HPV Statistici PDF

Human Papillomavirus
and
Related Diseases Report
EUROPE
Version posted at www.hpvcentre.net on 17 June 2019
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©ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre), 2019.
All rights reserved. HPV Information Centre publications can be obtained from the HPV Informa-
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The development of this report has been supported by grants from the European Comission (7th Frame-
work Programme grant HEALTH-F3-2010-242061, HEALTH-F2-2011-282562, HPV AHEAD).
Recommended citation:
Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC
Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related
Diseases in Europe. Summary Report 17 June 2019. [Date Accessed]
ICO/IARC HPV Information Centre

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Abbreviations
Table 1: Abbreviations
Abbreviation Full term
HPV Human papillomavirus
PREHDICT Project Health economic modelling of prevention strategies for HPV-related diseases in
European countries
HPV Information Centre ICO Information Centre on HPV and Cervical Cancer
GW Genital warts
RRP Recurrent respiratory papillomatosis
SIL Squamous intraepithelial lesions
LSIL Low-grade cervical lesions
HSIL High-grade cervical lesions
ICC Invasive cervical cancer
CIS Carcinoma in situ
CIN Cervical intraepithelial neoplasia
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

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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 cer-
vical 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 Europe 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 cer-
vical cancer prevention strategies in the region.
Europe has an estimated population of 325.3 million women aged 15 years and older who are at risk
of developing cervical cancer. Current estimates indicate that every year 61,072 women are diagnosed
with cervical cancer and 25,829 die from the disease. Cervical cancer ranks* as the ninth most frequent
cancer among women in Europe.
* Ranking of cervical cancer incidence to other cancers among all women according to highest incidence rates (ranking 1st) excluding non-melanoma skin cancer and considering separated
colon, rectum and anus. 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 on Europe and its regions
Northern Europe
Southern Europe
Western Europe
Eastern Europe
Europe
Population
Women at risk for cervical cancer (Female population aged >=15 yrs) in mil- 325.3 131.2 43.5 67.4 83.2
lions
Burden of cervical cancer
Annual number of new cervical cancer cases 61,072 35,940 6,319 9,155 9,658
Standardised incidence rates per 100,000 population 11.2 16.0 9.5 7.8 6.8
Annual number of cervical cancer deaths 25,829 16,011 2,060 3,512 4,246
Standardised mortality rates per 100,000 population 3.8 6.1 2.1 2.2 2.1
Burden of cervical HPV infection
Prevalence (%) of HPV 16 and/or HPV 18 among women with:
Normal cytology 3.8 9.7 4.2 3.8 2.6
Low-grade cervical lesions (LSIL/CIN-1) 27.1 31.8 30.6 25.4 25.2
High-grade cervical lesions (HSIL/ CIN-2 / CIN-3 / CIS) 54.5 60.5 54.9 53.2 59.4
Cervical cancer 74.0 84.7 77.0 68.0 78.7
LSIL, low-grade intraepithelial lesions; HSIL, high-grade intraepithelial lesions; CIN, cervical intraepithelial neoplasia; CIS, carcinoma in-situ.
Please see the specific sections for more information.

LIST OF CONTENTS -v-
Contents
Abbreviations iii
Executive summary iv
1 Introduction 1
2 Demographic and socioeconomic factors 3
3 Burden of HPV-related cancers 6

3.1 Cervical cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.1.1 Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.1.2 Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.2 Anogenital cancers other than the cervix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.2.1 Anal cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.2.2 Vulvar cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
3.2.3 Vaginal cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
3.2.4 Penile cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
3.3 Head and neck cancers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
3.3.1 Oropharyngeal cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
4 HPV-related statistics 74
4.1 HPV burden in women with normal cervical cytology, cervical precancerous lesions or
invasive cervical cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
4.1.1 HPV prevalence in women with normal cervical cytology . . . . . . . . . . . . . . . . 75
4.1.2 HPV type distribution among women with normal cervical cytology, precancerous
cervical lesions and cervical cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
4.1.3 HPV type distribution among HIV+ women with normal cervical cytology . . . . . . 102
4.1.4 Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
4.2 HPV burden in anogenital cancers other than the cervix . . . . . . . . . . . . . . . . . . . . . 104
4.2.1 Anal cancer and precancerous anal lesions . . . . . . . . . . . . . . . . . . . . . . . . . 104
4.2.2 Vulvar cancer and precancerous vulvar lesions . . . . . . . . . . . . . . . . . . . . . . . 108
4.2.3 Vaginal cancer and precancerous vaginal lesions . . . . . . . . . . . . . . . . . . . . . 113
4.2.4 Penile cancer and precancerous penile lesions . . . . . . . . . . . . . . . . . . . . . . . 116
4.3 HPV burden in men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
4.4 HPV burden in the head and neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
4.4.1 Burden of oral HPV infection in healthy population . . . . . . . . . . . . . . . . . . . . 126
4.4.2 HPV burden in head and neck cancers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
5 Factors contributing to cervical cancer 142
6 Sexual behaviour and reproductive health indicators 146
7 HPV preventive strategies 157

7.1 Cervical cancer screening practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
7.2 HPV vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
7.2.1 HPV vaccine licensure and introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
8 Protective factors for cervical cancer 162
9 References 164
10 Glossary 187

LIST OF FIGURES - vi -
List of Figures
1 European regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Population pyramid of Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3 Population trends in four selected age groups in Europe for 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
4 Age-standardised incidence rates (ASR) of cervical cancer in regions of Europe (estimates for 2018) . . . . . . . . 6
5 Age-standardised incidence rates of cervical cancer in Europe (estimates for 2018) . . . . . . . . . . . . . . . . . . 7
6 Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in Europe (estimates
for 2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
7 Ranking of cervical cancer versus other cancers among all women and women aged 15-44 years, according to
incidence rates in Europe (estimates for 2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
8 Comparison of the ten most frequent cancers in all women in Europe and its regions (estimates for 2018) . . . . 11
9 Annual number of new cases of cervical cancer by age group in European regions (estimates for 2018) . . . . . . 12
10 Time trends in cervical cancer incidence type in Austria (cancer registry data) . . . . . . . . . . . . . . . . . . . . . 13
11 Time trends in cervical cancer incidence type in Switzerland (cancer registry data) . . . . . . . . . . . . . . . . . . 13
12 Time trends in cervical cancer incidence type in Spain (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . 14
13 Time trends in cervical cancer incidence type in France (cancer registry data) . . . . . . . . . . . . . . . . . . . . . 14
14 Time trends in cervical cancer incidence type in the United Kingdom (cancer registry data) . . . . . . . . . . . . . 15
15 Time trends in cervical cancer incidence type in Italy (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . 15
16 Time trends in cervical cancer incidence type in Poland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . 16
17 Time trends in cervical cancer incidence type in the Russian Federation (cancer registry data) . . . . . . . . . . . 16
18 Age-standardised mortality rates (ASR) of cervical cancer in European regions (estimates for 2018) . . . . . . . . 17
19 Age-standardised mortality rates of cervical cancer in Europe (estimates for 2018) . . . . . . . . . . . . . . . . . . 18
20 Ranking of cervical cancer versus other cancers among all women and women aged 15-44 years, according to
mortality rates in Europe (estimates for 2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Comparison of the ten most frequent cancer deaths in all women in Europe and its regions (estimates for 2018) 21
22 Annual number of deaths of cervical cancer by age group in European regions (estimates for 2018) . . . . . . . . 22
23 Age-standardised incidence rates of anogenital cancers other than the cervix in Europe (estimates for 2012) . . 23
24 Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by country in Europe
(estimates for 2012) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
25 Time trends in anal cancer incidence in Austria (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . . 30
26 Time trends in anal cancer incidence in Croatia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . . 31
27 Time trends in anal cancer incidence in Denmark (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 32
28 Time trends in anal cancer incidence in Estonia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 33
29 Time trends in anal cancer incidence in France (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . . 34
30 Time trends in anal cancer incidence in Iceland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . . 35
31 Time trends in anal cancer incidence in Italy (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
32 Time trends in anal cancer incidence in the Netherlands (cancer registry data) . . . . . . . . . . . . . . . . . . . . 37
33 Time trends in anal cancer incidence in Poland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . . 38
34 Time trends in anal cancer incidence in the Russian Federation (cancer registry data) . . . . . . . . . . . . . . . . 39
35 Time trends in anal cancer incidence in Slovakia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 40
36 Time trends in anal cancer incidence in Spain (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
37 Time trends in anal cancer incidence in Switzerland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . 42
38 Time trends in anal cancer incidence in the United Kingdom (cancer registry data) . . . . . . . . . . . . . . . . . . 43
39 Time trends in vulvar cancer incidence in Austria (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 47
40 Time trends in vulvar cancer incidence in Croatia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 47
41 Time trends in vulvar cancer incidence in Denmark (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . 47
42 Time trends in vulvar cancer incidence in Estonia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 48
43 Time trends in vulvar cancer incidence in France (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 48
44 Time trends in vulvar cancer incidence in Iceland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 48
45 Time trends in vulvar cancer incidence in Italy (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . . 49
46 Time trends in vulvar cancer incidence in Netherlands (cancer registry data) . . . . . . . . . . . . . . . . . . . . . 49
47 Time trends in vulvar cancer incidence in Poland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 49
48 Time trends in vulvar cancer incidence in Russian Federation (cancer registry data) . . . . . . . . . . . . . . . . . 50
49 Time trends in vulvar cancer incidence in Slovakia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 50
50 Time trends in vulvar cancer incidence in Spain (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 50
51 Time trends in vulvar cancer incidence in Switzerland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . 51
52 Time trends in vulvar cancer incidence in United Kingdom (cancer registry data) . . . . . . . . . . . . . . . . . . . 51
53 Time trends in vaginal cancer incidence in Austria (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 55
54 Time trends in vaginal cancer incidence in Croatia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 55
55 Time trends in vaginal cancer incidence in Denmark (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . 55
56 Time trends in vaginal cancer incidence in Estonia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 56
57 Time trends in vaginal cancer incidence in France (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 56
58 Time trends in vaginal cancer incidence in Iceland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 56
59 Time trends in vaginal cancer incidence in Italy (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 57

LIST OF FIGURES - vii -
60 Time trends in vaginal cancer incidence in Netherlands (cancer registry data) . . . . . . . . . . . . . . . . . . . . . 57

61 Time trends in vaginal cancer incidence in Poland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 57
62 Time trends in vaginal cancer incidence in Russian Federation (cancer registry data) . . . . . . . . . . . . . . . . 58
63 Time trends in vaginal cancer incidence in Slovakia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . 58
64 Time trends in vaginal cancer incidence in Spain (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 58
65 Time trends in vaginal cancer incidence in Switzerland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . 59
66 Time trends in vaginal cancer incidence in United Kingdom (cancer registry data) . . . . . . . . . . . . . . . . . . 59
67 Time trends in penile cancer incidence in Austria (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 63
68 Time trends in penile cancer incidence in Croatia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 63
69 Time trends in penile cancer incidence in Denmark (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . 64
70 Time trends in penile cancer incidence in Estonia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 64
71 Time trends in penile cancer incidence in France (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 64
72 Time trends in penile cancer incidence in Iceland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 65
73 Time trends in penile cancer incidence in Italy (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . . 65
74 Time trends in penile cancer incidence in Netherlands (cancer registry data) . . . . . . . . . . . . . . . . . . . . . 65
75 Time trends in penile cancer incidence in Poland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . 66
76 Time trends in penile cancer incidence in Russian Federation (cancer registry data) . . . . . . . . . . . . . . . . . 66
77 Time trends in penile cancer incidence in Slovakia (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . 66
78 Time trends in penile cancer incidence in Spain (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . . . . . 67
79 Time trends in penile cancer incidence in Switzerland (cancer registry data) . . . . . . . . . . . . . . . . . . . . . . 67
80 Time trends in penile cancer incidence in United Kingdom (cancer registry data) . . . . . . . . . . . . . . . . . . . 67
81 Age-standardised incidence rates of head and neck cancer in Europe (estimates for 2012) . . . . . . . . . . . . . . 69
82 Age-standardised incidence rate of head and neck cancer cases attributable to HPV by country in Europe (esti-
mates for 2012) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
83 Prevalence of HPV among women with normal cervical cytology in Europe . . . . . . . . . . . . . . . . . . . . . . . 75
84 Crude age-specific HPV prevalence (%) and 95% confidence interval in women with normal cervical cytology in
Europe and its regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
85 Prevalence of HPV among women with normal cervical cytology in Europe by country and study . . . . . . . . . 77
86 Prevalence of HPV among women with normal cervical cytology in Europe by country and study (continued) . . 79
89 Prevalence of HPV 16 among women with normal cervical cytology in Europe by country and study . . . . . . . . 85
90 Prevalence of HPV 16 among women with normal cervical cytology in Europe by country and study (continued) 86
91 Prevalence of HPV 16 among women with low-grade cervical lesions in Europe by country and study . . . . . . . 87
92 Prevalence of HPV 16 among women with low-grade cervical lesions in Europe by country and study (continued) 88
93 Prevalence of HPV 16 among women with low-grade cervical lesions in Europe by country and study (continued) 89
94 Prevalence of HPV 16 among women with high-grade cervical lesions in Europe by country and study . . . . . . 90
95 Prevalence of HPV 16 among women with high-grade cervical lesions in Europe by country and study (continued) 91
96 Prevalence of HPV 16 among women with high-grade cervical lesions in Europe by country and study (continued) 92
97 Prevalence of HPV 16 among women with invasive cervical cancer in Europe by country and study . . . . . . . . 93
98 Prevalence of HPV 16 among women with invasive cervical cancer in Europe by country and study (continued) . 94
99 Prevalence of HPV 16 among women with invasive cervical cancer in Europe by country and study (continued) . 95
100 Comparison of the ten most frequent HPV oncogenic types among women with and without cervical lesions in
Europe and its regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
101 Comparison of the ten most frequent HPV oncogenic types among women with and without cervical lesions in
Europe and its regions (continued) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
102 Comparison of the ten most frequent HPV oncogenic types among women with invasive cervical cancer by his-
tology in Europe and its regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
103 Comparison of the ten most frequent HPV oncogenic types among women with invasive cervical cancer by his-
tology in Europe and its regions (continued) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
104 Comparison of the ten most frequent HPV types in anal cancer cases in Europe and the World . . . . . . . . . . . 107
105 Comparison of the ten most frequent HPV types in AIN 2/3 cases in Europe and the World . . . . . . . . . . . . . 107
106 Comparison of the ten most frequent HPV types in cases of vulvar cancer in Europe and the World . . . . . . . . 111
107 Comparison of the ten most frequent HPV types in VIN 2/3 cases in Europe and the World . . . . . . . . . . . . . 112
108 Comparison of the ten most frequent HPV types in vaginal cancer cases in Europe and the World . . . . . . . . . 114
109 Comparison of the ten most frequent HPV types in VaIN 2/3 cases in Europe and the World . . . . . . . . . . . . 115
110 Comparison of the ten most frequent HPV types in penile cancer cases in Europe and the World . . . . . . . . . . 118
111 Comparison of the ten most frequent HPV types in PeIN 2/3 cases in Europe and the World . . . . . . . . . . . . 118
112 Prevalence of female tobacco smoking in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
113 Total fertility rates in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
114 Prevalence of hormonal contraceptive use in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
115 Prevalence of HIV in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
116 Percentage of 15-year-old girls who report sexual intercourse in Europe . . . . . . . . . . . . . . . . . . . . . . . . . 146
117 Percentage of 15-year-old boys who report sexual intercourse in Europe . . . . . . . . . . . . . . . . . . . . . . . . . 147
118 Status of HPV vaccination programmes in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

