on 28 Jun 2017 (data as of 31 Oct 2015). 95% CI: 95% Confidence Interval; DBH: Dot Blot Hybridization; EIA: Enzyme ImmunoAssay; HC2: Hybrid Capture 2; LiPA: Line Probe Assay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; RLH: Reverse Line Hybridisation; RT-PCR: Real Time Polymerase Chain Reaction; SPF: Short Primer Fragment; TS: Type Specific; MSM: Men who have sex with men; MSW:Men who have sex with women; STD: sexually transmitted diseases; a Bleeker MC, Int J Cancer 2005; 113: 36 b Bleeker MC, Clin Infect Dis 2005; 41: 612 Data sources: See references in Section HPV burden in the head and neck The last evaluation of the International Agency for Research in Cancer (IARC) on the carcinogenicity of HPV in humans concluded that (a) there is enough evidence for the carcinogenicity of HPV type 16 in the oral cavity, oropharynx (including tonsil cancer, base of tongue cancer and other oropharyngeal cancer sites), and (b) limited evidence for laryngeal cancer (IARC Monograph Vol 100B). There is increasing evidence that HPV-related oropharyngeal cancers constitute an epidemiological, molecular and clinical distinct form as compared to non HPV-related ones. Some studies indicate that the most likely explanation for the origin of this distinct form of head and neck cancers associated with HPV is a sexually acquired oral HPV infection that is not cleared, persists and evolves into a neoplastic lesion. The most recent figures estimate that 25.6% of all oropharyngeal cancers are attributable to HPV infection with HPV16 being the most frequent type (de Martel C. Lancet Oncol. 2012;13(6):607). In this section, the HPV burden in the head and neck in the World is presented Burden of oral HPV infection in healthy population Table 26: Studies on oral HPV prevalence among healthy populations HPV detection Method and targeted HPV Age No. HPV prevalence Country Study types Population (years) Tested % (95% CI) MEN Denmark Eike 1995 PCR-MY09/11. Genotyping by amplification with TS primers (6, 11, 16, 18) and RFLP Finland Kero 2012 PCR-GP5+/GP6+ and MY09/MY11. Genotyping with Multimerix kit (6, 11, 16, 18, 31, 33, 39, 42, 43, 44, 45, 51, 52, 58, 59, 68, 70, 73, 82) Italy Montaldo 2007 PCR-MY09/MY11 and GP5+N. Genotyping by sequencing United Kingdom Kujan 2006 PCR-Roche master mix and HC2 digene (both able to detect the following HR types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68). No further genotyping (Continued) Patients with unrelated disease (otosclerosis, nasal complaints)and their accompanying relatives Fathers-to-be of cohort study ( ) ( ) Dental clinic visitors ( ) Healthy volunteers from university dental hospital ( )

242 4 HPV RELATED STATISTICS HPV detection Method and targeted HPV Age No. HPV prevalence Country Study types Population (years) Tested % (95% CI) WOMEN Denmark Eike 1995 PCR-MY09/11. Genotyping by amplification with TS primers (6, 11, 16, 18) and RFLP Finland Leimola-Virtanen 1996 PCR-GP5/GP6. No genotyping Finland Kero 2011 PCR-GP5+/GP6+ and MY09/MY11. Genotyping with Multimerix kit (6, 11, 16, 18, 31, 33, 39, 42, 43, 44, 45, 51, 52, 58, 59, 68, 70, 73, 82) Italy Montaldo 2007 PCR-MY09/MY11 and GP5+N. Genotyping by sequencing Spain Cañadas 2004 PCR-MY09/MY11. Genotyping by DBH with TS probes (6, 11, 16, 18, 26, 31-33, 35, 39, 40, 45, 51-56, 58, 59, 61, 66-68, 70, 71 (AE8), 72, 73, 81 (AE7), 83 (PAP291), 84 (PAP155), 85 (AE5), AE2 (IS39), and AE6) United Kingdom Kujan 2006 PCR-Roche master mix and HC2 digene (both able to detect the following HR types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68). No further genotyping BOTH OR UNSPECIFIED Denmark Eike 1995 PCR-MY09/11. Genotyping by amplification with TS primers (6, 11, 16, 18) and RFLP Finland Leimola-Virtanen 1996 PCR-GP5/GP6. No genotyping Finland Kero 2011 PCR-GP5+/GP6+ and MY09/MY11. Genotyping with Multimerix kit (6, 11, 16, 18, 31, 33, 39, 42, 43, 44, 45, 51, 52, 58, 59, 68, 70, 73, 82) Finland Kero 2012 PCR-GP5+/GP6+ and MY09/MY11. Genotyping with Multimerix kit (6, 11, 16, 18, 31, 33, 39, 42, 43, 44, 45, 51, 52, 58, 59, 68, 70, 73, 82) Greece Lambropoulos 1997 PCR-MY09/MY11. Genotyping by SBH with TS probes (6, 11, 16, 18, 33) Italy Montaldo 2007 PCR-MY09/MY11 and GP5+N. Genotyping by sequencing Italy Migaldi 2012 PCR-GP5+/GP6+, MY09/11, LCRS/E7AS, pu-1m and pu-2r. Genotyping by sequencing (Continued) Patients with unrelated disease (otosclerosis, nasal complaints)and their accompanying relatives Post-menopausal women participating in annual mass-screening program for the detection of cervical precancerous lesions Spouses in 3rd trimestres of pregnancy of the fathers-to-be of cohort study ( ) ( ) ( ) Dental clinic visitors ( ) Female sex workers who attended a dermatology or STD clinic. Healthy volunteers from university dental hospital. Patients with unrelated disease (otosclerosis, nasal complaints)and their accompanying relatives Post-menopausal women participating in annual mass-screening program for the detection of cervical precancerous lesions Spouses in 3rd trimestres of pregnancy of the fathers-to-be of cohort study Fathers-to-be of cohort study Healthy population receiving routine oral examination ( ) ( ) ( ) ( ) ( ) ( ) ( ) Dental clinic visitors ( ) Patients undergoing to routine oral examination ( )

243 4 HPV RELATED STATISTICS HPV detection Method and targeted HPV Age No. HPV prevalence Country Study types Population (years) Tested % (95% CI) Spain Cañadas 2004 PCR-MY09/MY11. Genotyping by DBH with TS probes (6, 11, 16, 18, 26, 31-33, 35, 39, 40, 45, 51-56, 58, 59, 61, 66-68, 70, 71 (AE8), 72, 73, 81 (AE7), 83 (PAP291), 84 (PAP155), 85 (AE5), AE2 (IS39), and AE6) United Kingdom Kujan 2006 PCR-Roche master mix and HC2 digene (both able to detect the following HR types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68). No further genotyping Female sex workers who attended a dermatology or STD clinic. Healthy volunteers from university dental hospital. Data updated on 15 Dec 2014 (data as of 29 Feb 2012). Only for European countries. 95% CI: 95% Confidence Interval; Data sources: See references in Section ( ) ( )

244 4 HPV RELATED STATISTICS HPV burden in head and neck cancers Table 27: Studies on HPV prevalence among cases of oral cavity cancer HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) MEN Oliveira 2009 (Brazil) Herrero 2003 (Canada) Noble-Topham 1993 (Canada) Zhang 2004 (China) Herrero 2003 (Cuba) Krüger 2014 (Germany) Nemes 2006 (Hungary) Balaram 1995 (India) Chaudhary 2010 (India) D Costa 1998 (India) Herrero 2003 (India) Laprise 2016 (India) Saghravanian 2011 (Iran) Herrero 2003 (Ireland) GP5+/GP6+ (L1) DBH ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) TS-PCR E6/E7 for 6b/11/16/18 Amplification with TS primers (6b/ ) TS-PCR E6 for 16/18 Amplification with TS primers (16. 18) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) PCR L1-Consensus primer, PCR-SPF10, LiPA (HPV 6, 11, 16, 18, 16/18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 81) MY09/MY11 (L1) Hybridization with TS probes ( ) MY09/MY11 (L1). GP5+/GP6+ (L1)/GP17+/GP18+ (L1). Y1/Y2 and TS-PCR for 6/11/16/18 Sequencing MY09/MY11 (L1) Amplification with TS primers (16) MY09/MY11 (L1) SBH ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) PCR-PGMY09/11, LBA (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 44, 51, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, 89) GP5+/GP6+ (L1) Amplification with TS primers HPV E6/7 ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) ( ) ( ) HPV 16 (11.8%) ( ) HPV 18 (57.1%) HPV 16 (14.3%) ( ) ( ) ( ) ( ) ( ) HPV 16 (33.6%) ( ) HPV 16 (12.7%) ( ) HPV 16 (3.9%) HPV 18 (0.8%) HPV 35 (0.8%) ( ) HPV 16 (4.5%) (Continued on next page)

245 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Herrero 2003 (Italy) Bhawal 2008 (Japan) Chiba 1996 (Japan) Shimizu 2004 (Japan) Tsuhako 2000 (Japan) Shin 2002 (Korea, Rep.) Ibieta 2005 (Mexico) Cruz 1996 (Netherlands) Herrero 2003 (Poland) Kozomara 2005 (Serbia) Kansky 2003 (Slovenia) Boy 2006 (South Africa) Herrero 2003 (Spain) Llamas-Martínez 2008 (Spain) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) TS-PCR E6 for ( ) HPV 16 (26.3%) Electrophoretic analysis using SiHa DNA as positive control for HPV-16 TS-PCR E6/E7 for ( ) HPV 16 (27.3%) 6/11/16/18/31/33/52b/58 Restriction enzyme digestion ( b. 58) TS-PCR L1 for ( ) HPV 58 (7.7%) 16/18/31/33/35/39/45/51/52/56/58/59/68/73/75/76/82 HPV 120 (7.7%) Sequencing TS-PCR E6/E7 for 16/18 and E6 for 6/11 Amplification with TS primers ( ) TS-PCR E6 for 16/18/33 Amplification with TS primers ( ) MY09/MY11 (L1) and GP5/GP6 (L1) Amplification with TS primers (16. 18) GP5+/GP6+ (L1) and CPI/CPII (L1) Amplification with TS primers and hybridization with TS probes ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) TS-PCR E6 for 16. L1 for 18. E4 for 31 and E1 for 33 Amplification with TS primers ( ) PGMY09/11 (L1). GP5+/GP6+ (L1) and WD72/76/66/67/154 (E6) RFLP TS-PCR E1 for 16 and E7 for 18 Hybridization with TS probes (16. 18) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) WD-66/67/72/76/154 (E6) RFLP ( ) ( ) HPV 16 (33.3%) HPV 18 (33.3%) HPV 6 (11.8%) HPV 11 (2.0%) ( ) HPV 18 (6.6%) HPV 16 (1.3%) HPV 33 (1.3%) ( ) ( ) HPV 16 (54.5%) HPV 6 (4.5%) ( ) ( ) HPV 33 (2.1%) HPV 58 (2.1%) ( ) HPV 18 (9.1%) ( ) HPV 16 (5.7%) ( ) - (Continued on next page)