LIST OF FIGURES - viii -
119 Prevalence of male circumcision in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162

120 Prevalence of condom use in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

LIST OF TABLES - ix -
List of Tables
1 Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
2 Key statistics on Europe and its regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
3 Population (in millions) estimates in Europe for 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Sociodemographic indicators in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
5 Incidence of cervical cancer in Europe (estimates for 2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
6 Cervical cancer mortality in Europe (estimates for 2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
7 Incidence of anal cancer in Europe by cancer registry and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
8 Incidence of vulvar cancer in Europe by cancer registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
9 Incidence of vaginal cancer in Europe by cancer registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
10 Incidence of penile cancer in Europe by cancer registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
11 Cancer incidence of the oropharynx in Europe and its regions by sex. Includes ICD-10 codes: C09-10 (estimates
for 2018). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
12 Cancer mortality of the oropharynx in Europe and its regions by sex. Includes ICD-10 codes: C09-10 (estimates
for 2018). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
13 Prevalence of HPV 16/18 in women with normal cytology, precancerous cervical lesions and invasive cervical
cancer in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
14 Type-specific HPV prevalence in women with normal cervical cytology, precancerous cervical lesions and invasive
cervical cancer in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
15 Type-specific HPV prevalence among invasive cervical cancer cases in Europe by histology . . . . . . . . . . . . . 101
16 European studies on HPV prevalence among HIV women with normal cytology . . . . . . . . . . . . . . . . . . . . 102
17 European studies on HPV prevalence among anal cancer cases (male and female) . . . . . . . . . . . . . . . . . . 104
18 European studies on HPV prevalence among AIN 2/3 cases (male and female) . . . . . . . . . . . . . . . . . . . . . 105
19 European studies on HPV prevalence among vulvar cancer cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
20 European studies on HPV prevalence among VIN 2/3 cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
21 European studies on HPV prevalence among vaginal cancer cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
22 European studies on HPV prevalence among VaIN 2/3 cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
23 European studies on HPV prevalence among penile cancer cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
24 European studies on HPV prevalence among PeIN 2/3 cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
25 European studies on anogenital HPV prevalence among men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
26 European studies on anogenital HPV prevalence among men from special subgroups . . . . . . . . . . . . . . . . . 120
27 European studies on oral HPV prevalence among healthy population . . . . . . . . . . . . . . . . . . . . . . . . . . 126
28 European studies on HPV prevalence among cases of oral cavity cancer . . . . . . . . . . . . . . . . . . . . . . . . . 128
29 European studies on HPV prevalence in cases of oropharyngeal cancer . . . . . . . . . . . . . . . . . . . . . . . . . 132
30 European studies on HPV prevalence in cases of hypopharyngeal or laryngeal cancer . . . . . . . . . . . . . . . . 137
31 Median age at first sex in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
32 Average number of sexual partners in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
33 Lifetime prevalence of anal intercourse among women in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
34 Cervical cancer screening policies in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
35 HPV vaccination policies for the female population in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
36 References of studies included . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
37 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

1 INTRODUCTION -1-
1 Introduction
Figure 1: European regions
The HPV Information Centre aims to compile and centralise updated data and statistics on human pa-
pillomavirus (HPV) and HPV-related cancers. This report aims to summarise the data available to fully
evaluate the burden of disease in Europe and to facilitate stakeholders and relevant bodies of decision
makers to formulate recommendations on the prevention of cervical cancer and other HPV-related can-
cers. 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 immunisation practises. The report is structured into the following sections:
Section 2, Demographic and socioeconomic factors. This section summarises the sociodemo-
graphic profile of Europe. For analytical purposes, Europe is divided into four regions: Eastern Europe,
Northern Europe, Southern Europe, Western Europe (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 Europe with estimates of prevalence, incidence and
mortality rates.
Section 4, HPV-related statistics. This section summarises reports on prevalence of HPV and HPV
type-specific distribution in women with normal cytology, women with precancerous lesions and inva-
sive cervical cancer. In addition, the burden of HPV in other anogenital cancers (anus, vulva, vagina,
and penis) is 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 the use of smoking, parity, oral contra-
ceptive use and co-infection with HIV.
Section 6, Sexual behaviour and reproductive health indicators. This section presents sexual

1 INTRODUCTION -2-
and reproductive behaviour 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 ba-
sic characteristics and performance of cervical cancer screening status, status of HPV vaccine licensure
introduction, and recommendations in national immunisation programmes.
Section 8, Protective factors for cervical cancer. This section presents the prevalence of male
circumcision and condom use.

2 DEMOGRAPHIC AND SOCIOECONOMIC FACTORS -3-
2 Demographic and socioeconomic factors
Table 3: Population (in millions) estimates in Europe for 2017

Region / Country Male Female
10-14 years 15+ years Total 10-14 years 15+ years Total
Europe1,± 19.42 296.45 356.72 18.48 325.29 382.49
Eastern Europe1,± 7.44 112.86 137.40 7.07 131.24 154.51
Belarus1,± 0.24 3.58 4.39 0.22 4.29 5.06
Bulgaria1,± 0.17 2.90 3.42 0.16 3.13 3.62
Czech Rep.1,± 0.27 4.36 5.19 0.25 4.58 5.37
Hungary1,± 0.25 3.93 4.66 0.24 4.43 5.12
Moldova1,a,± 0.10 1.62 1.95 0.10 1.80 2.11
Poland1,± 0.94 15.67 18.64 0.90 17.10 19.92
Romania1,± 0.54 7.80 9.31 0.51 8.50 9.93
Russia1,± 3.76 53.75 66.62 3.59 64.52 76.75
Slovakia1,± 0.14 2.21 2.63 0.13 2.39 2.80
Ukraine1,b,± 1.04 17.04 20.58 0.98 20.49 23.83
Northern Europe1,c,± 2.97 41.62 51.04 2.84 43.48 52.44
Denmark1,± 0.17 2.35 2.84 0.16 2.42 2.88
Estonia1,± 0.04 0.50 0.61 0.03 0.59 0.69
Finland1,d,± 0.15 2.27 2.73 0.14 2.37 2.81
Iceland1,± 0.01 0.13 0.17 0.01 0.13 0.17
Ireland1,± 0.17 1.84 2.37 0.16 1.88 2.38
Latvia1,± 0.05 0.74 0.89 0.05 0.91 1.05
Lithuania1,± 0.07 1.09 1.30 0.06 1.32 1.53
Norway1,e,± 0.16 2.20 2.69 0.15 2.18 2.64
Sweden1,± 0.28 4.06 4.96 0.27 4.11 4.96
UK1,± 1.87 26.31 32.32 1.78 27.45 33.19
Southern Europe1, f ,± 3.90 62.96 74.13 3.69 67.36 77.92
Albania1 0.09 1.17 1.44 0.08 1.21 1.47
Andorra2,± 0.00 0.04 0.04 0.00 0.04 0.04
Bosnia & H.1,± 0.08 1.63 1.89 0.08 1.66 1.91
Croatia1,± 0.11 1.71 2.03 0.10 1.88 2.18
Cyprus1,g,h,± 0.03 0.51 0.61 0.03 0.49 0.58
Greece1,± 0.27 4.50 5.31 0.26 4.82 5.58
Italy1,± 1.46 24.93 29.09 1.38 26.78 30.71
Macedonia1,i,± 0.06 0.86 1.04 0.06 0.88 1.05
Malta1,± 0.01 0.18 0.21 0.01 0.18 0.21
Montenegro1,± 0.02 0.25 0.31 0.02 0.26 0.32
Portugal1,± 0.26 4.14 4.85 0.25 4.73 5.41
San Marino2,± 0.00 0.01 0.02 0.00 0.01 0.02
Serbia1, j,± 0.26 3.56 4.28 0.24 3.81 4.49
Slovenia1,± 0.05 0.87 1.03 0.05 0.89 1.04
Spain1,k,± 1.22 19.11 22.59 1.15 20.21 23.48
Western Europe1,l,± 5.11 79.01 94.15 4.87 83.21 97.61
Austria1,± 0.21 3.60 4.23 0.20 3.77 4.37
Belgium1,± 0.32 4.65 5.65 0.31 4.84 5.79
France1,± 2.05 25.54 31.62 1.97 27.50 33.32
Germany1,± 1.81 34.36 39.66 1.71 35.94 40.97
Liechtenstein2,± 0.00 0.02 0.02 0.00 0.02 0.02
Luxembourg1,± 0.02 0.24 0.29 0.02 0.24 0.29
Monaco2,± 0.00 0.01 0.01 0.00 0.01 0.02
Netherlands1,± 0.50 7.04 8.46 0.47 7.23 8.57
Switzerland1,± 0.21 3.55 4.19 0.20 3.65 4.26
Data accessed on 27 Mar 2017.

Please refer to original source for methods of estimation.
a Including Transnistria.
b Including Crimea
c Including Faeroe Islands, and Isle of Man.
d Including Åland Islands.
e Including Svalbard and Jan Mayen Islands.
f Including Andorra, Gibraltar, Holy See, and San Marino.
g Including Northern-Cyprus.
h Refers to the whole country
i The former Yugoslav Republic of Macedonia.
j Including Kosovo.
k Including Canary Islands, Ceuta and Melilla.
l Including Liechtenstein, and Monaco.
Year of estimate: ± 2017;
Data sources:
1 United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, DVD Edition. Available at: https://esa.un.
org/unpd/wpp/Download/Standard/Population/. [Accessed on March 21, 2017].
(Continued on next page)

( Table 3 – continued from previous page)

2 International Programs Center for Demographic and Economic Studies, Population Division, U.S. Census Bureau. International Database. Available at http://www.census.gov/
population/international/data/idb/informationGateway.php. [Accessed on March 21, 2017].
Figure 2: Population pyramid of Europe

Males Females
80+ 12,889,798 24,231,287

75−79 10,602,505 15,671,803
70−74 13,496,265 17,220,632
65−69 18,440,730 22,208,104
60−64 22,077,975 25,657,011
55−59 24,909,128 27,205,652
50−54 26,042,405 27,300,161
45−49 25,487,419 26,081,991
40−44 25,656,041 25,985,629
35−39 25,864,557 25,816,018
30−34 26,410,886 25,900,782
25−29 24,774,054 24,018,695
20−24 20,920,742 20,028,642
15−19 18,874,728 17,966,348
10−14 19,424,445 18,479,130
5−9 20,575,143 19,537,521
Under 5 20,272,989 19,178,526
Population (in thousands) in Europe by sex and age group

Year of estimate: 2017;
Data sources:
United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, DVD Edition. Available at: https://esa.un.org/
unpd/wpp/Download/Standard/Population/. [Accessed on March 21, 2017].
Figure 3: Population trends in four selected age groups in Europe for 2017
Projections Projections
Number of women (in millions)
Number of women (in millions)
400 All Women
50 350
Women 15−24 yrs
40 300
250
30 Women 25−64 yrs
200
20
Girls 10−14 yrs
150
1950
1960
1970
1980
1990
2000
2010
2020
2030
2040
2050
2060
2070
2080
2090
2100
1950
1960
1970
1980
1990
2000
2010
2020
2030
2040
2050
2060
2070
2080
2090
2100
Female population trends in Europe

Number of women by year and age group

Year of estimate: 2017;
Data sources:
United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, DVD Edition. Available at: https://esa.un.org/
unpd/wpp/Download/Standard/Population/. [Accessed on March 21, 2017].

Table 4: Sociodemographic indicators in Europe

Indicator Male Female Total
1,±
Population in thousands 356,719.8 382,487.9 739,207.7
1,∓
Population growth rate (%) - - 0.1
1,∗
Median age of the population (in years) - - 41.7
2,∗
Population living in urban areas (%) - - 73.6
Crude birth rate (births per 1,000)1,∓ - - 10.8
1,∓
Crude death rate (deaths per 1,000) - - 11.1
3,a,b
Life expectancy at birth (in years) - - -
Adult mortality rate (probability of dying between 15 and 60 years old - - -
per 1,000)4
Under age five mortality rate (per 1,000 live births)3,c - - -
5,d
Density of physicians (per 1,000 population) - - -
6,e
Gross national income per capita (PPP current international $) - - -
7,?
Adult literacy rate (%) (aged 15 and older) 99.4 99.1 99.2
Youth literacy rate (%) (aged 15-24 years)7,? 99.7 99.7 99.7
7,?
Net primary school enrollment ratio 96.9 97.1 97
7, f ,?
Net secondary school enrollment ratio 91.2 91.9 91.5
a World Population Prospects, the 2015 revision (WPP2015). New York (NY): United Nations DESA, Population Division.
b WHO annual life tables for 1985–2015 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 90 000 in 2015 were not included in the analysis.
c Levels & Trends in Child Mortality. Report 2015. 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 (http://www.unicef.org/publications/files/Child_Mortality_Report_2015_
Web_9_Sept_15.pdf, accessed 26 March 2016).
d Number of medical doctors (physicians), including generalist and specialist medical practitioners, per 1 000 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; ∓ 2010-2015; ∗ 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: https://esa.un.
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 2016. Geneva, World Health Organization, 2016. Available at: http://who.int/entity/gho/publications/world_health_statistics/2016/en/index.
html. [Accessed on March 21, 2017].
4 World Health Organization. Global Health Observatory data repository. Available at: http://apps.who.int/gho/data/view.main.1360?lang=en. [Accessed on March 21, 2017].
5 The 2016 update, Global Health Workforce Statistics, World Health Organization, Geneva (http://www.who.int/hrh/statistics/hwfstats/). [Accessed on March 21, 2017].
6 World Bank, World Development Indicators Database. Washington, DC. International Comparison Program database. Available at: http://databank.worldbank.org/data/reports.
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: http://stats.uis.unesco.org [Accessed on March 21, 2017].

3 BURDEN OF HPV-RELATED CANCERS -6-
3 Burden of HPV-related cancers

3.1 Cervical cancer
Cancer of the cervix uteri is the 3rd most common cancer among women worldwide, with an estimated
569,847 new cases and 311,365 deaths in 2018 (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 Europe and its regions with
estimates of the annual number of new cases, deaths, incidence and mortality.
3.1.1 Incidence
KEY STATS.
About 61,072 new cervical cancer cases are diagnosed annually in

Europe (estimates for 2018).
Cervical cancer ranks* as the 9 th leading cause of female cancer in Eu-

rope.
Cervical cancer is the 2nd most common female cancer in women aged
15 to 44 years in Europe.
Figure 4: Age-standardised incidence rates (ASR) of cervical cancer in regions of Europe (estimates for
2018)
Eastern Europe 16.0
Northern Europe 9.5
Southern Europe 7.8
Western Europe 6.8

0 10 20
Cervical cancer: Age−standardised incidence rate per 100,000 women
World Standard. Female (All ages)
Data accessed on 05 Oct 2018.


( Figure 4 – continued from previous page)

Rates per 100,000 women per year.
Data sources:
Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for
Research on Cancer. Available from: https://gco.iarc.fr/today, accessed [05 October 2018].
Figure 5: Age-standardised incidence rates of cervical cancer in Europe (estimates for 2018)

For more detailed methods of estimation please refer to http://gco.iarc.fr/today/data-sources-methods
Data sources: Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018). Global Cancer Observatory: Cancer Today. Lyon, France: International
Agency for Research on Cancer. Available from: https://gco.iarc.fr/today, accessed [05 October 2018].

Figure 6: Age-standardised incidence rate of cervical cancer cases attributable to HPV by country in
Europe (estimates for 2018)
Latvia 25.0
Bosnia & H. 23.9
Estonia 22.5
Moldova 21.4
Serbia 20.3
Bulgaria 20.3
Romania 19.5
Lithuania 18.9
Hungary 17.2
Ukraine 17.0
Russia 17.0
Slovakia 16.6
Belarus 13.3
Montenegro 12.5
Ireland 11.0
Denmark 10.9
Norway 10.7
Macedonia 10.0
Czech Rep. 9.9
Poland 9.4
Sweden 9.0
Portugal 8.9
UK 8.4
Greece 8.1
Croatia 7.9
Belgium 7.8
Iceland 7.6
Germany 7.5
Slovenia 7.1
Italy 7.1
France 6.7
Albania 6.5
Netherlands 5.7
Cyprus 5.7
Luxembourg 5.6
Austria 5.5
Spain 5.2
Finland 4.7
Switzerland 3.8
Malta 3.5
San Marino**
Monaco**
Liechtenstein**
Andorra**
0 10 20 30
Cervical cancer: Age−standardised incidence rate per 100,0000 women

** No rates are available.


Table 5: Incidence of cervical cancer in Europe (estimates for 2018)

Cumulative risk (%) Ranking of CC
Areaα N casesα Crude ratea,α ASRa,α ages 0-74 yearsb,α All women c,a Women 15-44 years c,a
Europe 61,072 15.9 11.2 1.1 9 2
Eastern Europe 35,940 23.3 16.0 1.6 5 2
Belarus 979 19.4 13.3 1.3 9 3
Bulgaria 1,080 29.9 20.3 2.0 4 2
Czech Republic 813 15.1 9.9 1.0 12 3
Hungary 1,312 25.8 17.2 1.7 6 2
Poland 3,220 16.3 9.4 1.0 7 4
Republic of 639 30.4 21.4 2.1 2 1
Moldova
Romania 3,308 32.8 19.5 2.1 2 2
Russian Federation 18,164 23.6 17.0 1.6 4 2
Slovakia 692 24.7 16.6 1.7 6 2
Ukraine 5,733 24.2 17.0 1.7 4 2
Northern Europe 6,319 11.9 9.5 0.8 13 3
Denmark 415 14.3 10.9 1.0 11 3
Estonia 230 33.1 22.5 2.2 5 2
Finland 182 6.5 4.7 0.4 18 4
Iceland 15 8.9 7.6 0.6 10 2
Ireland 340 14.0 11.0 1.0 9 4
Latvia 339 32.5 25.0 2.3 5 1
Lithuania 431 27.8 18.9 1.8 4 2
Norway 361 13.6 10.7 1.0 10 3
Sweden 558 11.2 9.0 0.8 11 3
United Kingdom 3,430 10.2 8.4 0.7 13 2
Southern Europe 9,155 11.7 7.8 0.8 13 3
Albania 134 9.2 6.5 0.7 5 4
Andorra - - - - - -
Bosnia & Herze- 556 31.2 23.9 2.2 2 1
govina
Croatia 266 12.3 7.9 0.8 13 3
Cyprus 45 7.6 5.7 0.5 11 3
Greece 696 12.3 8.1 0.8 12 4
Italy 3,105 10.2 7.1 0.7 16 4
Macedonia 151 14.5 10.0 1.0 6 3
Malta 11 5.1 3.5 0.3 15 6
Montenegro 54 16.9 12.5 1.2 3 2
Portugal 750 13.8 8.9 0.8 9 3
San Marino - - - - - -
Serbia 1,327 29.6 20.3 2.1 4 2
Slovenia 110 10.5 7.1 0.7 14 3
Spain 1,942 8.2 5.2 0.5 16 4
Western Europe 9,658 9.8 6.8 0.7 15 4
Austria 390 8.7 5.5 0.5 14 4
Belgium 640 11.0 7.8 0.8 14 4
France 3,067 9.3 6.7 0.6 13 4
Germany 4,608 11.0 7.5 0.7 15 4
Luxembourg 25 8.5 5.6 0.5 12 4
Monaco - - - - - -
Netherlands 670 7.8 5.7 0.5 13 3
Switzerland 258 6.0 3.8 0.4 18 5
ASR: Age-standardized rate, Standardized rates have been estimated using the direct method and the World population as the reference;
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 15-44 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.
c Non-melanoma skin cancer is not included.
α For more detailed methods of estimation please refer to http://gco.iarc.fr/today/data-sources-methods
Data sources:

3 BURDEN OF HPV-RELATED CANCERS - 10 -
Figure 7: Ranking of cervical cancer versus other cancers among all women and women aged 15-44
years, according to incidence rates in Europe (estimates for 2018)

Non-melanoma skin cancer is not included.

Figure 8: Comparison of the ten most frequent cancers in all women in Europe and its regions (esti-
mates for 2018)
Europe Southern Europe
Breast 74.4 Breast 80.3
Lung 18.3 Colon 15.9
Corpus uteri 15.8 Lung 15.7
Colon 15.3 Thyroid 14.5
Thyroid 11.4 Corpus uteri 14.2
Melanoma of skin 11.3 Melanoma of skin 8.8
Cervix uteri 11.2 Ovary 8.2
Ovary 9.5 Cervix uteri 7.8
Rectum 7.8 Non−Hodgkin lymphoma 7.4
Non−Hodgkin lymphoma 6.6 Rectum 7.4
0 15 30 45 60 75 90 0 15 30 45 60 75 90
Eastern Europe Western Europe
Corpus uteri 19.0 Lung 25.7
Cervix uteri 16.0 Melanoma of skin 19.7
Colon 13.8 Colon 15.4
Lung 11.9 Thyroid 12.9
Ovary 11.9 Corpus uteri 12.3
Thyroid 9.7 Non−Hodgkin lymphoma 7.9
Rectum 9.0 Pancreas 7.2
Stomach 7.5 Ovary 7.0
Kidney 7.2 Leukaemia 6.9
0 15 30 45 60 75 90 0 15 30 45 60 75 90
Northern Europe
Breast 90.1
Lung 26.9
Colon 18.2
Melanoma of skin 17.8
Corpus uteri 15.7
Non−Hodgkin lymphoma 9.7
Cervix uteri 9.5
Ovary 9.2
Thyroid 9.0
Rectum 7.6
0 15 30 45 60 75 90
Age−standardised incidence rate per 100,000

women in Europe

Data sources:


Figure 9: Annual number of new cases of cervical cancer by age group in European regions (estimates
for 2018)

Southern Europe Northern Europe
Annual number of new cases of cervical cancer
35,000 32,872*
31,500
28,000
24,500
21,000
17,500
13,697* 14,498*
14,000
10,500
7,000
3,500
0
15−39 40−64 65+
* Eastern Europe 15-39 years: 7,721 cases. 40-64 years: 19,993 cases. 65+ years: 8,224 cases.
* Southern Europe 15-39 years: 1,699 cases. 40-64 years: 5,100 cases. 65+ years: 2,355 cases.
* Western Europe 15-39 years: 1,999 cases. 40-64 years: 5,043 cases. 65+ years: 2,614 cases.
* Northern Europe 15-39 years: 2,278 cases. 40-64 years: 2,736 cases. 65+ years: 1,305 cases.

Data sources:

Figure 10: Time trends in cervical cancer incidence type in Austria (cancer registry data)
Recent trend :−4.6 (−5.9 to −3.4) (1, b)
Overall trend :−3.7 (−4.1 to −3.4) (1, a)
40
Annual crude incidence rate
30
(per 100,000)
All ages (2, c)

20
●
● ● 15−44 yrs (2, c)
● ●
● ● ● ● ●
● ● ● ● 45−74 yrs (2, c)
10 ●
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Data accessed on 27 Apr 2015.
a Estimated annual percentage change based on the trend variable from the net drift for the most recent two 5-year periods.
b Estimated annual percentage change based on the trend variable from the net drift for 20 years, from 1990-2009.
c The following regional cancer registries provided data and contributed to their national estimate: Tyrol, Vorarlberg.
Data sources:
1 Vaccarella S, Lortet-Tieulent J, Plummer M, Franceschi S, Bray F. Worldwide trends in cervical cancer incidence: Impact of screening against changes in disease risk factors. eur J Cancer
2013;49:3262-73.
2 Ferlay J, Bray F, Steliarova-Foucher E and Forman D. Cancer Incidence in Five Continents, CI5plus: IARC CancerBase No. 9 [Internet]. Lyon, France: International Agency for Research
on Cancer; 2014. Available from: http://ci5.iarc.fr
Figure 11: Time trends in cervical cancer incidence type in Switzerland (cancer registry data)
25
20
(per 100,000)
15 All ages (2, b)

● ● 15−44 yrs (2, b)
10 ● ● ●
●
● ● ● ● 45−74 yrs (2, b)
● ● ●
● ●
5
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

b The following regional cancer registries provided data and contributed to their national estimate: Geneva, Graubunden and Glarus, Neuchatel, St Gall-Appenzell, Valais, Vaud.
Data sources:
2013;49:3262-73.

Figure 12: Time trends in cervical cancer incidence type in Spain (cancer registry data)
Recent trend :−1.3 (−3.1 to 0.5) (1, b)
Overall trend :−0.6 (−1.5 to 0.3) (1, a)
25
20
(per 100,000)
15 All ages (2, c)

15−44 yrs (2, c)
10 ●
●
● ●
● ● ●
● ● ● ● ● ●
● ● 45−74 yrs (2, c)
5
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
c The following regional cancer registries provided data and contributed to their national estimate: Albacete, Cuenca, Girona, Granada, Murcia, Navarra, Tarragona.
Data sources:
2013;49:3262-73.
Figure 13: Time trends in cervical cancer incidence type in France (cancer registry data)
Recent trend :−2.5 (−4.2 to −0.7) (1, b)
40
30
(per 100,000)
All ages (2, c)

20
●
15−44 yrs (2, c)
●
● ●
● ● ● ●
● ● ● ●
● ● ● ● 45−74 yrs (2, c)
10 ● ● ● ●
0
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

c The following regional cancer registries provided data and contributed to their national estimate: Bas-Rhin, Calvados, Doubs, Haut-Rhin, Herault, Isere, Somme, Tarn.
Data sources:
2013;49:3262-73.

Figure 14: Time trends in cervical cancer incidence type in the United Kingdom (cancer registry data)
Recent trend :−2.3 (−2.8 to −1.7) (1, b)
25
20
(per 100,000)
15 All ages (2, c)

●
●
● ●
● ●
● ● 15−44 yrs (2, c)
10 ●
● ●
● ● ● ●
45−74 yrs (2, c)

5
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
c The following regional cancer registries provided data and contributed to their national estimate: Birmingham and West Midlands Region, East of England Region, Merseyside and
Cheshire, North Western, Northern Ireland, Oxford, Scotland, South and Western Regions, Yorkshire.
Data sources:
2013;49:3262-73.
Figure 15: Time trends in cervical cancer incidence type in Italy (cancer registry data)
Recent trend :−3.1 (−4.7 to −1.5) (1, b)
25
20
(per 100,000)
15 All ages (2, c)

● ● ●
● ● ● 15−44 yrs (2, c)
10 ●
● ● ●
● ●
● ● ●
45−74 yrs (2, c)
5
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

c The following regional cancer registries provided data and contributed to their national estimate: Ferrara Province, Florence, Lombardy, Varese province, Modena, Parma, Ragusa Province,
Romagna, Sassari Province, Torino.
Data sources:
2013;49:3262-73.

Figure 16: Time trends in cervical cancer incidence type in Poland (cancer registry data)
Recent trend :−0.8 (−2.1 to 0.5) (1, b)
70
60
50
(per 100,000)
40 All ages (2)

●
30 ● ●
●
●
15−44 yrs (2)
● ● ● ● ● ● ●
● ● ● ● ●
● ● ● ● ● ● ●
20
● ● ●
● 45−74 yrs (2)
●
10
0
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Data sources:
2013;49:3262-73.
Figure 17: Time trends in cervical cancer incidence type in the Russian Federation (cancer registry
data)
Recent trend :1.7 (1.4 to 1.9) (1, b)
Overall trend :0.9 (0.8 to 1.1) (1, a)
30
25
(per 100,000)
20
● ●
All ages (2)
● ●
15 ● ● ● ● ●
● ● ● ●
● 15−44 yrs (2)
10 45−74 yrs (2)
5
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:
2013;49:3262-73.