246 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Herrero 2003 (Sudan) Dahlgren 2004 (Sweden) Chang 2003 (Taiwan) Chen 2002 (Taiwan) Lohavanichbutr 2009 (USA) Miller 1994 (Venezuela) Premoli-De- Percoco 2001 (Venezuela) WOMEN Oliveira 2009 (Brazil) Herrero 2003 (Canada) Noble-Topham 1993 (Canada) Zhang 2004 (China) Herrero 2003 (Cuba) Krüger 2014 (Germany) Nemes 2006 (Hungary) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) GP5+/GP6+ (L1) and CPI/CPII (L1) Amplification with TS primers ( ) and sequencing MY09 (L1) and GP5+/GP6+ (L1) Sequencing MY09/MY11 (L1) Hybridization with TS probes ( ) MY09/MY11 (L1) and GP5+/GP6+ (L1) Hybridization with Roche LBA ( ) TS-PCR E6 for 16/18 Hybridization with TS probes (16. 18) TS-PCR for 6/11/16/18 Hybridization with TS probes ( ) GP5+/GP6+ (L1) DBH ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) TS-PCR E6/E7 for 6b/11/16/18 Amplification with TS primers (6b/ ) TS-PCR E6 for 16/18 Amplification with TS primers (16. 18) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) PCR L1-Consensus primer, PCR-SPF10, LiPA (HPV 6, 11, 16, 18, 16/18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 81) MY09/MY11 (L1) Hybridization with TS probes ( ) (Continued on next page) ( ) HPV 16 (3.6%) ( ) ( ) ( ) HPV 16 (82.1%) HPV 18 (71.4%) HPV 6 (10.7%) HPV 11 (3.6%) ( ) ( ) HPV 16 (71.4%) HPV 18 (42.9%) ( ) ( ) HPV 16 (9.1%) ( ) HPV 18 (30.8%) HPV 16 (7.7%) ( ) ( ) HPV 16 (4.0%) ( ) -

247 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Balaram 1995 (India) Chaudhary 2010 (India) D Costa 1998 (India) Herrero 2003 (India) Laprise 2016 (India) Saghravanian 2011 (Iran) Herrero 2003 (Ireland) Herrero 2003 (Italy) Bhawal 2008 (Japan) Chiba 1996 (Japan) Shimizu 2004 (Japan) Tsuhako 2000 (Japan) Shin 2002 (Korea, Rep.) Ibieta 2005 (Mexico) Cruz 1996 (Netherlands) MY09/MY11 (L1). GP5+/GP6+ (L1)/GP17+/GP18+ (L1). Y1/Y2 and TS-PCR for 6/11/16/18 Sequencing MY09/MY11 (L1) Amplification with TS primers (16) MY09/MY11 (L1) SBH ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) PCR-PGMY09/11, LBA (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 44, 51, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, 89) GP5+/GP6+ (L1) Amplification with TS primers HPV E6/7 ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) TS-PCR E6 for 16 Electrophoretic analysis using SiHa DNA as positive control for HPV-16 TS-PCR E6/E7 for 6/11/16/18/31/33/52b/58 Restriction enzyme digestion ( b. 58) TS-PCR L1 for 16/18/31/33/35/39/45/51/52/56/58/59/68/73/75/76/82 Sequencing TS-PCR E6/E7 for 16/18 and E6 for 6/11 Amplification with TS primers ( ) TS-PCR E6 for 16/18/33 Amplification with TS primers ( ) MY09/MY11 (L1) and GP5/GP6 (L1) Amplification with TS primers (16. 18) GP5+/GP6+ (L1) and CPI/CPII (L1) Amplification with TS primers and hybridization with TS probes ( ) ( ) ( ) HPV 16 (30.3%) ( ) ( ) HPV 16 (1.5%) HPV 18 (0.7%) ( ) HPV 16 (23.1%) HPV 18 (23.1%) ( ) HPV 16 (25.0%) ( ) HPV 16 (9.5%) ( ) HPV 16 (55.6%) ( ) HPV 75 (9.1%) HPV 76 (9.1%) ( ) HPV 18 (52.4%) HPV 16 (28.6%) HPV 6 (19.0%) ( ) HPV 16 (3.9%) HPV 18 (3.9%) HPV 33 (1.3%) ( ) ( ) HPV 16 (23.1%) (Continued on next page)

248 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Herrero 2003 (Poland) Kozomara 2005 (Serbia) Kansky 2003 (Slovenia) Boy 2006 (South Africa) Herrero 2003 (Spain) Llamas-Martínez 2008 (Spain) Herrero 2003 (Sudan) Dahlgren 2004 (Sweden) Chang 2003 (Taiwan) Chen 2002 (Taiwan) Lohavanichbutr 2009 (USA) Miller 1994 (Venezuela) Premoli-De- Percoco 2001 (Venezuela) BOTH OR UNSPECIFIED González 2007 (Argentina) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) TS-PCR E6 for 16. L1 for 18. E4 for 31 and E1 for 33 Amplification with TS primers ( ) PGMY09/11 (L1). GP5+/GP6+ (L1) and WD72/76/66/67/154 (E6) RFLP TS-PCR E1 for 16 and E7 for 18 Hybridization with TS probes (16. 18) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) WD-66/67/72/76/154 (E6) RFLP ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) GP5+/GP6+ (L1) and CPI/CPII (L1) Amplification with TS primers ( ) and sequencing MY09 (L1) and GP5+/GP6+ (L1) Sequencing MY09/MY11 (L1) Hybridization with TS probes ( ) MY09/MY11 (L1) and GP5+/GP6+ (L1) Hybridization with Roche LBA ( ) TS-PCR E6 for 16/18 Hybridization with TS probes (16. 18) TS-PCR for 6/11/16/18 Hybridization with TS probes ( ) MY09/MY11 (L1) and GP5+/GP6+ (L1) RFLP and DBH ( ) ( ) HPV 16 (14.3%) ( ) HPV 18 (13.5%) ( ) HPV 16 (6.3%) ( ) ( ) ( ) HPV 16 (100.0%) ( ) ( ) HPV 16 (46.2%) HPV 18 (7.7%) ( ) HPV 16 (50.0%) HPV 18 (16.0%) ( ) HPV 16 (48.0%) HPV 11 (28.0%) HPV 6 (8.0%) HPV 18 (4.0%) (Continued on next page)

249 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Gudleviciene 2014 (Belarus) Duray 2012 (Belgium) Oliveira 2009 (Brazil) Rivero 2006 (Brazil) Herrero 2003 (Canada) Noble-Topham 1993 (Canada) Gan 2014 (China) Lee 2015 (China) PCR-GP5+/6+, PCR-PGMY09/11, PCR L1-Consensus primer, PCR-E6, PCR- MULTIPLEX (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, 82) PCR-GP5+/6+, PCR L1-Consensus primer, PCR-E6, PCR-E7, qpcr, TS (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68) GP5+/GP6+ (L1) DBH ( ) GP5+/GP6+ (L1) CSA-ISH (DAKO) ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) TS-PCR E6/E7 for 6b/11/16/18 Amplification with TS primers (6b/ ) PCR-GP5+/6+, PCR L1-Consensus primer (HPV 6, 16, 18) PCR-GP5+/6+, PCR-MY09/11, PCR L1-Consensus primer, (HPV 6, 11, 16, 18, 26, 31, 32, 33, 35, 39, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 74, 81, 82, 83, 84) Tang 2003 (China) TS-PCR E6 for 16/18/33 Sequencing Wen 1997 (China) TS-PCR E6 for 16/18 Hybridization with TS probes (HPV16.18 E6) Zhang 2004 (China) Herrero 2003 (Cuba) Koskinen 2003 (Finland) Klussmann 2001 (Germany) Krüger 2014 (Germany) TS-PCR E6 for 16/18 Amplification with TS primers (16. 18) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) ( ) ( ) ( ) HPV 18 (28.4%) HPV 16 (5.7%) ( ) HPV 16 (10.7%) ( ) HPV 18 (34.8%) HPV 16 (8.7%) ( ) ( ) ( ) HPV 16 (36.7%) HPV 18 (16.7%) ( ) HPV 18 (24.4%) HPV 16 (20.0%) ( ) HPV 16 (58.9%) HPV 18 (24.7%) ( ) HPV 16 (1.3%) HPV 18 (1.3%) SPF10 (L1) LiPA ( ) HPV 16 (46.4%) HPV 33 (21.4%) A10/A5-A6/A8 (L1) and ( ) HPV 16 (13.6%) CP62/70-CP65/69a (L1) HPV 19 (4.5%) Sequencing PCR L1-Consensus primer, ( ) - PCR-SPF10, LiPA (HPV 6, 11, 16, 18, 16/18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 81) (Continued on next page)

250 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Ostwald 2003 (Germany) Weiss 2011 (Germany) Aggelopoulou 1999 (Greece) Blioumi 2014 (Greece) Romanitan 2008 (Greece) Nemes 2006 (Hungary) Szarka 2009 (Hungary) Balaram 1995 (India) Bhattacharya 2009 (India) Chaudhary 2010 (India) D Costa 1998 (India) Herrero 2003 (India) Laprise 2016 (India) Mishra 2006 (India) Sebastian 2014 (India) Saghravanian 2011 (Iran) TS-PCR E6 for 6/11/16/18 Hybridization with TS probes (6/ ) RT-PCR E6/E7 for 16 Hybridization with TS probes (16) L1 consensus primers and TS-PCR E7 for 16/18 Amplification with TS primers (16. 18) PCR-GP5+/6+, PCR-MY09/11, PCR L1-Consensus primer, Sequencing (HPV 16, 56, 66) GP5+/GP6+ (L1). CPI/CPIIG (E1) and TS-PCR E6/E7 for 16 Amplification with TS primers (16) MY09/MY11 (L1) Hybridization with TS probes ( ) MY09/MY11 (L1) and GP5+/GP6+ (L1) RFLP MY09/MY11 (L1). GP5+/GP6+ (L1)/GP17+/GP18+ (L1). Y1/Y2 and TS-PCR for 6/11/16/18 Sequencing MY09/MY11 (L1) Amplification with TS primers (16. 18) MY09/MY11 (L1) Amplification with TS primers (16) MY09/MY11 (L1) SBH ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) PCR-PGMY09/11, LBA (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 44, 51, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, 89) MY09/MY11 (L1) Amplification with TS primers (16. 18) PCR, LBA (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84) GP5+/GP6+ (L1) Amplification with TS primers HPV E6/7 ( ) ( ) HPV 16 (29.7%) HPV 18 (13.6%) ( ) HPV 16 (2.9%) ( ) HPV 18 (27.2%) HPV 16 (6.2%) ( ) ( ) ( ) HPV 16 (34.2%) HPV 18 (6.3%) HPV 31 (3.8%) HPV 33 (2.5%) ( ) HPV 16 (27.7%) HPV 11 (6.2%) HPV 18 (6.2%) HPV 33 (3.1%) HPV 31 (1.5%) ( ) HPV 18 (47.3%) HPV 16 (41.8%) HPV 11 (19.8%) HPV 6 (14.3%) ( ) HPV 16 (60.1%) HPV 18 (5.2%) ( ) HPV 16 (32.4%) ( ) HPV 16 (15.2%) ( ) HPV 16 (2.7%) HPV 18 (0.8%) HPV 35 (0.4%) ( ) HPV 16 (27.3%) ( ) HPV 16 (14.3%) HPV 18 (14.3%) (Continued on next page)