3.1.2 Mortality
KEY STATS.
About 25,829 new cervical cancer deaths occur annually in Europe

(estimates for 2018).
Cervical cancer ranks* as the 11 th leading cause of female cancer

deaths in Europe.
Cervical cancer is the 2nd most common female cancer deaths in women
aged 15 to 44 years in Europe.
Figure 18: Age-standardised mortality rates (ASR) of cervical cancer in European regions (estimates
for 2018)
Eastern Europe 6.1
Southern
2.2
Europe
Western Europe 2.1
Northern
2.1
Europe
0 10
Cervical cancer: Age−standardised mortality rate per 100,000 women

Data sources:

Figure 19: Age-standardised mortality rates of cervical cancer in Europe (estimates for 2018)

For more detailed methods of estimation please refer to http://gco.iarc.fr/today/data-sources-methods
Table 6: Cervical cancer mortality in Europe (estimates for 2018)

Europe 25,829 6.7 3.8 0.4 11 2
Eastern Europe 16,011 10.4 6.1 0.7 8 1
Belarus 318 6.3 3.8 0.4 10 2
Bulgaria 475 13.1 7.4 0.8 5 1
Czech Republic 435 8.1 4.0 0.4 8 2
Hungary 499 9.8 5.1 0.6 8 2
Poland 1,947 9.9 4.9 0.6 9 3
Republic of 259 12.3 7.9 0.9 3 1
Moldova
Romania 1,743 17.3 8.9 1.0 3 2
Russian Federation 7,579 9.8 6.2 0.6 8 1
Slovakia 281 10.0 5.7 0.6 9 1
Ukraine 2,475 10.5 6.6 0.7 9 1
Northern Europe 2,060 3.9 2.1 0.2 17 2
Denmark 131 4.5 2.0 0.2 15 3
Estonia 60 8.6 4.3 0.5 10 2
Finland 64 2.3 0.9 0.1 19 4
Iceland 3 1.8 1.3 0.2 10 2
Ireland 107 4.4 2.9 0.3 14 2
Latvia 134 12.8 6.5 0.7 9 2
Lithuania 209 13.5 7.2 0.8 7 1
Norway 89 3.4 1.7 0.2 16 4
Sweden 222 4.5 2.0 0.2 14 2
United Kingdom 1,033 3.1 1.7 0.2 18 2
Southern Europe 3,512 4.5 2.2 0.2 15 2


Albania 53 3.6 2.3 0.3 6 6
Andorra - - - - - -
Bosnia & Herze- 141 7.9 4.7 0.5 10 2
govina
Croatia 175 8.1 3.7 0.4 12 2
Cyprus 18 3.0 1.5 0.1 12 3
Greece 271 4.8 2.1 0.2 11 3
Italy 986 3.2 1.5 0.2 17 4
Macedonia 59 5.7 3.5 0.4 11 5
Malta 7 3.3 1.4 0.1 13 6
Montenegro 21 6.6 4.2 0.4 5 2
Portugal 340 6.3 2.8 0.3 13 3
San Marino - - - - - -
Serbia 551 12.3 7.0 0.8 6 2
Slovenia 65 6.2 2.8 0.3 13 2
Spain 825 3.5 1.7 0.2 16 4
Western Europe 4,246 4.3 2.1 0.2 16 3
Austria 163 3.7 1.7 0.2 17 3
Belgium 235 4.0 2.0 0.2 17 5
France 1,472 4.4 2.3 0.2 16 4
Germany 2,011 4.8 2.2 0.2 17 3
Luxembourg 11 3.7 2.0 0.2 12 2
Monaco - - - - - -
Netherlands 250 2.9 1.4 0.1 19 4
Switzerland 104 2.4 1.1 0.1 19 6
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 15-44 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.
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.
c Non-melanoma skin cancer is not included.
α For more detailed methods of estimation please refer to http://gco.iarc.fr/today/data-sources-methods
Data sources:

Figure 20: Ranking of cervical cancer versus other cancers among all women and women aged 15-44
years, according to mortality rates in Europe (estimates for 2018)


Figure 21: Comparison of the ten most frequent cancer deaths in all women in Europe and its regions
(estimates for 2018)
Lung 13.0 Lung 11.5
Colon 6.4 Colon 6.1
Pancreas 5.7 Pancreas 5.2
Ovary 5.1 Ovary 4.1
Stomach 3.9 Stomach 3.4
Cervix uteri 3.8 Brain, nervous system 3.3
Brain, nervous system 3.2 Leukaemia 2.7
Rectum 3.2 Liver 2.6
Corpus uteri 2.9 Corpus uteri 2.3
0 5 10 15 20 0 5 10 15 20
Breast 15.5 Lung 17.0
Lung 9.4 Breast 15.5
Colon 7.2 Pancreas 6.3
Cervix uteri 6.1 Colon 5.6
Ovary 6.0 Ovary 4.4
Stomach 5.8 Brain, nervous system 3.0
Pancreas 5.5 Leukaemia 2.8
Rectum 4.5 Liver 2.2
Corpus uteri 3.9 Stomach 2.2
Brain,nervous system 3.4 Cervix uteri 2.1
0 5 10 15 20 0 5 10 15 20
Northern Europe
Lung 18.1
Breast 14.1
Pancreas 5.7
Colon 5.6
Ovary 5.1
Rectum 3.4
Brain, nervous system 3.0
Corpus uteri 2.6
Liver 2.5
Leukaemia 2.4
0 5 10 15 20
Age−standardised mortality rate per 100,000

women in Europe

Data sources:


Figure 22: Annual number of deaths of cervical cancer by age group in European regions (estimates for
2018)
Eastern Europe Southern Europe

Western Europe Northern Europe
Annual number of cervical cancer deaths
15,000
13,500 12,515*
12,000 10,976*
10,500
9,000
7,500
6,000
4,500
3,000 2,338*
1,500
0
15−39 40−64 65+
* Eastern Europe 15-39 years: 1,801 cases. 40-64 years: 8,334 cases. 65+ years: 5,876 cases.
* Western Europe 15-39 years: 197 cases. 40-64 years: 1,797 cases. 65+ years: 2,252 cases.
* Southern Europe 15-39 years: 160 cases. 40-64 years: 1,609 cases. 65+ years: 1,743 cases.
* Northern Europe 15-39 years: 180 cases. 40-64 years: 775 cases. 65+ years: 1,105 cases.

Data sources:

3.2 Anogenital cancers other than the cervix

Data on the role of HPV in anogenital cancers other than the cervix are limited, but there is an in-
creasing 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 cancer of the cervix, their association with
HPV make them potentially preventable and subject to similar preventative strategies as those for cer-
vical 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 23: Age-standardised incidence rates of anogenital cancers other than the cervix in Europe
(estimates for 2012)
Data accessed on 08 May 2017.

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 Albania, Greece, Hungary, Republic of Moldova, Macedonia, Montenegro: No data.
- For Austria, Belgium, Bulgaria, Belarus, Cyprus, Czech Republic, Denmark, Estonia, Finland, United Kingdom, Croatia, Ireland, Iceland, Lithuania, Latvia, Malta, Netherlands, Norway,
Slovakia, Slovenia, Sweden, Ukraine: High quality national data or high quality regional (coverage greater than 50%).
- For Bosnia & Herzegovina, Luxembourg, Russian Federation: National data (rates).
- For Switzerland, Germany, Spain, France, Italy, Serbia: High quality regional (coverage between 10% and 50%).
- For Poland, Portugal: 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 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 Austria, Bulgaria, Belarus, Czech Republic, Germany, Denmark, Estonia, Finland, United Kingdom, Croatia, Ireland, Iceland, Lithuania, Latvia, Malta, Netherlands, Norway, Russian
Federation, Slovakia, Slovenia, Sweden: Rates projected to 2012
- For Belgium, Bosnia & Herzegovina, Cyprus, Ukraine: Most recent rates applied to 2012 population
- For Switzerland, Spain, France, Italy, Poland: 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

Figure 24: Age-standardised incidence rate of other anogenital cancer cases attributable to HPV by
country in Europe (estimates for 2012)
Denmark 2.2
France 1.8
Norway 1.7
Netherlands 1.7
Iceland 1.5
Belgium 1.5
Ireland 1.4
UK 1.4
Sweden 1.3
Luxembourg 1.3
Germany 1.3
Slovenia 1.2
Austria 1.2
Serbia 1.1
Montenegro 1.1
Lithuania 1.1
Italy 1.1
Croatia 1.1
Switzerland 1.1
Malta 1.0
Latvia 1.0
Finland 1.0
Estonia 1.0
Spain 1.0
Czech Rep. 1.0
Bulgaria 1.0
Slovakia 0.9
Portugal 0.9
Macedonia 0.9
Hungary 0.9
Cyprus 0.9
Albania 0.9
Ukraine 0.8
Russia 0.8
Romania 0.8
Moldova 0.8
Greece 0.8
Poland 0.7
Bosnia & H. 0.7
Belarus 0.6
San Marino**
Monaco**
Liechtenstein**
Andorra**
0 0.5 1 1.5 2 2.5
Age−standardised incidence rate per 100,0000 women

World Standard



Other anogenital cancer cases (vulvar, vaginal, anal, and penile).

- 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 Greece, Republic of Moldova, Albania, Hungary, Macedonia, Montenegro: No data.
- For Spain, Switzerland, Italy, Serbia, Germany, France: High quality regional (coverage between 10% and 50%).
- 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 2012
- 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
3.2.1 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 in Europe by cancer registry and sex

Male Female
Country / Registry Period N casesa Crude rateb ASRb N casesa Crude rate c ASR c
Eastern Europe
Belarus1
National 2008-2012 72 0.3 0.2 175 0.7 0.4
Bulgaria1
National 2008-2012 98 0.5 0.3 154 0.8 0.4
Czech Rep.1
National 2008-2012 236 0.9 0.6 416 1.6 0.8
Hungary
- - - - - - - -
Moldova
- - - - - - - -
Poland1
Kielce 2008-2012 12 0.4 0.2 20 0.6 0.3
Lower Silesia 2008-2012 32 0.5 0.3 85 1.1 0.5
Lublin 2008-2012 26 0.5 0.3 36 0.6 0.3
Podkarpackie 2008-2012 25 0.5 0.4 37 0.7 0.3
Poznan 2008-2012 23 0.3 0.2 59 0.7 0.4
Romania
- - - - - - - -
Russia1
Arkhangelsk 2008-2012 8 0.3 0.2 18 0.5 0.3
Chelyabinsk 2008-2012 45 0.6 0.4 92 1 0.6
Karelia 2008-2012 2 0.1 0.1 9 0.5 0.2
Samara 2008-2012 42 0.6 0.4 70 0.8 0.5
Slovakia1
National 2008-2010 65 0.8 0.6 72 0.9 0.5
Ukraine1
National 2008-2012 493 0.5 0.3 811 0.7 0.3
Northern Europe


Male Female
Denmark1
National 2008-2012 192 1.4 0.8 423 3 1.7
Estonia1
National 2008-2012 19 0.6 0.3 65 1.8 0.8
Finland2
National 2003-2007 65 0.5 0.3 115 0.9 0.4
Iceland1
National 2008-2012 3 0.4 0.2 9 1.1 0.7
Ireland1
National 2008-2012 99 0.9 0.6 138 1.2 0.8
Latvia1
National 2010-2012 14 0.5 0.3 53 1.6 0.7
Lithuania1
National 2008-2012 35 0.5 0.3 65 0.8 0.4
Norway1
National 2008-2012 118 1 0.6 226 1.8 1
Sweden2
National 2003-2007 198 0.9 0.5 459 2 1
UK1
England 2008-2012 1758 1.4 0.8 2982 2.2 1.2
England, East 2008-2012 210 1.5 0.8 350 2.4 1.2
England, East Midlands 2008-2012 152 1.4 0.7 231 2 1.1
England, London 2008-2012 225 1.1 0.9 333 1.6 1.2
England, North East 2008-2012 74 1.2 0.7 164 2.5 1.4
England, North West 2008-2012 234 1.4 0.8 399 2.2 1.2
England, South East 2008-2012 283 1.3 0.8 512 2.3 1.3
England, South West 2008-2012 198 1.5 0.8 365 2.7 1.3
England, West Midlands 2008-2012 155 1.1 0.7 279 2 1.1
England, Yorkshire and 2008-2012 227 1.8 1 349 2.6 1.4
The Humber
National 2008-2012 2095 1.4 0.8 3598 2.3 1.3
Northern Ireland 2008-2012 45 1 0.7 92 2 1.2
Scotland 2008-2012 176 1.4 0.8 337 2.5 1.4
Wales 2008-2012 116 1.6 0.9 187 2.4 1.3
Southern Europe
Albania
- - - - - - - -
Andorra
- - - - - - - -
Bosnia & H.
- - - - - - - -
Croatia1
National 2008-2012 69 0.7 0.4 72 0.6 0.3
Cyprus1
National 2008-2012 12 0.6 0.4 22 1 0.6
Greece
- - - - - - - -
Italy1
Aosta Valley 2008-2012 6 1.9 1 7 2.2 1.2
Barletta 2008-2011 7 0.9 0.5 5 0.6 0.3
Bergamo 2008-2012 30 1.1 0.7 59 2.2 1
Biella 2008-2012 5 1.1 0.5 19 3.9 1.4
Caserta 2008-2010 12 0.9 0.5 9 0.6 0.4