251 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Herrero 2003 (Ireland) Badaracco 2000 (Italy) Badaracco 2007 (Italy) Herrero 2003 (Italy) Rittà 2009 (Italy) Scapoli 2009 (Italy) Bhawal 2008 (Japan) Chiba 1996 (Japan) Deng 2013 (Japan) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) MY09/MY11 (L1) Amplification with TS primers (6.16) and hybridization with TS probes ( ) MY09/MY11 (L1) and GP5+/GP6+ (L1) Sequencing GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) MY09/MY11 (L1) and GP5+/GP6+ (L1) Sequencing RT-PCR for 16/18/31/45 Hybridization with TS probes ( ) TS-PCR E6 for 16 Electrophoretic analysis using SiHa DNA as positive control for HPV-16 TS-PCR E6/E7 for 6/11/16/18/31/33/52b/58 Restriction enzyme digestion ( b. 58) PCR-GP5+/6+, PCR-MY09/11, TS, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) Higa 2003 (Japan) TS-PCR E6/E7 for 16/18 Amplification with TS E6/E7 primers ( ) Kojima 2002 (Japan) Shima 2000 (Japan) Shimizu 2004 (Japan) Sugiyama 2003 (Japan) TS-PCR L1 and E6 for 38 Sequencing TS-PCR E6/E7 for 6/11/16/18/31/33/52b/58 RFLP (16. 18) TS-PCR L1 for 16/18/31/33/35/39/45/51/52/56/58/59/68/73/75/76/82 Sequencing TS-PCR E6/E7 for 16/18 Electrophoretic analysis using SiHa DNA and Hela DNA as positive controls for HPV-16 and HPV-18. respectively ( ) HPV 16 (10.0%) ( ) HPV 18 (13.2%) HPV 6 (10.5%) HPV 16 (10.5%) HPV 11 (5.3%) HPV 56 (5.3%) ( ) HPV 16 (7.5%) HPV 33 (1.9%) HPV 58 (1.9%) ( ) HPV 16 (3.8%) ( ) HPV 16 (36.0%) ( ) HPV 16 (1.2%) ( ) HPV 16 (35.7%) ( ) HPV 16 (18.8%) ( ) ( ) HPV 16 (52.2%) HPV 18 (52.2%) HPV 6 (21.7%) HPV 11 (2.2%) ( ) HPV 38 (66.0%) ( ) HPV 18 (54.3%) HPV 16 (19.6%) ( ) HPV 58 (4.2%) HPV 75 (4.2%) HPV 76 (4.2%) HPV 120 (4.2%) ( ) HPV 16 (32.9%) HPV 18 (2.5%) (Continued on next page)

252 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Tang 2003 (Japan) TS-PCR E6 for 16/18/33 Sequencing Tsuhako 2000 (Japan) Shin 2002 (Korea, Rep.) Lim 2007 (Malaysia) Anaya-Saavedra 2008 (Mexico) Braakhuis 2004 (Netherlands) Cruz 1996 (Netherlands) van Monsjou 2012 (Netherlands) Eu- Mork (Northern rope) 2001 b Ibieta 2005 (Mexico) 2013 a Amer- Lingen (Northern ica) Matzow 1998 (Norway) Herrero 2003 (Poland) TS-PCR E6/E7 for 16/18 and E6 for 6/11 Amplification with TS primers ( ) TS-PCR E6 for 16/18/33 Amplification with TS primers ( ) GP5+/GP6+ (L1) Amplification with TS primers (16. 18) MY09/MY11 (L1) and GP5+GP6+ (L1) Sequencing MY09/MY11 (L1) and GP5/GP6 (L1) Amplification with TS primers (16. 18) GP5+/GP6+ (L1) and TS-PCR RLBH ( /MM /IS39. 71/CP /CP ) GP5+/GP6+ (L1) and CPI/CPII (L1) Amplification with TS primers and hybridization with TS probes ( ) PCR, LiPA (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 72, 73, 82) PCR L1-Consensus primer, PCR-SPF10, LiPA (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 81) GP5+/GP6+ (L1) and CPI/CPII (L1) Amplification with TS primers ( ) GP5+/GP6+ (L1). CPI/CPIIG (E1) and TS-PCR for 6/16/18/31/33 Amplification with TS primers ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) ( ) HPV 18 (33.3%) HPV 16 (23.3%) ( ) HPV 18 (38.9%) HPV 16 (31.9%) HPV 6 (13.9%) HPV 11 (1.4%) ( ) HPV 18 (10.5%) HPV 16 (5.3%) HPV 33 (2.6%) ( ) HPV 18 (75.0%) HPV 16 (30.0%) ( ) HPV 16 (24.2%) HPV 18 (8.1%) HPV 33 (3.2%) HPV 2 (1.6%) HPV 11 (1.6%) ( ) HPV 16 (28.0%) ( ) HPV 16 (9.4%) ( ) HPV 16 (42.9%) HPV 6 (2.9%) ( ) ( ) ( ) HPV 16 (4.4%) HPV 6 (1.1%) HPV 11 (1.1%) HPV 33 (1.1%) (Continued on next page)

253 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Snietura 2010 (Poland) Kozomara 2005 (Serbia) Kansky 2003 (Slovenia) Boy 2006 (South Africa) Van Rensburg 1996 (South Africa) García-de Marcos 2014 (Spain) Herrero 2003 (Spain) Llamas-Martínez 2008 (Spain) Herrero 2003 (Sudan) Dahlgren 2004 (Sweden) Sand 2000 (Sweden) Chang 2003 (Taiwan) Chen 2002 (Taiwan) Yang 2004 (Taiwan) Real-time High Risk HPV test (Abbott Molecular) using L1 consensus primers Amplification with TS primers ( and 68 - the technique only differentiates other) TS-PCR E6 for 16. L1 for 18. E4 for 31 and E1 for 33 Amplification with TS primers ( ) PGMY09/11 (L1). GP5+/GP6+ (L1) and WD72/76/66/67/154 (E6) RFLP TS-PCR E1 for 16 and E7 for 18 Hybridization with TS probes (16. 18) TS-PCR E6 for 6/11/16/18 Hybridization with TS probes ( ) PCR L1-Consensus primer, PCR-SPF10, EIA, LiPA (HPV 6, 11, 16, 18, 31, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 70, 73, 74) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) WD-66/67/72/76/154 (E6) RFLP ( ) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) GP5+/GP6+ (L1) and CPI/CPII (L1) Amplification with TS primers ( ) and sequencing MY09/MY11 (L1) Amplification with TS primers (6b/ ) MY09 (L1) and GP5+/GP6+ (L1) Sequencing MY09/MY11 (L1) Hybridization with TS probes ( ) MY09/MY11 (L1) Amplification with TS primers ( ) ( ) HPV 16 (4.4%) ( ) HPV 31 (32.0%) HPV 16 (26.0%) HPV 18 (26.0%) ( ) HPV 16 (1.8%) HPV 33 (1.8%) HPV 58 (1.8%) ( ) HPV 18 (11.9%) ( ) HPV 11 (0.7%) HPV 16 (0.7%) ( ) ( ) HPV 16 (5.8%) ( ) HPV 16 (33.3%) HPV 6 (30.3%) HPV 31 (9.1%) ( ) HPV 16 (2.3%) ( ) HPV 16 (2.4%) ( ) HPV 16 (4.2%) HPV 18 (4.2%) ( ) HPV 16 (28.2%) HPV 18 (26.2%) HPV 6 (1.0%) HPV 11 (1.0%) HPV 32 (1.0%) ( ) HPV 16 (82.8%) HPV 18 (75.9%) HPV 6 (10.3%) HPV 11 (3.4%) ( ) HPV 16 (8.1%) HPV 18 (5.4%) (Continued on next page)

254 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Lopes 2011 (UK) Snijders 1996 (UK) GP5+/GP6+ (L1) and qpcr for 16/18 Hybridization with TS probes (16. 18) GP5+/GP6+ (L1) Amplification with TS primers and SBH with TS probes ( ) Yeudall 1991 (UK) TS-PCR E6/E7 for 16. E6 for 18 and specific for 4 Hybridization with TS probes ( ) Chuang 2008 (USA) Furniss 2007 (USA) RT-PCR E6/E7 for 16 Hybridization with TS probes (16) TS-PCR L1 for 16 Amplification with TS primers (16) Ha 2002 (USA) RT-PCR E6/E7 for 16 Amplification with TS primers (16) Harris 2011 (USA) Holladay 1993 (USA) Hooper 2015 (USA) Liang 2008 (USA) Lohavanichbutr 2009 (USA) Paz 1997 (USA) Schlecht 2011 (USA) Schwartz 1998 (USA) Smith 2004 (USA) Walline 2013 (USA) MY09/MY11 (L1) and GP5+GP6+ (L1) Sequencing L1 consensus primers Hybridization with TS probes ( ) HC2, PCR-E6, PCR-E7, PCR- MULTIPLEX (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 42, 44, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 70, 73, 82) GP5+/GP6+ (L1) Amplification with TS primers (16) MY09/MY11 (L1) and GP5+/GP6+ (L1) Hybridization with Roche LBA ( ) MY09/MY11 (L1) and IU/IWDO (E1) Amplification with TS primers ( ) MY09/MY11 (L1) and HMB01 (L1) DBH (40 HPV types including ) MY09/MY11 (L1) and TS-PCR E6 for 6/11/16/18 Hybridization with TS probes ( /33/35) MY09/MY11 (L1) and HMB01 (L1) Sequencing PCR-PGMY09/11, PCR L1-Consensus primer, PCR-E6, PCR- MULTIPLEX (HPV 16, 31, 33, 35, 39, 58, 66) Zhao 2005 (USA) RT-PCR E6/E7 for 16 Hybridization with TS probes (16) ( ) HPV 16 (2.1%) HPV 18 (2.1%) ( ) HPV 16 (20.0%) ( ) HPV 16 (25.6%) HPV 18 (20.5%) ( ) HPV 16 (25.3%) ( ) HPV 16 (2.9%) ( ) HPV 16 (8.0%) ( ) HPV 16 (17.9%) HPV 18 (2.6%) ( ) ( ) HPV 16 (2.0%) ( ) HPV 16 (18.2%) HPV 32 (1.1%) HPV 53 (1.1%) ( ) HPV 16 (9.4%) HPV 6 (1.9%) HPV 8 (1.9%) ( ) HPV 16 (11.1%) ( ) HPV 16 (11.4%) HPV 6 (6.2%) HPV 11 (3.6%) HPV 18 (1.0%) ( ) HPV 16 (8.1%) HPV 33 (2.4%) ( ) ( ) HPV 16 (15.8%) (Continued on next page)

255 4 HPV RELATED STATISTICS HPV detection ( Table 27 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Miller 1994 (Venezuela) Premoli-De- Percoco 2001 (Venezuela) Ribeiro 2011 c (World) TS-PCR E6 for 16/18 Hybridization with TS probes (16. 18) TS-PCR for 6/11/16/18 Hybridization with TS probes ( ) PGMY09/11 (L1) Amplification with TS primers (16) ( ) HPV 16 (59.3%) HPV 18 (25.9%) ( ) HPV 16 (50.0%) HPV 18 (16.0%) Data updated on 28 Jun 2017 (data as of 31 Dec 2015). 95% CI: 95% Confidence Interval; DBH: Dot Blot Hybridization; EIA: Enzyme ImmunoAssay; HC2: Hybrid Capture 2; ISH: In Situ Hybridization; LBA: Line-Blot Assay; LiPA: Line Probe Assay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; RLBH: Reverse Line Blot Hybridization; RT-PCR: Real Time Polymerase Chain Reaction; SBH: Southern Blot Hybridization; SPF: Short Primer Fragment; TS: Type Specific; a Includes cases from Canada and USA b Includes cases from Norway, Sweden and Finland c Includes cases from Argentina, Brazil, Cuba, Russia, Slovakia, Czech Republic, Romania and Poland Data sources: See references in Section 9. Table 28: Studies on HPV prevalence among cases of oropharyngeal cancer HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) MEN Li 2007 (China) Herrero 2003 (Cuba) Rotnáglová 2011 (Czech Rep.) Charfi 2008 (France) Hoffmann 2010 (Germany) Krupar 2014 (Germany) Reimers 2007 (Germany) Herrero 2003 (Italy) GP5+/GP6+ (L1). CP65/70ct-CP66/69ct (L1). FAP59/6415 (L1). A5/A10-A6/A8 (L1) and TS-PCR E6 for 16 Sequencing GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) GP5+/GP6+ (L1) RBLH ( ) GP5+/GP6+ (L1) and TS-PCR for 6/11/16/18/33 Amplification with TS primers ( ) GP5+/GP6+ (L1). MY09/MY11 (L1) and TS-PCR for 6/11/16/18 Hybridization with TS probes - Multiplex luminex* PCR-E6, PCR-E7, PCR- MULTIPLEX (HPV 11, 16, 18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56, 58, 59, 66, 68) A10/A5-A6/A8 (L1) and CP62/70-CP65/69a (L1) Sequencing GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) ( ) HPV 16 (14.3%) ( ) HPV 16 (19.0%) ( ) ( ) ( ) HPV 16 (51.6%) HPV 35 (6.5%) ( ) HPV 16 (50.0%) ( ) ( ) HPV 16 (20.0%) HPV 33 (3.3%) HPV 35 (3.3%) (Continued on next page)

256 4 HPV RELATED STATISTICS HPV detection ( Table 28 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Hannisdal 2010 (Norway) Herrero 2003 (Spain) Attner 2010 (Sweden) Dahlgren 2004 (Sweden) Hammarstedt 2006 (Sweden) Näsman 2009 (Sweden) Lindel 2001 (Switzerland) Al-Swiahb 2010 (Taiwan) Kuo 2008 (Taiwan) Chaturvedi 2011 (USA) Cohen 2008 (USA) Ernster 2007 (USA) Lohavanichbutr 2009 (USA) Posner 2011 (USA) GP5+/GP6+ (L1) Sequencing ( ) - GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) ( ) HPV 16 (5.0%) GP5+/GP6+ (L1). CPI/IIG (E1) ( ) - and TS-PCR E6/7 for 16/33 Amplification with TS primers (16. 33) and sequencing GP5+/GP6+ (L1) and CPI/CPII ( ) - (L1) Amplification with TS primers ( ) and sequencing GP5+/GP6+ (L1). CPI/CPIIG ( ) - (E1) and TS-PCR E6 for 16 Sequencing GP5+/GP6+ (L1). CPI/CPIIG ( ) - (E1) and TS-PCR E6 for 16 Sequencing SPF10 (L1) Sequencing ( ) - MY09/MY11 (L1) and GP5/GP6 (L1) In situ hybridization with TS probes ( ) and Roche LBA ( ) - MY09 (L1) and GP5+/GP6+ (L1) ( ) - Hybridization with HPV gene chip ( CP8061.CP8304.L1AE5MM4.MM7.MM8) SPF10 (L1) Inno-LiPA ( ( ) ) GP5+/GP6+ (L1) and TS-PCR E ( ) HPV 16 (70.4%) for 16 Hybridization with TS probes (16) TS-PCR for 16/18 Amplification ( ) HPV 16 (72.5%) with TS primers (16. 18) MY09/MY11 (L1) and ( ) - GP5+/GP6+ (L1) Hybridization with Roche LBA ( ) TS-PCR E6/E7 for ( ) HPV 16 (50.6%) Amplification with TS primers (16) Tezal 2009 (USA) TS-PCR E6 for 16/18 Amplification with TS primers (16. 18) WOMEN ( ) HPV 16 (76.9%) (Continued on next page)

257 4 HPV RELATED STATISTICS HPV detection ( Table 28 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Li 2007 (China) Herrero 2003 (Cuba) Rotnáglová 2011 (Czech Rep.) Charfi 2008 (France) Hoffmann 2010 (Germany) Reimers 2007 (Germany) Herrero 2003 (Italy) Hannisdal 2010 (Norway) Herrero 2003 (Spain) Attner 2010 (Sweden) Dahlgren 2004 (Sweden) Hammarstedt 2006 (Sweden) Näsman 2009 (Sweden) Lindel 2001 (Switzerland) Al-Swiahb 2010 (Taiwan) GP5+/GP6+ (L1). CP65/70ct-CP66/69ct (L1). FAP59/6415 (L1). A5/A10-A6/A8 (L1) and TS-PCR E6 for 16 Sequencing ( ) HPV 16 (60.0%) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) GP5+/GP6+ (L1) RBLH ( ( ) ) GP5+/GP6+ (L1) and TS-PCR for ( ) - 6/11/16/18/33 Amplification with TS primers ( ) GP5+/GP6+ (L1). MY09/MY ( ) HPV 16 (50.0%) (L1) and TS-PCR for 6/11/16/18 Hybridization with TS probes - Multiplex luminex* A10/A5-A6/A8 (L1) and ( ) - CP62/70-CP65/69a (L1) Sequencing GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) GP5+/GP6+ (L1) Sequencing ( ) - GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) ( ) HPV 16 (50.0%) GP5+/GP6+ (L1). CPI/IIG (E1) ( ) - and TS-PCR E6/7 for 16/33 Amplification with TS primers (16. 33) and sequencing GP5+/GP6+ (L1) and CPI/CPII ( ) - (L1) Amplification with TS primers ( ) and sequencing GP5+/GP6+ (L1). CPI/CPIIG ( ) - (E1) and TS-PCR E6 for 16 Sequencing GP5+/GP6+ (L1). CPI/CPIIG ( ) - (E1) and TS-PCR E6 for 16 Sequencing SPF10 (L1) Sequencing ( ) - MY09/MY11 (L1) and GP5/GP6 (L1) In situ hybridization with TS probes ( ) and Roche LBA (Continued on next page) ( ) -

258 4 HPV RELATED STATISTICS HPV detection ( Table 28 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Kuo 2008 (Taiwan) Chaturvedi 2011 (USA) Cohen 2008 (USA) Ernster 2007 (USA) Lohavanichbutr 2009 (USA) Posner 2011 (USA) MY09 (L1) and GP5+/GP6+ (L1) Hybridization with HPV gene chip ( ( ) CP8061.CP8304.L1AE5MM4.MM7.MM8) SPF10 (L1) Inno-LiPA ( ( ) ) GP5+/GP6+ (L1) and TS-PCR E ( ) HPV 16 (62.5%) for 16 Hybridization with TS probes (16) TS-PCR for 16/18 Amplification ( ) HPV 16 (61.9%) with TS primers (16. 18) MY09/MY11 (L1) and GP5+/GP6+ (L1) Hybridization with Roche LBA ( ) TS-PCR E6/E7 for ( ) HPV 16 (50.0%) Amplification with TS primers (16) Tezal 2009 (USA) TS-PCR E6 for 16/18 Amplification with TS primers (16. 18) BOTH OR UNSPECIFIED Hong 2010 (Australia) Hong 2013 (Australia) Cortezzi 2004 (Brazil) Nichols 2013 (Canada) Li 2007 (China) Herrero 2003 (Cuba) E6-based MT-PCR Amplification with MT-PCR kit ( ) PCR-E6, PCR- MULTIPLEX, Sequencing (HPV 16, 18, 35, 51, 53) GP5+/GP6+ (L1) DBH ( ) PCR-E6, PCR-E7, PCR- MULTIPLEX (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 67, 68) GP5+/GP6+ (L1). CP65/70ct-CP66/69ct (L1). FAP59/6415 (L1). A5/A10-A6/A8 (L1) and TS-PCR E6 for 16 Sequencing GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) ( ) HPV 16 (25.0%) ( ) HPV 16 (42.1%) HPV 18 (1.7%) HPV 35 (1.7%) HPV 39 (1.0%) HPV 33 (0.7%) ( ) HPV 16 (54.7%) HPV 18 (1.4%) HPV 35 (0.3%) HPV 53 (0.3%) HPV 51 (0.2%) ( ) HPV 16 (14.3%) ( ) HPV 16 (47.4%) HPV 18 (2.1%) HPV 67 (2.1%) HPV 33 (1.1%) ( ) HPV 16 (29.0%) ( ) HPV 16 (15.4%) (Continued on next page)