Male Female
Catania, Messina and 2008-2012 38 0.8 0.5 56 1.1 0.5
Enna
Como 2008-2011 13 1.1 0.6 25 2.1 1
Cremona 2008-2010 7 1.3 0.8 9 1.6 0.8
Ferrara 2008-2011 12 1.7 0.7 16 2.1 0.5
Florence and Prato 2008-2010 29 1.7 0.8 57 3 1.3
Friuli-Venezia Giulia 2008-2010 27 1.5 0.7 61 3.2 1.2
Latina 2008-2012 47 3.5 2 36 2.6 1.1
Lecco 2008-2010 4 0.8 0.4 10 2 0.8
Lombardy, South, Pavia 2008-2010 13 1.6 0.8 17 2 1
Mantua 2008-2010 67 11.4 5 61 9.8 3.8
Milan 2008-2012 120 1.8 0.9 206 2.9 1.3
Modena 2008-2012 20 1.2 0.6 33 1.9 0.9
Monza 2008-2012 25 1.2 0.5 35 1.6 0.6
Naples 2008-2012 9 0.7 0.4 12 0.8 0.5
Nuoro 2008-2012 2 0.4 0.1 5 0.9 0.2
Palermo 2008-2012 33 1.1 0.6 44 1.4 0.6
Parma 2008-2012 15 1.5 0.9 36 3.3 1.4
Piacenza 2008-2011 12 2.2 0.9 11 1.9 0.6
Ragusa and 2008-2012 15 1.1 0.5 15 1 0.4
Caltanissetta
Reggio Emilia 2008-2012 17 1.3 0.7 20 1.5 0.8
Romagna 2008-2012 47 1.6 0.8 80 2.5 1.2
Sassari 2008-2011 11 1.1 0.6 15 1.5 0.7
Sondrio 2008-2012 3 0.7 0.3 9 1.9 1.1
South Tyrol 2008-2010 5 0.7 0.3 12 1.6 0.5
Syracuse 2008-2012 8 0.8 0.4 5 0.5 0.2
Taranto 2008-2011 10 0.9 0.5 22 1.8 1
Trento 2008-2010 8 1.1 0.4 10 1.3 0.4
Turin 2008-2012 110 2 0.9 117 2 0.8
Umbria 2008-2011 27 1.6 0.7 39 2.1 0.9
Varese 2008-2012 18 0.9 0.5 55 2.5 1
Veneto 2008-2010 40 1.1 0.5 64 1.6 0.7
Macedonia
- - - - - - - -
Malta1
National 2008-2012 18 1.7 1.1 7 0.7 0.4
Montenegro
- - - - - - - -
Portugal1
Azores 2008-2011 3 0.6 0.4 4 0.8 0.5
San Marino
- - - - - - - -
Serbia2
Central 2003-2007 90 0.7 0.4 86 0.6 0.3
Slovenia1
National 2008-2012 26 0.5 0.3 45 0.9 0.4
Spain1
Albacete 2008-2010 4 0.7 0.4 5 0.8 0.5
Asturias 2008-2010 19 1.3 0.7 23 1.4 0.6
Basque Country 2008-2012 52 1 0.5 53 1 0.4


Male Female
Canary Islands 2008-2011 51 1.5 0.9 31 0.9 0.5
Castellón 2008-2012 10 0.7 0.5 13 0.9 0.5
Ciudad Real 2008-2011 5 0.5 0.2 7 0.7 0.3
Cuenca 2008-2011 5 1.1 0.5 3 0.7 0.2
Girona 2008-2012 15 0.8 0.5 12 0.7 0.4
Granada 2008-2012 15 0.7 0.4 9 0.4 0.1
La Rioja 2008-2012 3 0.4 0.3 1 0.1 0
Mallorca 2008-2011 24 1.4 1 18 1.1 0.6
Murcia 2008-2010 8 0.4 0.2 6 0.3 0.1
Navarra 2008-2010 6 0.6 0.3 7 0.7 0.4
Tarragona 2008-2012 35 1.7 1 30 1.5 0.8
Western Europe
Austria1
Carinthia 2008-2012 21 1.5 0.8 29 2 1.1
National 2008-2012 230 1.1 0.7 454 2.1 1.1
Tyrol 2008-2012 21 1.2 0.7 42 2.3 1.3
Vorarlberg 2008-2012 9 1 0.6 16 1.7 0.8
Belgium1
National 2008-2012 317 1.2 0.7 454 1.6 0.9
France1
Bas-Rhin 2008-2011 14 0.6 0.4 50 2.2 1.2
Calvados 2008-2012 18 1.1 0.7 54 3 1.7
Doubs 2008-2012 12 0.9 0.5 41 3 1.6
Gironde 2008-2012 54 1.5 1 140 3.7 2
Haut-Rhin 2008-2012 21 1.1 0.7 44 2.3 1.2
Hérault 2008-2012 54 2.2 1.4 120 4.4 2.3
Isère 2008-2012 32 1.1 0.7 75 2.4 1.5
Lille-Métropole 2008-2012 14 0.7 0.6 47 2.3 1.5
Limousin 2009-2012 5 0.7 0.3 30 3.8 1.8
Loire-Atlantique 2008-2012 42 1.3 0.9 114 3.4 1.9
Manche 2008-2011 9 0.9 0.5 33 3.2 1.5
Martinique 2008-2012 3 0.3 0.2 22 2.1 1.2
Somme 2008-2012 19 1.4 0.9 32 2.2 1.2
Tarn 2008-2012 8 0.9 0.4 33 3.4 1.6
Territoire de Belfort 2008-2012 2 0.6 0.2 6 1.7 1.1
Vendée 2008-2012 10 0.6 0.3 48 3 1.4
Germany1
Bavaria 2008-2012 390 1.3 0.7 751 2.4 1.2
Bremen 2008-2012 31 1.9 1.1 66 3.9 2
Hamburg 2008-2012 146 3.4 2.1 244 5.4 2.8
Lower Saxony 2008-2012 273 1.4 0.7 501 2.5 1.2
Munich 2008-2012 178 1.6 0.8 345 3 1.5
North Rhine-Westphalia 2008-2012 781 1.8 1 1188 2.6 1.3
Rhineland-Palatinate 2008-2012 128 1.3 0.7 231 2.3 1.1
Saarland 2008-2012 43 1.7 1 58 2.2 1.2
Schleswig-Holstein 2008-2012 153 2.2 1.2 257 3.6 1.8
Luxembourg
- - - - - - - -
Monaco
- - - - - - - -


Male Female
Netherlands1
National 2008-2012 409 1 0.6 497 1.2 0.7
Switzerland1
Fribourg 2008-2012 8 1.2 0.8 20 2.9 1.6
Geneva 2008-2012 22 2 1.2 64 5.4 3.2
Graubünden and Glarus 2008-2012 6 1 0.6 16 2.8 1.4
Neuchâtel 2008-2012 10 2.4 1.3 19 4.3 1.9
St Gall-Appenzell 2008-2012 13 1 0.6 35 2.6 1.3
Ticino 2008-2012 12 1.5 0.7 33 3.8 1.8
Valais 2008-2012 3 0.4 0.2 23 2.9 1.6
Vaud 2008-2012 33 1.9 1.1 86 4.7 2.4
Zurich 2008-2012 65 1.9 1.2 105 3.1 1.7
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 Bray F, Colombet M, Mery L, Piñeros M, Znaor A, Zanetti R and Ferlay J, editors (2017). Cancer Incidence in Five Continents, Vol. XI (electronic version). Lyon: International Agency for
Research on Cancer. Available from: http://ci5.iarc.fr, accessed [05 October 2018].
2 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. http://ci5.iarc.fr

Figure 25: Time trends in anal cancer incidence in Austria (cancer registry data)
Anal cancer in men
10
8
(per 100,000)
6
All ages
15−44 yrs
4
45−74 yrs
2
● ●
● ● ● ● ●
● ●
●
● ●
● ●
0 ●
1993*
1994
1995*
1996*
1997*
1998*
1999
2000*
2001*
2002*
2003
2004*
2005*
2006*
2007
Anal cancer in women
10
8
(per 100,000)
6
All ages
15−44 yrs
4
45−74 yrs
●
● ●
2 ●
●
● ● ●
●
● ●
●
● ● ●
0
1993*
1994*
1995*
1996*
1997
1998*
1999*
2000*
2001
2002*
2003*
2004*
2005
2006
2007
*No cases were registered for this age group.

The following regional cancer registries provided data and contributed to their national estimate: Tyrol, Vorarlberg.
Data sources:
Ferlay J, Bray F, Steliarova-Foucher E and Forman D. Cancer Incidence in Five Continents, CI5plus: IARC CancerBase No. 9 [Internet]. Lyon, France: International Agency for Research

Figure 26: Time trends in anal cancer incidence in Croatia (cancer registry data)
Anal cancer in men
2
(per 100,000)
All ages
1
15−44 yrs
45−74 yrs
● ● ● ● ●
● ● ●
● ● ● ●
● ● ● ● ● ●
● ●
0
1988*
1989*
1990*
1991*
1992*
1993*
1994*
1995*
1996
1997*
1998
1999
2000*
2001
2002*
2003
2004
2005
2006
2007
2
(per 100,000)
All ages
1
15−44 yrs
●
● ● ●
45−74 yrs
●
● ● ● ● ●
● ● ● ●
● ● ●
● ● ●
0
1988
1989*
1990
1991
1992*
1993
1994*
1995*
1996*
1997*
1998*
1999
2000
2001*
2002
2003
2004
2005
2006*
2007*

Data was provided by the national registry.
Data sources:

Figure 27: Time trends in anal cancer incidence in Denmark (cancer registry data)
Anal cancer in men
10
8
(per 100,000)
6
All ages
15−44 yrs
4
45−74 yrs
2
● ●
● ●
● ● ● ● ● ● ● ● ● ● ●
● ● ● ● ● ● ● ●
● ● ● ● ●
● ●
0
1978*
1979*
1980
1981*
1982
1983
1984*
1985
1986
1987
1988*
1989*
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
10
8
(per 100,000)
6
All ages
15−44 yrs
4
45−74 yrs
● ●
● ● ● ●
● ● ● ●
2 ●
● ●
● ●
● ● ●
● ● ● ● ● ●
● ●
● ● ●
●
0
1978
1979
1980
1981
1982
1983
1984
1985
1986*
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:

Figure 28: Time trends in anal cancer incidence in Estonia (cancer registry data)
Anal cancer in men
5
4
(per 100,000)
3
All ages
15−44 yrs
2
45−74 yrs
●
1 ●
● ● ●
●
● ● ● ● ● ● ●
● ● ● ●
● ● ● ●
● ● ● ● ● ● ●
● ● ● ●
● ● ●
0 ● ● ● ● ●
1968*
*
1970*
*
1972*
*
1974*
*
1976*
*
1978*
*
1980*
*
1982
*
1984*
*
1986*
1988*
*
1990
*
1992*
*
1994*
*
1996
*
1998*
2000*
*
2002*
*
2004*
*
2006*
*
5
4
(per 100,000)
3
All ages
15−44 yrs
2
● ● 45−74 yrs
●
●
●
● ●
● ● ● ● ● ●
1 ● ●
●
● ● ● ● ●
● ● ● ●
●
● ● ● ● ●
● ● ●
● ● ●
● ● ●
0
1968*
*
1970*
1972*
*
1974*
*
1976*
*
1978*
*
1980*
1982*
1984
*
1986
*
1988*
*
1990*
*
1992*
*
1994*
1996*
*
1998*
2000
*
2002
*
2004*
*
2006
*

Data sources:

Figure 29: Time trends in anal cancer incidence in France (cancer registry data)
Anal cancer in men
10
8
(per 100,000)
6
All ages
15−44 yrs
4
45−74 yrs
2
● ●
● ● ● ● ● ● ● ●
● ● ● ● ● ● ●
● ● ●
0
1988
1989
1990
1991
1992*
1993
1994
1995
1996
1997*
1998*
1999
2000
2001
2002
2003
2004
2005
2006*
2007
10
8
(per 100,000)
6
All ages
15−44 yrs
4
45−74 yrs
●
● ● ● ● ●
● ● ● ● ●
2 ● ● ● ● ● ●
●
●
●
0
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

The following regional cancer registries provided data and contributed to their national estimate: Bas-Rhin, Calvados, Doubs, Haut-Rhin, Herault, Isere, Somme, Tarn.
Data sources:

Figure 30: Time trends in anal cancer incidence in Iceland (cancer registry data)
Anal cancer in men
10
8
(per 100,000)
6
All ages
15−44 yrs
4
45−74 yrs
2 ●
● ●
● ● ● ● ● ● ● ● ● ● ● ● ● ●
0 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
1958*
*
1960*
*
1962*
*
1964*
*
1966*
*
1968*
*
1970*
*
1972*
*
1974*
*
1976*
*
1978*
*
1980*
*
1982*
*
1984
*
1986*
*
1988*
*
1990*
*
1992*
*
1994*
*
1996*
*
1998*
*
2000*
*
2002*
*
2004*
*
2006*
*
10
8
(per 100,000)
6
All ages
15−44 yrs
4
45−74 yrs
●
● ● ● ● ● ●
2 ● ● ● ● ●
●
●
● ● ● ● ● ● ● ● ● ● ●
0 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
1958*
*
1960*
*
1962*
*
1964*
*
1966*
*
1968*
*
1970*
*
1972*
*
1974*
*
1976*
*
1978*
*
1980*
*
1982*
*
1984*
*
1986*
*
1988*
*
1990*
*
1992*
*
1994*
1996*
*
1998*
*
2000*
*
2002*
*
2004*
*
2006*
*

Data sources:

Figure 31: Time trends in anal cancer incidence in Italy (cancer registry data)
Anal cancer in men
5
4
(per 100,000)
3
All ages
15−44 yrs
2 ● ● ●
45−74 yrs
●
●
● ● ●
● ● ● ●
●
1 ●
●
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
5
4
(per 100,000)
3
●
All ages
●
●
● ● 15−44 yrs
2 ●
● ● ●
● ● 45−74 yrs
● ●
● ●
0
1993
1994
1995
1996*
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

The following regional cancer registries provided data and contributed to their national estimate: Ferrara Province, Florence, Lombardy, Varese province, Modena, Parma, Ragusa Province,
Data sources:

Figure 32: Time trends in anal cancer incidence in the Netherlands (cancer registry data)
Anal cancer in men
5
4
(per 100,000)
3
All ages
15−44 yrs
2
45−74 yrs
1
● ●
●
● ● ● ● ●
● ● ● ●
● ● ● ● ● ●
●
0
1989
1990
1991
1992
1993*
1994*
1995
1996*
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
5
4
(per 100,000)
3
All ages
15−44 yrs
2
45−74 yrs
1 ● ●
● ● ●
● ●
● ● ● ● ●
● ● ●
● ● ●
●
0
1989*
1990
1991*
1992*
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:

Figure 33: Time trends in anal cancer incidence in Poland (cancer registry data)
Anal cancer in men
14
12
10
(per 100,000)
8 All ages
15−44 yrs
6 ●
45−74 yrs
●
4 ●
●
●
● ● ●
2
● ●
●
●
● ●
● ● ● ● ● ● ● ●
0 ● ● ● ● ● ● ●
1978*
1979*
1980*
1981*
1982*
1983*
1984*
1985*
1986*
1987*
1988*
1989
1990*
1991*
1992*
1993*
1994*
1995*
1996*
1997*
1998*
1999*
2000*
2001*
2002*
2003*
2004*
2005*
2006*
14
12
10
(per 100,000)
8 All ages
● 15−44 yrs
6
45−74 yrs
●
4
●
● ● ●
2 ●
● ● ●
● ● ●
● ●
● ● ●
●
● ● ●
0 ● ● ● ● ● ● ●
1978*
1979*
1980*
1981*
1982*
1983*
1984
1985*
1986*
1987
1988
1989*
1990
1991
1992
1993*
1994*
1995*
1996*
1997*
1998*
1999*
2000*
2001
2002*
2003*
2004
2005*
2006*