259 4 HPV RELATED STATISTICS HPV detection ( Table 28 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Klozar 2008 (Czech Rep.) Rotnáglová 2011 (Czech Rep.) Jouhi 2015 (Finland) Charfi 2008 (France) Fonmarty 2015 (France) Fouret 1997 (France) Andl 1998 (Germany) Hoffmann 1998 (Germany) Hoffmann 2010 (Germany) Holzinger 2012 (Germany) Klussmann 2001 (Germany) Krupar 2014 (Germany) Reimers 2007 (Germany) Weiss 2011 (Germany) Wittekindt 2005 (Germany) GP5+/GP6+ (L1) RLBH ( ) GP5+/GP6+ (L1) RBLH ( ) PCR-E6, PCR-E7, PCR- MULTIPLEX (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 53, 56, 58, 59, 66, 68, 70, 73, 82) GP5+/GP6+ (L1) and TS-PCR for 6/11/16/18/33 Amplification with TS primers ( ) PCR, LiPA (HPV 6, 11, 16, 18, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 73, 74, 82) TS-PCR E6 for 16/18/31/33/45 Hybridization with TS probes ( ) TS-PCR for 6/11/16/18 Hybridization with TS probes ( ) and cycle sequencing system of BRL MY09/MY11 (L1) and TS-PCR for 6/11/16/18/33 SBH ( ) GP5+/GP6+ (L1). MY09/MY11 (L1) and TS-PCR for 6/11/16/18 Hybridization with TS probes - Multiplex luminex* PCR-GP5+/6+, PCR L1-Consensus primer, PCR- MULTIPLEX (HPV 16, 18, 33, 35) A10/A5-A6/A8 (L1) and CP62/70-CP65/69a (L1) Sequencing PCR-E6, PCR-E7, PCR- MULTIPLEX (HPV 11, 16, 18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56, 58, 59, 66, 68) A10/A5-A6/A8 (L1) and CP62/70-CP65/69a (L1) Sequencing RT-PCR E6/E7 for 16 Hybridization with TS probes (16) A10/A5-A6/A8 (L1) and (L1) Sequencing ( ) HPV 16 (40.0%) HPV 33 (5.0%) ( ) HPV 16 (60.6%) HPV 33 (1.8%) HPV 18 (0.9%) HPV 26 (0.9%) HPV 52 (0.9%) ( ) HPV 16 (45.7%) HPV 18 (2.9%) HPV 45 (2.9%) ( ) HPV 16 (51.9%) HPV 33 (1.9%) ( ) HPV 16 (28.2%) HPV 33 (2.8%) HPV 6 (1.4%) ( ) HPV 16 (15.5%) ( ) HPV 16 (38.1%) HPV 33 (4.8%) ( ) HPV 16 (8.7%) HPV 45 (8.7%) HPV 6 (4.3%) ( ) HPV 16 (51.3%) HPV 35 (5.1%) ( ) HPV 16 (48.7%) HPV 18 (0.5%) HPV 33 (0.5%) HPV 35 (0.5%) ( ) HPV 16 (42.4%) HPV 5 (3.0%) HPV 33 (3.0%) HPV 96 (3.0%) ( ) HPV 16 (50.0%) ( ) HPV 16 (27.4%) HPV 33 (0.9%) ( ) HPV 16 (38.4%) ( ) HPV 16 (50.0%) HPV 33 (2.9%) (Continued on next page)

260 4 HPV RELATED STATISTICS HPV detection ( Table 28 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Romanitan 2008 (Greece) Bahl 2014 (India) Boscolo-Rizzo 2009 (Italy) Herrero 2003 (Italy) Licitra 2006 (Italy) Rittà 2009 (Italy) Deng 2013 (Japan) Hama 2014 (Japan) Hatakeyama 2014 (Japan) Braakhuis 2004 (Netherlands) Henneman 2015 (Netherlands) van Monsjou 2012 (Netherlands) GP5+/GP6+ (L1). CPI/CPIIG (E1) and TS-PCR E6/E7 for 16 Amplification with TS primers (16) PCR-PGMY09/11, PCR L1-Consensus primer, LBA (HPV 6, 11, 16, 18, 31, 33, 34, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 82, 83, 84, 89) MY09/MY11 (L1) RFLP* and amplification with TS primers E6/E2 for 16 GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) RT-PCR E1 for 16/18 Hybridization with TS probes (16. 18) MY09/MY11 (L1) and GP5+/GP6+ (L1) Sequencing PCR-GP5+/6+, PCR-MY09/11, TS, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) HC2, PCR-E6, PCR-E7 (HPV 6, 11, 16, 18, 26, 31, 33, 35, 52, 58) PCR- MULTIPLEX (HPV 6, 11, 16, 18, 30, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66) GP5+/GP6+ (L1) and TS-PCR RLBH ( /MM /IS39. 71/CP /CP ) PCR-SPF10, LiPA (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68) PCR, LiPA (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 72, 73, 82) ( ) HPV 16 (32.1%) ( ) HPV 16 (18.1%) HPV 18 (2.9%) HPV 31 (1.0%) HPV 33 (1.0%) ( ) HPV 16 (18.2%) ( ) HPV 16 (16.7%) HPV 33 (2.8%) HPV 35 (2.8%) ( ) HPV 16 (18.9%) ( ) HPV 16 (50.0%) ( ) HPV 16 (37.5%) HPV 33 (4.2%) HPV 58 (4.2%) HPV 35 (2.1%) HPV 67 (2.1%) ( ) HPV 16 (44.6%) HPV 18 (1.9%) HPV 58 (1.3%) HPV 31 (0.6%) HPV 33 (0.6%) ( ) HPV 16 (25.3%) HPV 18 (2.5%) HPV 58 (1.3%) ( ) HPV 16 (37.8%) ( ) HPV 16 (32.2%) HPV 33 (2.1%) HPV 35 (0.7%) ( ) HPV 16 (60.0%) HPV 35 (5.0%) (Continued on next page)

261 4 HPV RELATED STATISTICS HPV detection ( Table 28 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Hannisdal 2010 (Norway) Snietura 2010 (Poland) Szkaradkiewicz 2002 (Poland) Kim 2007 (Rep. Korea) Oh 2004 (Rep. Korea) Paquette 2013 (South Africa) Herrero 2003 (Spain) Attner 2010 (Sweden) Dahlgren 2004 (Sweden) Hammarstedt 2006 (Sweden) Lindquist 2012 (Sweden) Näsman 2009 (Sweden) GP5+/GP6+ (L1) Sequencing ( ) HPV 16 (48.9%) HPV 31 (2.9%) HPV 18 (2.2%) HPV 33 (0.7%) HPV 67 (0.7%) Real-time High Risk HPV test ( ) HPV 16 (50.0%) (Abbott Molecular) using L1 consensus primers Amplification with TS primers ( and 68 - the technique only differentiates other) MY09/MY11 (L1) Amplification ( ) - with TS primers (16. 18) RT-PCR E2/E6 for 16 Hybridization with HPV genotyping DNA chip arrayed by multiple oligonucleotide probes ( ) MY09/MY11 (L1) and HMB01 (L1) Microarray hybridization ( ) PCR-GP5+/6+, PCR L1-Consensus primer, PCR-E6, PCR-E7, TS (HPV 16, 18, 31, 33, 52, 58) GP5+/GP6+ (L1) Hybridization with EIA oligonucleotide probes ( ) GP5+/GP6+ (L1). CPI/IIG (E1) and TS-PCR E6/7 for 16/33 Amplification with TS primers (16. 33) and sequencing GP5+/GP6+ (L1) and CPI/CPII (L1) Amplification with TS primers ( ) and sequencing GP5+/GP6+ (L1). CPI/CPIIG (E1) and TS-PCR E6 for 16 Sequencing GP5+/GP6+ (L1) and CPI/CPIIG (E1) Amplification with TS primers (16) and Multiplex Luminex ( ) GP5+/GP6+ (L1). CPI/CPIIG (E1) and TS-PCR E6 for 16 Sequencing ( ) HPV 16 (65.4%) HPV 18 (1.9%) HPV 33 (1.9%) HPV 35 (1.9%) HPV 58 (1.9%) ( ) HPV 16 (59.0%) HPV 6 (2.6%) HPV 33 (2.6%) HPV 58 (2.6%) ( ) HPV 16 (61.8%) HPV 31 (21.8%) HPV 18 (7.3%) ( ) HPV 16 (9.1%) ( ) HPV 16 (64.2%) HPV 33 (7.4%) HPV 35 (2.1%) HPV 58 (1.1%) ( ) HPV 16 (28.0%) HPV 33 (4.0%) HPV 35 (4.0%) HPV 38 (4.0%) ( ) HPV 16 (42.9%) HPV 33 (1.5%) HPV 35 (0.5%) HPV 45 (0.5%) ( ) HPV 16 (64.3%) ( ) HPV 16 (78.6%) HPV 33 (1.0%) HPV 35 (1.0%) HPV 59 (1.0%) (Continued on next page)

262 4 HPV RELATED STATISTICS HPV detection ( Table 28 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Lindel 2001 (Switzerland) Al-Swiahb 2010 (Taiwan) Kuo 2008 (Taiwan) Tural 2013 (Turkey) Anderson 2007 (UK) Conway 2012 (UK) SPF10 (L1) Sequencing ( ) HPV 16 (11.1%) HPV 33 (1.0%) HPV 35 (1.0%) HPV 45 (1.0%) MY09/MY11 (L1) and GP5/GP6 (L1) In situ hybridization with TS probes ( ) and Roche LBA MY09 (L1) and GP5+/GP6+ (L1) Hybridization with HPV gene chip ( CP8061.CP8304.L1AE5MM4.MM7.MM8) PCR-MY09/11, PCR L1-Consensus primer, PCR-E6, PCR-E7, PCR- MULTIPLEX, Sequencing (HPV 6, 11, 16, 18, 26, 30, 31, 33, 34, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 70, 73, 82, 85) GP5+/GP6+ (L1) Hybridization with Roche LBA ( ) PCR-GP5+/6+, TS, Sequencing (HPV 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) Evans 2013 (UK) PCR-GP5+/6+, EIA (HPV 6, 11, 16, 18, 31, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 56, 58, 59, 66, 68) Schache 2011 (UK) Thavaraj 2011 (UK) TS-PCR E6 for 16 Amplification with TS primers (16) GP5+/GP6+ (L1) Luminex 200 IS ( ) Wells 2015 (UK) PCR- MULTIPLEX (HPV 16, 18, 35, 51, 82) Agoston 2010 (USA) Generic L1 primers from Access Genetics and TS-PCR E7 for 16 RFLP (Continued on next page) ( ) HPV 16 (14.2%) HPV 18 (2.6%) HPV 31 (0.7%) HPV 6 (0.4%) HPV 11 (0.4%) ( ) HPV 16 (63.0%) HPV 58 (3.3%) HPV 18 (2.2%) HPV 33 (2.2%) HPV 69 (2.2%) ( ) HPV 16 (44.4%) HPV 18 (6.2%) HPV 33 (1.2%) ( ) HPV 16 (19.4%) HPV 11 (2.8%) ( ) HPV 16 (40.0%) ( ) HPV 16 (80.7%) HPV 18 (1.2%) HPV 33 (1.2%) HPV 56 (1.2%) ( ) HPV 16 (40.8%) ( ) HPV 16 (64.1%) HPV 33 (2.1%) HPV 18 (0.7%) HPV 35 (0.7%) ( ) HPV 16 (45.6%) HPV 18 (5.3%) HPV 35 (1.8%) HPV 51 (1.8%) HPV 82 (1.8%) ( ) HPV 16 (73.5%) HPV 58 (1.0%)