Data was provided by the Cracow City registry.
Data sources:

Figure 34: Time trends in anal cancer incidence in the Russian Federation (cancer registry data)
Anal cancer in men
5
4
(per 100,000)
3
All ages
15−44 yrs
2
45−74 yrs
1
● ●
●
● ● ● ●
● ● ● ● ●
●
0 ●
1994*
1995
1996
1997
1998*
1999
2000
2001*
2002*
2003*
2004*
2005
2006
2007*
5
4
(per 100,000)
3
All ages
15−44 yrs
2
45−74 yrs
1 ● ●
●
● ● ● ● ●
●
● ●
●
●
●
0
1994
1995
1996
1997*
1998
1999*
2000*
2001
2002*
2003
2004
2005
2006
2007

Data was provided by the St Petersburg registry.
Data sources:

Figure 35: Time trends in anal cancer incidence in Slovakia (cancer registry data)
Anal cancer in men
5
4
(per 100,000)
3
All ages
15−44 yrs
2
45−74 yrs
1 ●
● ● ●
● ● ●
● ● ●
● ● ● ● ● ● ● ● ● ● ●
● ● ● ● ● ● ●
● ●
● ● ●
● ●
0
1973*
1974
1975*
1976
1977*
1978*
1979*
1980*
1981*
1982*
1983
1984*
1985
1986
1987
1988*
1989*
1990
1991*
1992*
1993
1994
1995*
1996
1997
1998
1999*
2000*
2001
2002
2003*
2004*
2005
2006*
2007
5
4
(per 100,000)
3
All ages
15−44 yrs
2
45−74 yrs
●
1 ●
●
● ● ● ●
● ● ● ● ● ●
● ● ● ● ● ● ● ●
● ● ● ● ●
● ●
● ● ● ● ● ●
●
0
1973*
1974*
1975*
1976
1977*
1978*
1979
1980
1981
1982
1983
1984*
1985*
1986*
1987
1988*
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998*
1999
2000*
2001
2002*
2003*
2004*
2005
2006
2007

Data sources:

Figure 36: Time trends in anal cancer incidence in Spain (cancer registry data)
Anal cancer in men
5
4
(per 100,000)
3
All ages
15−44 yrs
2
45−74 yrs
1 ● ● ●
● ●
●
●
●
● ● ● ●
● ●
0
1993
1994
1995
1996*
1997
1998
1999
2000
2001
2002*
2003
2004
2005
2006
2007
5
4
(per 100,000)
3
All ages
15−44 yrs
2
45−74 yrs
1 ●
● ●
●
● ● ● ●
● ●
●
● ● ● ●
0
1993*
1994*
1995*
1996*
1997
1998*
1999
2000
2001*
2002
2003*
2004
2005
2006*
2007

The following regional cancer registries provided data and contributed to their national estimate: Albacete, Cuenca, Girona, Granada, Murcia, Navarra, Tarragona.
Data sources:

Figure 37: Time trends in anal cancer incidence in Switzerland (cancer registry data)
Anal cancer in men
10
8
(per 100,000)
6
All ages
15−44 yrs
4
45−74 yrs
2 ●
● ● ● ●
● ● ● ●
● ●
● ●
● ●
0
1993*
1994
1995*
1996
1997*
1998
1999
2000*
2001
2002
2003
2004
2005
2006
2007
10
8
(per 100,000)
6
All ages
15−44 yrs
4 ● ● ● ●
● ● 45−74 yrs
●
● ● ● ● ●
●
●
●
2
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

The following regional cancer registries provided data and contributed to their national estimate: Geneva, Graubunden and Glarus, Neuchatel, St Gall-Appenzell, Valais, Vaud.
Data sources:

Figure 38: Time trends in anal cancer incidence in the United Kingdom (cancer registry data)
Anal cancer in men
5
4
(per 100,000)
3
All ages
15−44 yrs
2
45−74 yrs
● ● ●
● ● ●
1 ●
●
● ●
● ● ● ● ●
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
5
4
(per 100,000)
3
All ages
15−44 yrs
2
● ● ● ● ● 45−74 yrs
● ●
● ● ● ● ●
● ●
●
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

The following regional cancer registries provided data and contributed to their national estimate: Birmingham and West Midlands Region, East of England Region, Merseyside and Cheshire,
North Western, Northern Ireland, Oxford, Scotland, South and Western Regions, Yorkshire.
Data sources:
NOTE.
Time trends in cancer incidence are shown only in countries with

available data.

3.2.2 Vulvar cancer
Cancer of the vulva is rare among women worldwide, with an estimated 27,000 new cases in 2008, rep-
resenting 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) keratinising
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. Keratinising 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 in Europe by cancer registry

Female
Country Cancer registry Period N casesa Crude rateb ASRb
Eastern Europe
Belarus1 National 2008-2012 792 3.1 1.3
Bulgaria1 National 2008-2012 576 3 1.2
Czech Republic1 National 2008-2012 1069 4 1.8
Hungary - - - - -
Poland1 Kielce 2008-2012 80 2.4 1
Lower Silesia 2008-2012 212 2.8 1.2
Lublin 2008-2012 139 2.5 1.2
Podkarpackie 2008-2012 122 2.3 1.1
Poznan 2008-2012 182 2.1 1
Republic of Moldova - - - - -
Romania - - - - -
Russian Federation1 Arkhangelsk 2008-2012 84 2.5 1.2
Chelyabinsk 2008-2012 263 2.8 1.3
Karelia 2008-2012 45 2.5 1.2
Samara 2008-2012 224 2.6 1.2
Slovakia1 National 2008-2010 244 2.9 1.5
Ukraine1 National 2008-2012 3503 2.8 1.2
Northern Europe
Denmark1 National 2008-2012 514 3.7 1.7
Estonia1 National 2008-2012 123 3.5 1.2
Finland2 National 2003-2007 376 2.8 1.2
Iceland1 National 2008-2012 19 2.4 1.5
Ireland1 National 2008-2012 250 2.2 1.4
Latvia1 National 2010-2012 114 3.4 1.2
Lithuania1 National 2008-2012 296 3.6 1.4
Norway1 National 2008-2012 404 3.3 1.6
Sweden2 National 2003-2007 803 3.5 1.4
United Kingdom1 England 2008-2012 5009 3.7 1.8
England, East 2008-2012 548 3.7 1.6
England, East Midlands 2008-2012 490 4.3 2
England, London 2008-2012 451 2.2 1.3
England, North East 2008-2012 278 4.2 1.9
England, North West 2008-2012 757 4.2 2
England, South East 2008-2012 786 3.6 1.6
England, South West 2008-2012 590 4.4 1.8
England, West Midlands 2008-2012 570 4 2
England, Yorkshire and The Humber 2008-2012 539 4 2
National 2008-2012 5999 3.8 1.8
Northern Ireland 2008-2012 134 2.9 1.6
Scotland 2008-2012 527 3.9 2
Wales 2008-2012 329 4.2 1.9
Southern Europe


Female
Albania - - - - -
Andorra - - - - -
Bosnia & - - - - -
Herzegovina
Croatia1 National 2008-2012 401 3.5 1.5
Cyprus1 National 2008-2012 49 2.3 1.2
Greece - - - - -
Italy1 Aosta Valley 2008-2012 12 3.7 1.1
Barletta 2008-2011 27 3.4 1.5
Bergamo 2008-2012 101 3.7 1.4
Biella 2008-2012 29 6 1.6
Caserta 2008-2010 41 2.9 1.2
Catania, Messina and Enna 2008-2012 151 3 1.2
Como 2008-2011 38 3.2 1.1
Cremona 2008-2010 16 2.9 0.7
Ferrara 2008-2011 37 4.9 1.3
Florence and Prato 2008-2010 69 3.7 1.1
Friuli-Venezia Giulia 2008-2010 81 4.2 1.3
Latina 2008-2012 49 3.5 1.4
Lecco 2008-2010 19 3.7 1.4
Lombardy, South, Pavia 2008-2010 35 4.2 1.2
Mantua 2008-2010 26 4.2 1.2
Milan 2008-2012 231 3.2 1.1
Modena 2008-2012 57 3.3 0.9
Monza 2008-2012 79 3.7 1.4
Naples 2008-2012 44 3 1.4
Nuoro 2008-2012 11 2 1
Palermo 2008-2012 107 3.3 1.3
Parma 2008-2012 41 3.7 1
Piacenza 2008-2011 27 4.6 1.3
Ragusa and Caltanissetta 2008-2012 49 3.3 1.6
Reggio Emilia 2008-2012 47 3.5 1.1
Romagna 2008-2012 140 4.4 1.4
Sassari 2008-2011 17 1.7 0.8
Sondrio 2008-2012 22 4.7 1.5
South Tyrol 2008-2010 8 1 0.3
Syracuse 2008-2012 32 3.1 1.4
Taranto 2008-2011 31 2.6 1.2
Trento 2008-2010 31 3.9 1.8
Turin 2008-2012 194 3.3 1
Umbria 2008-2011 98 5.4 1.5
Varese 2008-2012 79 3.6 1
Veneto 2008-2010 176 4.4 1.6
Macedonia - - - - -
Malta1 National 2008-2012 47 4.5 2
Montenegro - - - - -
Portugal1 Azores 2008-2011 10 2 1.1
San Marino - - - - -
Serbia2 Central 2003-2007 459 3.3 1.6
Slovenia1 National 2008-2012 220 4.3 1.7
Spain1 Albacete 2008-2010 23 3.9 1.1
Asturias 2008-2010 66 4 1.3
Basque Country 2008-2012 211 3.8 1.4
Canary Islands 2008-2011 82 2.3 1.2


Female
Castellón 2008-2012 46 3.1 1.3

Ciudad Real 2008-2011 37 3.5 1.2
Cuenca 2008-2011 17 4 1.3
Girona 2008-2012 52 2.8 1.1
Granada 2008-2012 68 2.9 1.2
La Rioja 2008-2012 20 2.5 0.8
Mallorca 2008-2011 53 3.1 1.5
Murcia 2008-2010 41 1.9 0.9
Navarra 2008-2010 34 3.6 1.4
Tarragona 2008-2012 63 3.2 1.4
Western Europe
Austria1 Carinthia 2008-2012 65 4.5 1.4
National 2008-2012 745 3.5 1.4
Tyrol 2008-2012 80 4.4 2.1
Vorarlberg 2008-2012 35 3.7 1.8
Belgium1 National 2008-2012 1102 4 1.8
France1 Bas-Rhin 2008-2011 51 2.3 1
Calvados 2008-2012 46 2.6 0.9
Doubs 2008-2012 32 2.4 1.1
Gironde 2008-2012 86 2.3 0.9
Haut-Rhin 2008-2012 66 3.4 1.6
Hérault 2008-2012 54 2 0.8
Isère 2008-2012 78 2.5 1
Lille-Métropole 2008-2012 57 2.7 1.5
Limousin 2009-2012 26 3.3 0.9
Loire-Atlantique 2008-2012 24 0.7 0.3
Manche 2008-2011 28 2.7 0.9
Martinique 2008-2012 2 0.2 0
Somme 2008-2012 38 2.6 1.1
Tarn 2008-2012 35 3.6 1.1
Territoire de Belfort 2008-2012 13 3.6 1.3
Vendée 2008-2012 32 2 0.7
Germany1 Bavaria 2008-2012 1750 5.5 2.3
Bremen 2008-2012 135 8 3.3
Hamburg 2008-2012 422 9.3 4.3
Lower Saxony 2008-2012 1460 7.2 3.1
Munich 2008-2012 585 5 2
North Rhine-Westphalia 2008-2012 4000 8.8 3.8
Rhineland-Palatinate 2008-2012 722 7.1 2.9
Saarland 2008-2012 320 12.2 5.7
Schleswig-Holstein 2008-2012 766 10.6 4.7
Luxembourg - - - - -
Monaco - - - - -
Netherlands1 National 2008-2012 1853 4.4 2.1
Switzerland1 Fribourg 2008-2012 22 3.2 1.9
Geneva 2008-2012 31 2.6 1.1
Graubünden and Glarus 2008-2012 24 4.1 1.5
Neuchâtel 2008-2012 15 3.4 1.3
St Gall-Appenzell 2008-2012 44 3.2 1.2
Ticino 2008-2012 28 3.2 1.1
Valais 2008-2012 23 2.9 1
Vaud 2008-2012 54 3 1.2
Zurich 2008-2012 119 3.5 1.5
Please refer to original source (available at http://ci5.iarc.fr/CI5-XI/Default.aspx)


b Rates per 100,000 women per year.
Data sources:
Figure 39: Time trends in vulvar cancer incidence in Austria (cancer registry data)
10
(per 100,000)
8
6
All ages
4 ●
●
● ●
● ●
●
●
● ● ● ● ● 15−44 yrs
2 ● ●
0 45−74 yrs
1993*
1994*
1995
1996
1997
1998
1999*
2000
2001
2002
2003
2004
2005
2006
2007
Data sources:
Figure 40: Time trends in vulvar cancer incidence in Croatia (cancer registry data)
10
(per 100,000)
8
6
All ages
4 ● ● ●
● ●
● ●
●
● ● ● ● ● ● ● 15−44 yrs
2 ● ● ● ● ●
0 45−74 yrs
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:
Figure 41: Time trends in vulvar cancer incidence in Denmark (cancer registry data)
10
(per 100,000)
8
6
●
All ages
4 ● ● ●
● ● ● ● ● ● ● ●
● ●
● ● ● ● ● ● ● ●
● ● ● ● ● ● ● ● 15−44 yrs
2
0 45−74 yrs
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007