263 4 HPV RELATED STATISTICS HPV detection ( Table 28 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Chaturvedi 2011 (USA) Cohen 2008 (USA) D Souza 2007 (USA) D Souza 2014 (USA) Ernster 2007 (USA) Furniss 2007 (USA) Hooper 2015 (USA) Isayeva 2014 (USA) Jordan 2012 (USA) SPF10 (L1) Inno-LiPA ( ) GP5+/GP6+ (L1) and TS-PCR E7 for 16 Hybridization with TS probes (16) MY09/MY11 (L1) Hybridization with Roche LBA ( ) PCR-PGMY09/11, LiPA (HPV 6, 11, 16, 18, 26, 31, 33, 34, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84) TS-PCR for 16/18 Amplification with TS primers (16. 18) TS-PCR L1 for 16 Amplification with TS primers (16) HC2, PCR-E6, PCR-E7, PCR- MULTIPLEX (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 42, 44, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 70, 73, 82) PCR-E6, PCR-E7, TS (HPV 16, 18) PCR L1-Consensus primer, PCR-SPF10, LiPA (HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 69, 70, 71, 72, 73, 82) Kerr 2015 (USA) PCR, RFLP, TS (HPV 16, 33, 35, 58) Kingma 2010 (USA) Kong 2009 (USA) Lohavanichbutr 2009 (USA) Posner 2011 (USA) PGMY09/11 (L1) Inno-LiPA ( ) GP5+/GP6+ (L1) and TS-PCR Sequencing MY09/MY11 (L1) and GP5+/GP6+ (L1) Hybridization with Roche LBA ( ) TS-PCR E6/E7 for 16 Amplification with TS primers (16) (Continued on next page) ( ) HPV 16 (38.8%) HPV 35 (1.5%) HPV 33 (1.1%) HPV 58 (1.1%) HPV 18 (0.8%) ( ) HPV 16 (68.6%) ( ) HPV 16 (58.3%) HPV 33 (6.7%) HPV 35 (1.7%) ( ) HPV 16 (53.7%) HPV 52 (8.5%) HPV 33 (2.4%) HPV 73 (1.8%) HPV 51 (1.2%) ( ) HPV 16 (69.4%) ( ) HPV 16 (34.9%) ( ) HPV 16 (70.5%) HPV 18 (2.3%) HPV 33 (2.3%) HPV 35 (2.3%) ( ) HPV 16 (65.7%) HPV 18 (14.7%) ( ) HPV 16 (73.0%) HPV 18 (2.6%) HPV 33 (1.7%) HPV 6 (1.3%) HPV 11 (1.3%) ( ) HPV 16 (71.4%) HPV 33 (3.6%) HPV 35 (3.6%) HPV 58 (3.6%) ( ) HPV 16 (67.2%) HPV 18 (14.8%) HPV 33 (4.9%) HPV 45 (1.6%) HPV 82 (1.6%) ( ) HPV 16 (65.3%) HPV 18 (2.0%) HPV 33 (2.0%) ( ) HPV 16 (67.7%) HPV 35 (3.2%) HPV 45 (3.2%) ( ) HPV 16 (50.5%)

264 4 HPV RELATED STATISTICS HPV detection ( Table 28 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Schlecht 2011 (USA) Schwartz 1998 (USA) MY09/MY11 (L1) and HMB01 (L1) DBH (40 HPV types including ) MY09/MY11 (L1) and TS-PCR E6 for 6/11/16/18 Hybridization with TS probes ( /33/35) Sethi 2012 (USA) PCR-SPF10, EIA, LiPA (HPV 6, 11, 16, 18, 31, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 70, 73, 74) Smith 2004 (USA) MY09/MY11 (L1) and HMB01 (L1) Sequencing Steinau 2014 (USA) Strome 2002 (USA) PCR, LBA, LiPA (HPV 16, 18, 31, 33, 35, 39, 45, 52) MY09/MY11 (L1) and TS-PCR E6 for 6/11/16/18 Sequencing Tezal 2009 (USA) TS-PCR E6 for 16/18 Amplification with TS primers (16. 18) Walline 2013 (USA) PCR-PGMY09/11, PCR L1-Consensus primer, PCR-E6, PCR- MULTIPLEX (HPV 16, 18, 33, 35, 39, 66) Zhao 2005 (USA) RT-PCR E6/E7 for 16 Hybridization with TS probes (16) Ribeiro 2011 a PGMY09/11 (L1) Amplification (World) with TS primers (16) ( ) HPV 16 (43.3%) HPV 35 (3.3%) ( ) HPV 16 (34.5%) HPV 6 (12.7%) HPV 11 (3.6%) ( ) HPV 16 (45.7%) HPV 33 (2.5%) HPV 35 (1.2%) HPV 56 (1.2%) ( ) HPV 16 (37.1%) HPV 18 (1.6%) HPV 33 (1.6%) ( ) HPV 16 (60.5%) HPV 33 (5.6%) HPV 18 (2.5%) HPV 35 (2.0%) HPV 39 (0.9%) ( ) HPV 16 (40.4%) HPV 12 (3.8%) HPV 59 (1.9%) ( ) HPV 16 (70.0%) ( ) HPV 16 (78.8%) HPV 33 (1.9%) HPV 35 (1.9%) HPV 18 (1.0%) HPV 39 (0.5%) ( ) HPV 16 (57.7%) ( ) HPV 16 (0.7%) Data updated on 28 Jun 2017 (data as of 31 Dec 2015 / 31 Dec 2015). 95% CI: 95% Confidence Interval; DBH: Dot Blot Hybridization; EIA: Enzyme ImmunoAssay; HC2: Hybrid Capture 2; LBA: Line-Blot Assay; LiPA: Line Probe Assay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; RLBH: Reverse Line Blot Hybridization; RT-PCR: Real Time Polymerase Chain Reaction; SBH: Southern Blot Hybridization; SPF: Short Primer Fragment; TS: Type Specific; a Includes cases from Argentina, Brazil, Cuba, Russia, Slovakia, Czech Republic, Romania and Poland Data sources: See references in Section 9. Table 29: Studies on HPV prevalence among cases of hypopharyngeal or laryngeal cancer HPV detection Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) MEN Fliss 1994 (Canada) Torrente 2005 (Chile) TS-PCR E6/E7 for 6b/11/16/18 Amplification with TS primers (6b/ ) ( ) HPV 16 (32.1%) HPV 18 (32.1%) MY09/MY11 (L1) RFLP ( ) - (Continued on next page)

265 4 HPV RELATED STATISTICS HPV detection ( Table 29 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Liu 2010 (China) Hoffmann 2006 (Germany) Hoffmann 2009 (Germany) Azzimonti 2004 (Italy) Cattani 1998 (Italy) Gallo 2009 (Italy) Anwar 1993 (Japan) Shidara 1994 (Japan) Lie 1996 (Norway) Morshed 2008 (Poland) Bozdayi 2009 (Turkey) Dönmez 2000 (Turkey) WOMEN Fliss 1994 (Canada) Torrente 2005 (Chile) Liu 2010 (China) GP5+/GP6+ (L1) and TS-PCR E6/E7 for 16 and E6 for 18 Amplification with TS primers (16. 18) ( ) - MY09/MY11 (L1) and TS-PCR ( ) HPV 16 (23.5%) for 6/11/16/18/33 Hybridization with TS and consensus probes and further confirmation by SBH with TS and consensus probes ( ) MY09/MY11 (L1) and TS-PCR ( ) HPV 16 (19.0%) for 6/11/16/18 Hybridization with TS and consensus probes and further confirmation by SBH with TS and consensus probes ( ) GP5+/GP6+ (L1) Sequencing ( ) HPV 16 (43.5%) HPV 18 (13.0%) MY09/MY11 (L1) and TS-PCR ( ) - for 33 Hybridization with TS probes ( ) and amplification with TS primer (33) MY09/MY11 (L1). LCRF LCRF2. LCRF3. LCRF4. E7R1. E7R2. E7R3. E7R4 (E6) and TS-PCR E1 for 6/11/16/18-31/33 Sequencing TS-PCR for 16/18/33 Hybridization with TS probes ( ) L1C1/L1C2 RFLP ( ) CP (E1). MY09/MY11 (L1) and GP5+/GP6+ (L1) Amplification with TS primers ( ) ( ) HPV 18 (34.6%) HPV 16 (3.8%) HPV 33 (3.8%) ( ) HPV 16 (17.5%) HPV 18 (2.5%) ( ) HPV 16 (2.6%) SPF10 (L1) LiPA ( ) - MY09/MY11 (L1) Amplification with GP5+/6+ and TS primers for HPV16 positive; For HPV16 negative cases. sequencing was performed MY09/MY11 (L1) RFLP ( ) ( ) ( ) HPV 11 (7.3%) HPV 6 (5.5%) TS-PCR E6/E7 for 6b/11/16/18 Amplification with TS primers (6b/ ) MY09/MY11 (L1) RFLP ( ) - GP5+/GP6+ (L1) and TS-PCR E6/E7 for 16 and E6 for 18 Amplification with TS primers (16. 18) ( ) - (Continued on next page)

266 4 HPV RELATED STATISTICS HPV detection ( Table 29 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Hoffmann 2006 (Germany) Hoffmann 2009 (Germany) Azzimonti 2004 (Italy) Cattani 1998 (Italy) Gallo 2009 (Italy) Anwar 1993 (Japan) Shidara 1994 (Japan) Lie 1996 (Norway) Morshed 2008 (Poland) Bozdayi 2009 (Turkey) Dönmez 2000 (Turkey) BOTH OR UNSPECIFIED Gudleviciene 2014 (Belarus) Duray 2011 (Belgium) MY09/MY11 (L1) and TS-PCR for 6/11/16/18/33 Hybridization with TS and consensus probes and further confirmation by SBH with TS and consensus probes ( ) ( ) HPV 16 (33.3%) MY09/MY11 (L1) and TS-PCR ( ) - for 6/11/16/18 Hybridization with TS and consensus probes and further confirmation by SBH with TS and consensus probes ( ) GP5+/GP6+ (L1) Sequencing ( ) HPV 16 (50.0%) MY09/MY11 (L1) and TS-PCR for 33 Hybridization with TS probes ( ) and amplification with TS primer (33) MY09/MY11 (L1). LCRF1. LCRF2. LCRF3. LCRF4. E7R1. E7R2. E7R3. E7R4 (E6) and TS-PCR E1 for 6/11/16/18-31/33 Sequencing TS-PCR for 16/18/33 Hybridization with TS probes ( ) L1C1/L1C2 RFLP ( ) CP (E1). MY09/MY11 (L1) and GP5+/GP6+ (L1) Amplification with TS primers ( ) ( ) HPV 16 (21.4%) ( ) HPV 18 (25.0%) ( ) HPV 16 (40.0%) HPV 18 (20.0%) SPF10 (L1) LiPA ( ) - MY09/MY11 (L1) Amplification with GP5+/6+ and TS primers for HPV16 positive; For HPV16 negative cases. sequencing was performed MY09/MY11 (L1) RFLP ( ) PCR-GP5+/6+, PCR-PGMY09/11, PCR L1-Consensus primer, PCR-E6, PCR- MULTIPLEX (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, 82) GP5+/GP6+ (L1) and RT-PCR E6/E7 for L1. 68 TS real-time and consensus PCR E6/E7 ( L1. 68) ( ) HPV 6 (2.9%) HPV 16 (2.9%) ( ) HPV 16 (62.7%) HPV 18 (16.9%) HPV 51 (8.5%) HPV 33 (5.1%) HPV 66 (5.1%) (Continued on next page)