Data sources:
Figure 42: Time trends in vulvar cancer incidence in Estonia (cancer registry data)
10
(per 100,000)
8
6 ●
● ● ●
All ages
4 ● ● ●
● ● ● ●
● ● ● ●
● ● ● ● ● ● ●
● ● ●
● ●
● ● ● ● ●
● ● ● ● ● ●
15−44 yrs
●
2 ●
0 45−74 yrs
1968
*
1970
*
1972*
1974*
1976*
*
1978
1980
1982*
1984*
*
1986*
*
1988
1990
1992*
*
1994*
1996
1998
2000*
*
2002*
*
2004
2006*
*
Data sources:
Figure 43: Time trends in vulvar cancer incidence in France (cancer registry data)
5
(per 100,000)
4
3
● ● ● ●
●
● ● ● ● ● All ages
2 ●
●
●
●
● ● ● ● ● ●
15−44 yrs
1
0 45−74 yrs
1988
1989*
1990
1991*
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:
Figure 44: Time trends in vulvar cancer incidence in Iceland (cancer registry data)
14
(per 100,000)
12
10
8 All ages
6
4 ● ● ●
● ●
●
●
●
● ●
15−44 yrs
● ●
2 ● ●
●
●
● ●
● ● ● ● ● ● ● ● ● ● ● ● ●
●
●
●
●
0 ● ● ● ● ● ● ● ● ● ● ●
● ● ● ● 45−74 yrs
1958*
*
1960*
*
1962*
*
1964*
*
1966*
*
1968*
*
1970*
*
1972*
*
1974*
*
1976*
*
1978*
*
1980*
*
1982*
1984
*
1986*
*
1988*
*
1990*
*
1992*
*
1994*
1996*
1998*
2000*
*
2002*
*
2004*
*
2006*
*


Data sources:
Figure 45: Time trends in vulvar cancer incidence in Italy (cancer registry data)
10
(per 100,000)
8
6
● All ages
4 ● ●
●
● ●
●
● ● ● ● ● ● ● ●
15−44 yrs
2
0 45−74 yrs
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Data sources:
Figure 46: Time trends in vulvar cancer incidence in Netherlands (cancer registry data)
10
(per 100,000)
8
6
All ages
4 ● ● ● ● ● ●
●
● ● ● ● ● ● ●
● ● ● ● ● 15−44 yrs
2
0 45−74 yrs
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:
Figure 47: Time trends in vulvar cancer incidence in Poland (cancer registry data)
10
(per 100,000)
8
6
All ages
4 ●
● ●
● ● ●
● 15−44 yrs
2 ● ● ●
● ● ●
● ●
●
● ●
● ● ● ● ● ● ● ●
● ● ●
0 45−74 yrs
1978*
1979*
1980*
1981*
1982
1983*
1984*
1985
1986*
1987*
1988
1989*
1990*
1991*
1992*
1993
1994*
1995
1996
1997*
1998
1999*
2000*
2001*
2002*
2003
2004
2005*
2006*


Data sources:
Figure 48: Time trends in vulvar cancer incidence in Russian Federation (cancer registry data)
10
(per 100,000)
8
6
All ages
4 ●
● ● ● ●
● ● ●
● ● ● ● ● ● 15−44 yrs
2
0 45−74 yrs
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Data sources:
Figure 49: Time trends in vulvar cancer incidence in Slovakia (cancer registry data)
10
(per 100,000)
8
6
All ages
4 ● ●
● ● ● ● ● ● ● ●
●
●
● 15−44 yrs
2 ●
● ●
●
● ● ● ● ● ● ● ● ● ● ● ●
● ● ● ● ● ●
0 45−74 yrs
1973*
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984*
1985
1986*
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004*
2005
2006
2007

Data sources:
Figure 50: Time trends in vulvar cancer incidence in Spain (cancer registry data)
10
(per 100,000)
8
6
All ages
4 ●
●
● ● ● ● ● ● ● ● ● ●
● ● ● 15−44 yrs
2
0 45−74 yrs
1993
1994*
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007


Data sources:
Figure 51: Time trends in vulvar cancer incidence in Switzerland (cancer registry data)
10
(per 100,000)
8
6
All ages
4 ● ● ● ● ● ●
●
● ● ●
●
● ● 15−44 yrs
2 ●
●
0 45−74 yrs
1993
1994
1995
1996*
1997
1998*
1999*
2000
2001
2002
2003
2004
2005
2006
2007
Data sources:
Figure 52: Time trends in vulvar cancer incidence in United Kingdom (cancer registry data)
10
(per 100,000)
8
6
All ages
4 ● ● ● ● ● ● ● ● ● ●
● ● ● ● ●
15−44 yrs
2
0 45−74 yrs
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:
NOTE.

available data.

3.2.3 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 in Europe by cancer registry

Female
Country name Cancer registry Period N casesa Crude rateb ASRb
Eastern Europe
Bulgaria1 National 2008-2012 152 0.8 0.4
Czech Republic1 National 2008-2012 243 0.9 0.4
Hungary - - - - -
Poland1 Kielce 2008-2012 5 0.2 0.1
Lower Silesia 2008-2012 40 0.5 0.2
Lublin 2008-2012 26 0.5 0.2
Podkarpackie 2008-2012 29 0.5 0.3
Poznan 2008-2012 32 0.4 0.2
Romania - - - - -
Russian Federation1 Arkhangelsk 2008-2012 12 0.4 0.2
Chelyabinsk 2008-2012 44 0.5 0.3
Karelia 2008-2012 8 0.4 0.2
Samara 2008-2012 53 0.6 0.3
Ukraine1 National 2008-2012 740 0.6 0.3
Northern Europe
Estonia1 National 2008-2012 35 1 0.5
Latvia1 National 2010-2012 27 0.8 0.4
Lithuania1 National 2008-2012 54 0.6 0.3
Norway1 National 2008-2012 76 0.6 0.3
Sweden2 National 2003-2007 205 0.9 0.3
United Kingdom1 England 2008-2012 1081 0.8 0.4
England, East 2008-2012 94 0.6 0.3
England, East Midlands 2008-2012 109 1 0.5
England, London 2008-2012 155 0.8 0.5
England, North East 2008-2012 36 0.5 0.3
England, North West 2008-2012 141 0.8 0.4
England, South West 2008-2012 122 0.9 0.4
England, West Midlands 2008-2012 103 0.7 0.4
England, Yorkshire and The Humber 2008-2012 151 1.1 0.6
National 2008-2012 1323 0.8 0.4
Scotland 2008-2012 130 1 0.5
Wales 2008-2012 71 0.9 0.5
Southern Europe


Female
Albania - - - - -
Andorra - - - - -
Bosnia & - - - - -
Herzegovina
Cyprus1 National 2008-2012 9 0.4 0.3
Greece - - - - -
Barletta 2008-2011 4 0.5 0.3
Bergamo 2008-2012 23 0.8 0.4
Biella 2008-2012 8 1.7 0.4
Caserta 2008-2010 2 0.1 0.1
Catania, Messina and Enna 2008-2012 23 0.5 0.2
Como 2008-2011 9 0.8 0.3
Cremona 2008-2010 8 1.4 0.4
Ferrara 2008-2011 4 0.5 0.1
Friuli-Venezia Giulia 2008-2010 19 1 0.4
Latina 2008-2012 11 0.8 0.4
Lecco 2008-2010 2 0.4 0.2
Mantua 2008-2010 2 0.3 0.1
Milan 2008-2012 71 1 0.4
Modena 2008-2012 16 0.9 0.3
Monza 2008-2012 18 0.8 0.4
Naples 2008-2012 5 0.3 0.2
Nuoro 2008-2012 1 0.2 0
Palermo 2008-2012 13 0.4 0.2
Parma 2008-2012 6 0.5 0.2
Piacenza 2008-2011 5 0.9 0.4
Ragusa and Caltanissetta 2008-2012 7 0.5 0.2
Reggio Emilia 2008-2012 6 0.4 0.2
Romagna 2008-2012 31 1 0.4
Sassari 2008-2011 3 0.3 0.2
Sondrio 2008-2012 6 1.3 0.6
South Tyrol 2008-2010 7 0.9 0.3
Syracuse 2008-2012 4 0.4 0.2
Taranto 2008-2011 6 0.5 0.3
Trento 2008-2010 7 0.9 0.6
Turin 2008-2012 78 1.3 0.5
Umbria 2008-2011 9 0.5 0.1
Varese 2008-2012 9 0.4 0.2
Veneto 2008-2010 32 0.8 0.4
Macedonia - - - - -
Malta1 National 2008-2012 9 0.9 0.6
Portugal1 Azores 2008-2011 3 0.6 0.4
Serbia2 Central 2003-2007 112 0.8 0.4
Spain1 Albacete 2008-2010 1 0.2 0
Asturias 2008-2010 18 1.1 0.4
Basque Country 2008-2012 34 0.6 0.3
Canary Islands 2008-2011 13 0.4 0.2


Female
Castellón 2008-2012 10 0.7 0.4

Ciudad Real 2008-2011 7 0.7 0.2
Cuenca 2008-2011 2 0.5 0
Girona 2008-2012 5 0.3 0.1
Granada 2008-2012 9 0.4 0.2
La Rioja 2008-2012 3 0.4 0.2
Mallorca 2008-2011 12 0.7 0.4
Murcia 2008-2010 7 0.3 0.2
Navarra 2008-2010 5 0.5 0.3
Tarragona 2008-2012 10 0.5 0.2
Western Europe
National 2008-2012 191 0.9 0.4
Tyrol 2008-2012 8 0.4 0.2
Vorarlberg 2008-2012 7 0.7 0.3
Belgium1 National 2008-2012 208 0.8 0.3
France1 Bas-Rhin 2008-2011 14 0.6 0.3
Calvados 2008-2012 5 0.3 0.1
Doubs 2008-2012 7 0.5 0.2
Gironde 2008-2012 16 0.4 0.2
Haut-Rhin 2008-2012 16 0.8 0.3
Hérault 2008-2012 15 0.5 0.2
Isère 2008-2012 15 0.5 0.3
Lille-Métropole 2008-2012 11 0.5 0.3
Limousin 2009-2012 2 0.3 0.1
Manche 2008-2011 3 0.3 0.1
Martinique 2008-2012 1 0.1 0
Somme 2008-2012 16 1.1 0.5
Tarn 2008-2012 5 0.5 0.2
Vendée 2008-2012 10 0.6 0.3
Germany1 Bavaria 2008-2012 279 0.9 0.4
Bremen 2008-2012 18 1.1 0.4
Hamburg 2008-2012 85 1.9 0.8
Lower Saxony 2008-2012 237 1.2 0.5
Munich 2008-2012 104 0.9 0.4
Rhineland-Palatinate 2008-2012 107 1 0.4
Saarland 2008-2012 35 1.3 0.5
Schleswig-Holstein 2008-2012 72 1 0.4
Monaco - - - - -
Geneva 2008-2012 8 0.7 0.2
Neuchâtel 2008-2012 4 0.9 0.3
Ticino 2008-2012 7 0.8 0.2
Valais 2008-2012 1 0.1 0
Vaud 2008-2012 22 1.2 0.5
Zurich 2008-2012 27 0.8 0.4


b Rates per 100,000 women per year.
Data sources:
Figure 53: Time trends in vaginal cancer incidence in Austria (cancer registry data)
5
(per 100,000)
4
3
All ages
2 ●
●
● ● ● 15−44 yrs
1 ●
● ● ●
● ●
● ● ● ●
0 45−74 yrs
1993*
1994*
1995*
1996*
1997*
1998
1999*
2000*
2001*
2002*
2003*
2004*
2005*
2006*
2007*
Data sources:
Figure 54: Time trends in vaginal cancer incidence in Croatia (cancer registry data)
5
(per 100,000)
4
3
All ages
2
15−44 yrs
1 ● ● ● ●
● ● ● ● ●
● ●
●
●
● ● ● ● ● ●
0
● 45−74 yrs
1988
1989
1990
1991*
1992*
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002*
2003*
2004
2005*
2006
2007

Data sources:
Figure 55: Time trends in vaginal cancer incidence in Denmark (cancer registry data)
5
(per 100,000)
4
3
All ages
2
●
● ●
●
● ●
● ●
● ● 15−44 yrs
1 ●
●
● ● ●
●
● ● ● ● ●
● ● ● ● ● ● ● ●
●
0 45−74 yrs
1978
1979
1980*
1981
1982
1983*
1984
1985*
1986*
1987*
1988
1989
1990
1991*
1992
1993
1994*
1995
1996
1997
1998*
1999
2000
2001*
2002
2003
2004*
2005*
2006*
2007


Data sources:
Figure 56: Time trends in vaginal cancer incidence in Estonia (cancer registry data)
5
(per 100,000)
4
3
All ages
2 ● ●
● ● ●
● ● ● ● ● ● ●
● ● ●
● ●
15−44 yrs
1 ● ●
●
● ●
● ● ● ● ● ●
● ● ● ● ● ●
● ● ● ●
0 ● ● 45−74 yrs
1968*
*
1970*
*
1972
*
1974*
1976*
*
1978*
*
1980*
*
1982*
*
1984*
*
1986*
*
1988*
*
1990*
*
1992
*
1994
*
1996
*
1998*
*
2000*
2002
*
2004*
2006*
*
Data sources:
Figure 57: Time trends in vaginal cancer incidence in France (cancer registry data)
5
(per 100,000)
4
3
All ages
2
● ●
● 15−44 yrs
1 ● ● ● ● ● ● ● ●
● ● ● ● ●
● ● ● ●
0 45−74 yrs
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000*
2001
2002*
2003*
2004*
2005
2006
2007

Data sources:
Figure 58: Time trends in vaginal cancer incidence in Iceland (cancer registry data)
10
(per 100,000)
8
6
All ages
4
● 15−44 yrs
2 ●
● ● ● ● ● ●
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
0 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 45−74 yrs
1958*
*
1960*
*
1962*
*
1964*
*
1966*
*
1968*
*
1970*
*
1972
*
1974*
*
1976*
*
1978*
*
1980*
*
1982*
*
1984*
*
1986*
*
1988*
*
1990*
*
1992*
*
1994*
1996*
*
1998*
*
2000*
*
2002*
*
2004*
*
2006*
*


Data sources:
Figure 59: Time trends in vaginal cancer incidence in Italy (cancer registry data)
2
(per 100,000)
1 ● ● All ages
● ● ● ● ● ● ●
● ● ● ●
● ●
15−44 yrs
0 45−74 yrs
1993
1994
1995*
1996
1997
1998*
1999
2000*
2001*
2002
2003
2004
2005
2006*
2007
Data sources:
Figure 60: Time trends in vaginal cancer incidence in Netherlands (cancer registry data)
2
(per 100,000)
1 All ages
● ● ●
● ● ● ● ● ● ● ● ● ●
● ● ● ● ● ● 15−44 yrs
0 45−74 yrs
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998*
1999
2000
2001
2002
2003
2004
2005*
2006
2007*