267 4 HPV RELATED STATISTICS HPV detection ( Table 29 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Miranda 2009 (Brazil) Fliss 1994 (Canada) Gheit 2014 (Chile) Torrente 2005 (Chile) Liu 2010 (China) Ma 1998 (China) García-Milián 1998 (Cuba) Lindeberg 1999 (Denmark) Koskinen 2003 (Finland) Fouret 1997 (France) Fischer 2003 (Germany) Hoffmann 1998 (Germany) Hoffmann 2006 (Germany) GP5+/GP6+ (L1) Amplification with TS primers ( ) and sequencing TS-PCR E6/E7 for 6b/11/16/18 Amplification with TS primers (6b/ ) PCR-E7, PCR- MULTIPLEX (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 70, 73, 82) ( ) HPV 16 (7.4%) HPV 6 (3.7%) ( ) HPV 16 (31.0%) HPV 18 (31.0%) ( ) HPV 31 (6.3%) HPV 11 (3.1%) HPV 59 (3.1%) MY09/MY11 (L1) RFLP ( ) HPV 16 (9.7%) HPV 58 (6.5%) HPV 38 (3.2%) HPV 39 (3.2%) HPV 45 (3.2%) GP5+/GP6+ (L1) and TS-PCR E6/E7 for 16 and E6 for 18 Amplification with TS primers (16. 18) TS-PCR E6/E7 for 6/11/16/18/31/33/52b/58 SBH ( b. 58) MY09/MY11 (L1) and TS-PCR E6 for 6/11/16/18 SBH ( ) MY09/MY11 (L1). GP5+/GP6+ (L1) and CPII/II (L1) Hybridization with TS probes ( ) ( ) HPV 16 (34.5%) HPV 18 (7.1%) ( ) HPV 16 (29.4%) HPV 6 (24.5%) HPV 18 (21.6%) HPV 11 (2.0%) HPV 33 (1.0%) ( ) HPV 16 (45.5%) HPV 6 (3.0%) HPV 18 (3.0%) ( ) - SPF10 (L1) LiPA ( ) HPV 16 (46.4%) HPV 33 (14.3%) HPV 6 (10.7%) HPV 11 (3.6%) HPV 51 (3.6%) TS-PCR E6 for 16/18/31/33/ ( ) HPV 16 (6.8%) Hybridization with TS probes ( ) L1-CP65F. 66F. 69F. 70F Sequencing MY09/MY11 (L1) and TS-PCR for 6/11/16/18/33 SBH ( ) MY09/MY11 (L1) and TS-PCR for 6/11/16/18/33 Hybridization with TS and consensus probes and further confirmation by SBH with TS and consensus probes ( ) ( ) HPV 73 (4.3%) HPV 21 (2.1%) HPV 22 (2.1%) HPV 38 (2.1%) HPV 41 (2.1%) ( ) HPV 16 (3.9%) HPV 18 (2.0%) HPV 45 (2.0%) ( ) HPV 16 (25.0%) (Continued on next page)

268 4 HPV RELATED STATISTICS HPV detection ( Table 29 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Hoffmann 2009 (Germany) Kleist 2000 (Germany) Klussmann 2001 (Germany) Krupar 2014 (Germany) Gorgoulis 1999 (Greece) Vlachtsis 2005 (Greece) Major 2005 (Hungary) Jacob 2002 (India) Azzimonti 2004 (Italy) Badaracco 2000 (Italy) Badaracco 2007 (Italy) Boscolo-Rizzo 2009 (Italy) Cattani 1998 (Italy) Gallo 2009 (Italy) Anwar 1993 (Japan) MY09/MY11 (L1) and TS-PCR for 6/11/16/18 Hybridization with TS and consensus probes and further confirmation by SBH with TS and consensus probes ( ) MY09/MY11 (L1) Amplification with TS primers (16. 18) A10/A5-A6/A8 (L1) and CP62/70-CP65/69a (L1) Sequencing PCR-E6, PCR-E7, PCR- MULTIPLEX (HPV 11, 16, 18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56, 58, 59, 66, 68) MY09/MY11 (L1) and GP5/GP6 (L1) Amplification with TS primers ( ) and confirmation by DBH with TS probes ( ). TS-PCR for 16/18 Amplification with TS primers (16. 18) MY09/MY11 (L1) and GP5+/GP6+ (L1) RFLP ( ) TS-PCR E1 for 6/11/18 and L1 for 16 SBH with TS probes ( ) ( ) HPV 16 (14.8%) ( ) HPV 16 (8.6%) HPV 18 (8.6%) ( ) HPV 16 (13.3%) HPV 19 (3.3%) ( ) HPV 16 (14.3%) HPV 6 (3.3%) HPV 18 (3.3%) HPV 33 (3.3%) ( ) HPV 16 (34.4%) HPV 18 (6.7%) ( ) HPV 11 (18.2%) HPV 6 (13.6%) HPV 16 (13.6%) ( ) HPV 16 (34.1%) GP5+/GP6+ (L1) Sequencing ( ) HPV 16 (44.0%) HPV 18 (12.0%) MY09/MY11 (L1) Amplification with TS primers (6.16) and hybridization with TS probes ( ) MY09/MY11 (L1) and GP5+/GP6+ (L1) Sequencing MY09/MY11 (L1) RFLP* and amplification with TS primers E6/E2 for 16 MY09/MY11 (L1) and TS-PCR for 33 Hybridization with TS probes ( ) and amplification with TS primer (33) MY09/MY11 (L1). LCRF1. LCRF2. LCRF3. LCRF4. E7R1. E7R2. E7R3. E7R4 (E6) and TS-PCR E1 for 6/11/16/18-31/33 Sequencing TS-PCR for 16/18/33 Hybridization with TS probes ( ) ( ) HPV 16 (27.3%) HPV 6 (18.2%) HPV 45 (4.5%) ( ) HPV 16 (10.0%) HPV 6 (6.7%) ( ) HPV 16 (4.4%) ( ) HPV 16 (12.0%) HPV 18 (10.7%) HPV 33 (1.3%) ( ) HPV 18 (33.3%) HPV 16 (3.3%) HPV 33 (3.3%) (Continued on next page)

269 4 HPV RELATED STATISTICS HPV detection ( Table 29 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Deng 2013 (Japan) Mineta 1998 (Japan) Ogura 1991 (Japan) Shidara 1994 (Japan) Gudleviciene 2009 (Lithuania) Gudleviciene 2014 (Lithuania) Koskinen 2007 a (Northern Europe) Mork 2001 a (Northern Europe) Lie 1996 (Norway) Morshed 2008 (Poland) Snietura 2011 (Poland) Poljak 1997 (Slovenia) Alvarez Alvarez 1997 (Spain) Pérez-Ayala 1990 (Spain) Adams 1999 (Switzerland) PCR-GP5+/6+, PCR-MY09/11, TS, Sequencing (HPV 6, 11, 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) TS-PCR E7 for 16/18 Amplification with TS primers (16. 18) TS-PCR E6 for 16/18 Hybridization with TS probes (16. 18) L1C1/L1C2 RFLP ( ) Consensus primers from Master Mix Amplification with TS primers (16. 18) PCR-GP5+/6+, PCR-PGMY09/11, PCR L1-Consensus primer, PCR-E6, PCR- MULTIPLEX (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, 82) MY09/MY11 (L1). GP5+/GP6+ (L1) and SPF10 (L1) LiPA ( ) HPV 16 (11.5%) HPV 33 (3.8%) ( ) HPV 16 (26.2%) HPV 18 (4.8%) ( ) HPV 16 (10.7%) HPV 18 (3.6%) ( ) HPV 16 (20.0%) HPV 18 (4.4%) ( ) HPV 16 (12.0%) ( ) HPV 6 (1.9%) HPV 16 (1.9%) HPV 31 (1.9%) HPV 39 (1.9%) HPV 58 (1.9%) ( ) HPV 16 (1.4%) GP5+/GP6+ (L1) and CPI/CPII (L1) Amplification with TS primers ( ) ( ) HPV 16 (2.5%) CP (E1). MY09/MY11 (L1) and ( ) HPV 16 (2.6%) GP5+/GP6+ (L1) Amplification with TS primers ( ) SPF10 (L1) LiPA ( ) HPV 16 (30.1%) HPV 18 (6.5%) HPV 33 (5.4%) Real-time High Risk HPV test (Abbott Molecular) using L1 consensus primers RT-PCR ( ) PGMY09/11 (L1). GP5+/GP ( ) HPV 16 (3.3%) (L1) and WD72/76/66/67/154 (E6) Amplification with TS primers ( ) TS-PCR E6 and L1 for 6b/16/18 Amplification with TS primers (6b ) TS-PCR E6 for 6/11 Hybridization with TS probes (11.16) MY09/MY11 (L1) RFLP ( ) ( ) HPV 6 (22.9%) HPV 16 (5.7%) ( ) HPV 16 (56.9%) ( ) HPV 16 (16.7%) (Continued on next page)

270 4 HPV RELATED STATISTICS HPV detection ( Table 29 continued from previous page) Prevalence of 5 most method and targeted HPV prevalence frequent HPVs Study HPV types No. Tested % (95% CI) HPV type (%) Bozdayi 2009 (Turkey) Dönmez 2000 (Turkey) Gungor 2007 (Turkey) Anderson 2007 (UK) Conway 2012 (UK) MY09/MY11 (L1) Amplification with GP5+/6+ and TS primers for HPV16 positive; For HPV16 negative cases. sequencing was performed MY09/MY11 (L1) RFLP ( ) SP10296 (L1) Amplification with mpcr kit ( ) GP5+/GP6+ (L1) Hybridization with Roche LBA ( ) PCR-GP5+/6+, TS, Sequencing (HPV 16, 18, 20, 21, 22, 23, 26, 30, 31, 32, 33, 34, 35, 38, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 57, 58, 59, 60, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 74, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91) Salam 1995 (UK) MY09/MY11 (L1) RFLP ( ) Snijders 1996 (UK) Brandwein 1993 (USA) Chernock 2013 (USA) Furniss 2007 (USA) Paz 1997 (USA) Schlecht 2011 (USA) Shen 1996 (USA) GP5+/GP6+ (L1) Amplification with TS primers and SBH with TS probes ( ) Perkin Census L1 consensus primers Hybridization with TS probes ( ) PCR L1-Consensus primer, PCR-SPF10, LiPA (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68) TS-PCR L1 for 16 Amplification with TS primers (16) MY09/MY11 (L1) and IU/IWDO (E1) Amplification with TS primers ( ) MY09/MY11 (L1) and HMB01 (L1) DBH (40 HPV types including ) MY09/MY11 (L1) and TS-PCR E7 for 16/18 RFLP* Zhao 2005 (USA) RT-PCR E6/E7 for 16 Hybridization with TS probes (16) Ribeiro 2011 b PGMY09/11 (L1) Amplification (World) with TS primers (16) ( ) HPV 16 (40.0%) HPV 6 (1.5%) ( ) HPV 11 (7.3%) HPV 6 (5.5%) ( ) HPV 11 (7.4%) HPV 6 (2.1%) HPV 16 (1.1%) ( ) HPV 6 (8.3%) HPV 16 (5.6%) HPV 11 (2.8%) ( ) HPV 16 (19.4%) ( ) HPV 16 (2.5%) ( ) HPV 16 (13.2%) HPV 31 (10.5%) HPV 53 (9.2%) ( ) HPV 16 (31.7%) ( ) HPV 16 (2.3%) ( ) HPV 16 (27.5%) ( ) HPV 6 (3.1%) HPV 11 (3.1%) HPV 18 (3.1%) ( ) HPV 16 (18.2%) ( ) HPV 16 (0.8%) Data updated on 28 Jun 2017 (data as of 31 Dec 2015). 95% CI: 95% Confidence Interval; DBH: Dot Blot Hybridization; LBA: Line-Blot Assay; LiPA: Line Probe Assay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; RT-PCR: Real Time Polymerase Chain Reaction; SBH: Southern Blot Hybridization; SPF: Short Primer Fragment; TS: Type Specific; a Includes cases from Norway, Sweden and Finland b Includes cases from Argentina, Brazil, Cuba, Russia, Slovakia, Czech Republic, Romania and Poland Data sources: See references in Section 9.

271 5 FACTORS CONTRIBUTING TO CERVICAL CANCER Factors contributing to cervical cancer HPV is a necessary cause of cervical cancer, but it is not a sufficient cause. Other cofactors are necessary for progression from cervical HPV infection to cancer. Tobacco smoking, high parity, long-term hormonal contraceptive use, and co-infection with HIV have been identified as established cofactors. Co-infection with Chlamydia trachomatis and herpes simplex virus type-2, immunosuppression, and certain dietary deficiencies are other probable cofactors. Genetic and immunological host factors and viral factors other than type, such as variants of type, viral load and viral integration, are likely to be important but have not been clearly identified. (Muñoz N, Vaccine 2006; 24(S3): 1-10). In this section, the prevalence of smoking, parity (fertility), oral contraceptive use, and HIV in the World are presented. Figure 142: Female smoking prevalence Data accessed on 22 Mar Adjusted and age-standardized prevalence estimates of tobacco use by country, for the year These rates are constructed solely for the purpose of comparing tobacco use prevalence estimates across countries, and should not be used to estimate the number of smokers in the population. Data sources: WHO report on the global tobacco epidemic, 2015: The MPOWER package. Geneva, World Health Organization, Available at report/2015/en/index.html

272 5 FACTORS CONTRIBUTING TO CERVICAL CANCER Figure 143: Total fertility rates Data accessed on 22 Mar For Aruba, Argentina, Australia, Austria, Belgium, Bulgaria, Belarus, Brunei, Chile, Costa Rica, Cuba, Germany, Fiji, United Kingdom, Georgia, Grenada, Hong Kong SAR, Hungary, Iran, Japan, Kyrgyzstan, Republic of Korea, Kuwait, Libya, St Lucia, Macao SAR, Malaysia, New Caledonia, Netherlands, New Zealand, Oman, Puerto Rico, Qatar, Romania, Sweden, Trinidad & Tobago, St Vincent & The Grenadines: The number of women by age is estimated by the United Nations Population Division and published in World Population Prospects: the 2015 Revision. Data sources: For Channel Islands, Aruba, Afghanistan, Angola, United Arab Emirates, Argentina, Armenia, Australia, Burundi, Benin, Burkina Faso, Bangladesh, Bahrain, Bahamas, Bosnia & Herzegovina, Belize, Bolivia, Brazil, Barbados, Brunei, Bhutan, Botswana, Central African Republic, Canada, Chile, China, Côte d Ivoire, Cameroon, DR Congo, Congo, Colombia, Comoros, Cape Verde, Costa Rica, Cuba, Curaçao, Djibouti, Dominican Republic, Algeria, Ecuador, Egypt, Eritrea, Western Sahara, Ethiopia, Fiji, FS Micronesia, Gabon, Ghana, Guinea, Guadeloupe, Gambia, Guinea-Bissau, Equatorial Guinea, Grenada, Guatemala, French Guiana, Guam, Guyana, Hong Kong SAR, Honduras, Haiti, Indonesia, India, Iran, Iraq, Israel, Jamaica, Jordan, Japan, Kazakhstan, Kenya, Kyrgyzstan, Cambodia, Kiribati, Republic of Korea, Kuwait, Laos, Lebanon, Liberia, Libya, St Lucia, Sri Lanka, Lesotho, Macao SAR, Morocco, Republic of Moldova, Madagascar, Maldives, Mexico, Mali, Myanmar, Mongolia, Mozambique, Mauritania, Martinique, Mauritius, Malawi, Malaysia, Mayotte, Namibia, New Caledonia, Niger, Nigeria, Nicaragua, Nepal, New Zealand, Oman, Pakistan, Panama, Peru, Philippines, Papua New Guinea, Puerto Rico, DPR Korea, Paraguay, Palestine, French Polynesia, Qatar, Reunion, Rwanda, Saudi Arabia, Sudan, Senegal, Singapore, Solomon Islands, Sierra Leone, El Salvador, Somalia, South Sudan, Sao Tome & Principe, Suriname, Swaziland, Syria, Chad, Togo, Thailand, Tajikistan, Turkmenistan, Timor-Leste, Tonga, Trinidad & Tobago, Tunisia, Taiwan, Tanzania, Uganda, Uruguay, USA, Uzbekistan, St Vincent & The Grenadines, Venezuela, US Virgin Islands, Viet Nam, Vanuatu, Samoa, Yemen, South Africa, Zambia, Zimbabwe: United Nations, Department of Economic and Social Affairs, Population Division (2015). World Fertility Data 2015 (POP/DB/Fert/Rev2015). Available at: [Accessed on March 22, 2017]. Albania, Austria, Azerbaijan, Belgium, Bulgaria, Belarus, Switzerland, Cyprus, Czech Republic, Germany, Denmark, Spain, Estonia, Finland, France, United Kingdom, Georgia, Greece, Croatia, Hungary, Ireland, Iceland, Italy, Liechtenstein, Lithuania, Luxembourg, Latvia, Macedonia, Malta, Montenegro, Netherlands, Norway, Poland, Portugal, Romania, Russian Federation, Serbia, Slovakia, Slovenia, Sweden, Turkey, Ukraine: Eurostat - Statistical office of the European Comission [web site]. Luxembourg: European Commission; Available at: [Accessed on March 22, 2017].

273 5 FACTORS CONTRIBUTING TO CERVICAL CANCER Figure 144: World prevalence of hormonal contraceptive use Data accessed on 22 Mar Proportion (%) of women using hormonal contraception (pill, injectable or implant), among those of reproductive age who are married or in union. For Anguilla, Argentina, Botswana, Cook Islands, Guadeloupe, Croatia, N Mariana Islands, Martinique, Palau, Reunion: Data pertain to all women of reproductive age, irrespective of marital status. For United Arab Emirates, Bahrain, Saudi Arabia: Data pertain to nationals of the country. For Belgium, Puerto Rico: Data pertain to sexually active women of reproductive age. For Bulgaria, Germany, Estonia, Lithuania, Romania: Data pertain to women with co-resident male partner. For Canada: Data pertain to women who have ever had sex. Data pertain to all women of reproductive age, irrespective of marital status. Data pertain to sexually active, non-pregnant women. For Chile: Data pertain to men and women of reproductive age. For Czech Republic, Russian Federation: Data pertain to women with a partner. For Denmark: Data pertain to women in a steady sexual relationship. For United Kingdom: Excluding Northern Ireland. For Greece, Poland: Data pertain to women who were sexually active during the month prior to the interview. For Guam: Data pertain to sexually active, non-pregnant women. For Israel: Data pertain to the Jewish population. For Kuwait: Data pertain to nationals of the country. Data pertain to non-pregnant women. For Sri Lanka: Excluding the Northern Province. For Malta: Data pertain to married women who visited a practitioner belonging to the Malta College of Family Doctors. For Myanmar: Data pertain to ever-married women of reproductive age. For Norway: Data pertain to women who were sexually active during the three months prior to the interview. For Portugal: Data pertain to non-pregnant women. For Slovakia, US Virgin Islands: Data pertain to women exposed to the risk of pregnancy. For Sweden: Data pertain to women who have ever had sex. For Chad: Includes sexually active unmarried women For Uruguay: Data pertain to men and women of reproductive age who are married or in a union. Data sources: United Nations, Department of Economic and Social Affairs, Population Division (2016). World Contraceptive Use 2016 (POP/DB/CP/Rev2016). development/desa/population/publications/dataset/contraception/wcu2016.shtml. Available at: [Accessed on March 22, 2017].

274 5 FACTORS CONTRIBUTING TO CERVICAL CANCER Figure 145: World HIV prevalence Data accessed on 22 Mar Estimates include all people with HIV infection, regardless of whether they have developed symptoms of AIDS. For Armenia, Barbados, Chile, Lebanon, Mauritius, Tunisia: Child estimates not published due to small numbers For Benin: PMTCT numerator for 2015 was unavailable at the time of development of projection For Colombia, Greece, Italy: Antiretroviral therapy data was not available at the time of publication For Kyrgyzstan: Approximately 400 children (01-14) For Cambodia: Child estimates not published Data sources: UNAIDS database [internet]. Available at: [Accessed on March 22, 2017]