Data sources:
Figure 61: Time trends in vaginal cancer incidence in Poland (cancer registry data)
5
(per 100,000)
4
3
All ages
2
●
●
● 15−44 yrs
1 ● ● ● ● ● ● ● ● ● ●
●
● ● ● ● ● ●
0 ●
●
● ●
● ●
●
●
● 45−74 yrs
1978*
1979*
1980*
1981*
1982
1983*
1984
1985*
1986*
1987*
1988*
1989*
1990*
1991*
1992*
1993*
1994*
1995*
1996*
1997
1998*
1999*
2000*
2001*
2002*
2003*
2004*
2005*
2006*


Data sources:
Figure 62: Time trends in vaginal cancer incidence in Russian Federation (cancer registry data)
2
(per 100,000)
● ● ●
1 ● All ages
● ●
● ● ● ●
● ● ●
●
15−44 yrs
0 45−74 yrs
1994
1995
1996
1997
1998*
1999
2000
2001*
2002
2003*
2004
2005*
2006
2007*
Data sources:
Figure 63: Time trends in vaginal cancer incidence in Slovakia (cancer registry data)
5
(per 100,000)
4
3
All ages
2
15−44 yrs
1 ● ●
● ● ● ● ● ● ● ●
●
● ● ●
●
●
● ● ● ● ● ●
●
● ● ● ● ● ● ● ● ● ● ● ●
0 45−74 yrs
1973
1974*
1975*
1976*
1977
1978*
1979*
1980
1981
1982
1983
1984*
1985
1986
1987*
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004*
2005
2006*
2007

Data sources:
Figure 64: Time trends in vaginal cancer incidence in Spain (cancer registry data)
2
(per 100,000)
1 All ages
●
● ●
●
●
●
●
●
●
●
●
●
15−44 yrs
●
●
0
● 45−74 yrs
1993*
1994*
1995*
1996*
1997
1998
1999
2000*
2001
2002
2003
2004*
2005
2006
2007*


Data sources:
Figure 65: Time trends in vaginal cancer incidence in Switzerland (cancer registry data)
2
(per 100,000)
1 ● ● ● All ages
● ● ● ●
● ●
● ● ●
● ● 15−44 yrs
0 45−74 yrs
1993
1994
1995*
1996
1997*
1998
1999*
2000*
2001*
2002*
2003*
2004*
2005*
2006
2007*
Data sources:
Figure 66: Time trends in vaginal cancer incidence in United Kingdom (cancer registry data)
2
(per 100,000)
1 ● ● ● ● All ages
● ● ● ● ●
● ● ● ● ● ●
15−44 yrs
0 45−74 yrs
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:
NOTE.

available data.

3.2.4 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 50-70 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 pe-
nile 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 60-100% of PeIN lesions are HPV DNA
positive.
Table 10: Incidence of penile cancer in Europe by cancer registry

Male
Eastern Europe
Bulgaria1 National 2008-2012 262 1.4 0.8
Czech Republic1 National 2008-2012 432 1.7 1
Hungary2 County Szabolcs-Szatmar 1983-1987 12 0.8 0.7
County Vas 1983-1987 4 0.6 0.4
Poland1 Kielce 2008-2012 29 0.9 0.6
Lower Silesia 2008-2012 89 1.3 0.8
Lublin 2008-2012 58 1.1 0.8
Podkarpackie 2008-2012 55 1.1 0.8
Poznan 2008-2012 106 1.3 0.9
Romania2 County Cluj 1983-1987 17 0.9 0.8
Russian Federation1 Arkhangelsk 2008-2012 29 1 0.9
Chelyabinsk 2008-2012 68 0.9 0.6
Karelia 2008-2012 12 0.8 0.7
Samara 2008-2012 59 0.8 0.6
Ukraine1 National 2008-2012 1076 1 0.7
Northern Europe
Estonia1 National 2008-2012 52 1.7 1.1
Latvia1 National 2010-2012 46 1.6 1
Lithuania1 National 2008-2012 123 1.7 1
Norway1 National 2008-2012 203 1.7 1
Sweden3 National 2003-2007 412 1.8 1
United Kingdom1 England 2008-2012 2202 1.7 1
England, East 2008-2012 224 1.6 0.8
England, East Midlands 2008-2012 210 1.9 1
England, London 2008-2012 199 1 0.8
England, North East 2008-2012 111 1.8 1
England, North West 2008-2012 398 2.3 1.3
England, South West 2008-2012 255 2 1
England, West Midlands 2008-2012 231 1.7 1
England, Yorkshire and The Humber 2008-2012 245 1.9 1.1


Male
National 2008-2012 2758 1.8 1

Scotland 2008-2012 302 2.4 1.4
Wales 2008-2012 163 2.2 1.2
Southern Europe
Albania - - - - -
Andorra - - - - -
Bosnia & - - - - -
Herzegovina
Cyprus1 National 2008-2012 39 1.9 1.2
Greece - - - - -
Barletta 2008-2011 13 1.7 1.1
Bergamo 2008-2012 34 1.3 0.7
Biella 2008-2012 7 1.6 0.6
Caserta 2008-2010 14 1.1 0.6
Catania, Messina and Enna 2008-2012 95 2.1 1
Como 2008-2011 5 0.4 0.2
Cremona 2008-2010 5 0.9 0.4
Ferrara 2008-2011 10 1.5 0.6
Friuli-Venezia Giulia 2008-2010 33 1.8 0.8
Latina 2008-2012 24 1.8 1
Lecco 2008-2010 9 1.8 1
Mantua 2008-2010 8 1.4 0.5
Milan 2008-2012 108 1.6 0.8
Modena 2008-2012 21 1.3 0.5
Monza 2008-2012 24 1.2 0.6
Naples 2008-2012 20 1.4 1
Nuoro 2008-2012 3 0.6 0.2
Palermo 2008-2012 58 1.9 1.1
Parma 2008-2012 13 1.3 0.6
Piacenza 2008-2011 8 1.4 0.8
Ragusa and Caltanissetta 2008-2012 27 1.9 1
Reggio Emilia 2008-2012 17 1.3 0.7
Romagna 2008-2012 56 1.9 0.8
Sassari 2008-2011 16 1.7 0.9
Sondrio 2008-2012 5 1.1 0.5
South Tyrol 2008-2010 12 1.6 0.9
Syracuse 2008-2012 18 1.8 0.9
Taranto 2008-2011 21 1.9 0.9
Trento 2008-2010 13 1.7 0.8
Turin 2008-2012 71 1.3 0.5
Umbria 2008-2011 31 1.8 0.7
Varese 2008-2012 15 0.7 0.3
Veneto 2008-2010 43 1.2 0.6
Macedonia - - - - -
Malta1 National 2008-2012 13 1.3 0.7
Portugal1 Azores 2008-2011 7 1.4 1.2
Serbia3 Central 2003-2007 175 1.3 0.8


Male

Spain1 Albacete 2008-2010 11 1.8 1.1
Asturias 2008-2010 35 2.3 1
Basque Country 2008-2012 97 1.8 0.8
Canary Islands 2008-2011 53 1.5 1
Castellón 2008-2012 49 3.2 1.6
Ciudad Real 2008-2011 16 1.5 0.5
Cuenca 2008-2011 4 0.9 0.3
Girona 2008-2012 37 2 1.1
Granada 2008-2012 48 2.1 1.2
La Rioja 2008-2012 10 1.2 0.5
Mallorca 2008-2011 29 1.7 1
Murcia 2008-2010 31 1.4 0.9
Navarra 2008-2010 17 1.8 1
Tarragona 2008-2012 37 1.8 1
Western Europe
National 2008-2012 295 1.4 0.8
Tyrol 2008-2012 31 1.8 1
Vorarlberg 2008-2012 6 0.7 0.4
Belgium1 National 2008-2012 413 1.6 0.8
France1 Bas-Rhin 2008-2011 21 1 0.6
Calvados 2008-2012 16 1 0.5
Doubs 2008-2012 12 0.9 0.5
Gironde 2008-2012 33 0.9 0.5
Haut-Rhin 2008-2012 25 1.4 0.7
Hérault 2008-2012 33 1.3 0.5
Isère 2008-2012 30 1 0.6
Lille-Métropole 2008-2012 21 1.1 0.7
Limousin 2009-2012 9 1.2 0.5
Manche 2008-2011 18 1.8 0.8
Martinique 2008-2012 16 1.8 0.9
Somme 2008-2012 17 1.2 0.6
Tarn 2008-2012 18 2 0.8
Vendée 2008-2012 19 1.2 0.6
Germany1 Bavaria 2008-2012 446 1.5 0.7
Bremen 2008-2012 45 2.8 1.4
Hamburg 2008-2012 77 1.8 1
Lower Saxony 2008-2012 412 2.1 1
Munich 2008-2012 157 1.4 0.7
Rhineland-Palatinate 2008-2012 184 1.9 0.9
Saarland 2008-2012 45 1.8 0.9
Schleswig-Holstein 2008-2012 142 2.1 1
Monaco - - - - -
Geneva 2008-2012 17 1.6 0.9
Neuchâtel 2008-2012 5 1.2 0.6


Male

Ticino 2008-2012 15 1.8 0.7
Valais 2008-2012 16 2.1 1
Vaud 2008-2012 22 1.3 0.7
Zurich 2008-2012 44 1.3 0.7
b Rates per 100,000 men per year.
Data sources:
2 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.
Figure 67: Time trends in penile cancer incidence in Austria (cancer registry data)
5
(per 100,000)
4
3
All ages
2
● ●
●
15−44 yrs
1 ●
●
●
●
●
●
● ●
● ● ●
0 ● 45−74 yrs
1993
1994*
1995*
1996
1997*
1998*
1999*
2000
2001*
2002*
2003
2004*
2005*
2006*
2007*

Data sources:
Figure 68: Time trends in penile cancer incidence in Croatia (cancer registry data)
5
(per 100,000)
4
3
All ages
2
●
● ●
● 15−44 yrs
1 ● ● ● ● ● ● ● ●
● ● ●
● ● ●
0
● ● 45−74 yrs
1988
1989*
1990
1991*
1992
1993
1994
1995
1996
1997
1998*
1999
2000
2001
2002
2003
2004
2005
2006*
2007

Data sources:

Figure 69: Time trends in penile cancer incidence in Denmark (cancer registry data)
5
(per 100,000)
4
3
● ● ●
All ages
2 ● ● ●
●
●
●
●
●
●
● ●
● ●
● ● ●
● ● ●
● ● ● ● ● ● ● ●
15−44 yrs
1
0 45−74 yrs
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992*
1993
1994
1995
1996*
1997
1998
1999
2000*
2001*
2002
2003
2004
2005
2006
2007
Data sources:
Figure 70: Time trends in penile cancer incidence in Estonia (cancer registry data)
10
(per 100,000)
8
6
All ages
4
15−44 yrs
2 ● ●
● ●
● ●
●
● ● ● ● ● ● ● ● ● ● ●
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
0 ● 45−74 yrs
1968
*
1970*
1972
1974
1976
*
1978*
*
1980*
1982*
*
1984*
*
1986*
*
1988*
1990
1992
*
1994*
*
1996
*
1998
*
2000
2002*
*
2004
2006*

Data sources:
Figure 71: Time trends in penile cancer incidence in France (cancer registry data)
5
(per 100,000)
4
3
All ages
2
●
●
● ●
● ●
●
●
● ● ● ● ●
15−44 yrs
1 ●
●
● ● ●
● ●
0 45−74 yrs
1988
1989
1990
1991
1992
1993
1994
1995*
1996
1997
1998
1999
2000*
2001
2002
2003
2004
2005
2006*
2007

Data sources:

Figure 72: Time trends in penile cancer incidence in Iceland (cancer registry data)
14
(per 100,000)
12
10
8 All ages
6
4 ● ● ●
15−44 yrs
● ● ● ●
2 ●
●
● ●
● ● ● ● ●
● ●
●
0 ● ● ● ● ● ● ● ●
● ●
● ●
●
● ● ●
●
● ● ●
● ●
●
● ● ● ● ● ●
●
● 45−74 yrs
1958*
*
1960*
*
1962*
*
1964*
*
1966*
*
1968*
*
1970*
*
1972*
*
1974*
*
1976*
*
1978*
*
1980*
*
1982*
*
1984*
*
1986*
*
1988*
*
1990*
*
1992
*
1994*
*
1996*
*
1998
*
2000*
*
2002*
*
2004*
*
2006*
*
Data sources:
Figure 73: Time trends in penile cancer incidence in Italy (cancer registry data)
5
(per 100,000)
4
3
All ages
2 ●
● ●
● ● ● ● ● ● ● ● ●
15−44 yrs
1 ● ● ●
0 45−74 yrs
1993
1994*
1995
1996*
1997
1998
1999*
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:
Figure 74: Time trends in penile cancer incidence in Netherlands (cancer registry data)
5
(per 100,000)
4
3
All ages
2
● ●
●
● ● ● ●
● ● ● ● ● ● ●
15−44 yrs
1 ●
● ●
● ●
0 45−74 yrs
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:

Figure 75: Time trends in penile cancer incidence in Poland (cancer registry data)
10
(per 100,000)
8
6
All ages
4
● 15−44 yrs
2 ● ●
● ● ● ● ● ● ● ● ●
0 ● ● ●
● ●
●
● ● ● ● ● ●
●
●
● ● ● 45−74 yrs
1978*
1979*
1980*
1981
1982
1983*
1984*
1985
1986*
1987*
1988*
1989*
1990*
1991
1992*
1993*
1994*
1995*
1996*
1997*
1998*
1999*
2000*
2001*
2002
2003*
2004*
2005
2006
Data sources:
Figure 76: Time trends in penile cancer incidence in Russian Federation (cancer registry data)
5
(per 100,000)
4
3
All ages
2
15−44 yrs
1 ● ● ● ●
●
●
●
●
●
●
● ● ●
0 ● 45−74 yrs
1994
1995
1996
1997
1998*
1999
2000*
2001*
2002*
2003
2004
2005*
2006
2007

Data sources:
Figure 77: Time trends in penile cancer incidence in Slovakia (cancer registry data)
5
(per 100,000)
4
3
All ages
2
● ● ● ● ● ● ● 15−44 yrs
1 ● ● ● ● ●
● ● ● ● ● ● ● ●
●
● ●
● ●
●
● ● ● ● ●
● ● ● ●
0 45−74 yrs
1973*
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985*
1986
1987
1988
1989
1990
1991*
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001*
2002
2003
2004
2005
2006
2007

Data sources:

Figure 78: Time trends in penile cancer incidence in Spain (cancer registry data)
5
(per 100,000)
4
3
● ● ● ● All ages
2 ● ● ● ● ● ●
●
●
● ●
● 15−44 yrs
1
0 45−74 yrs
1993
1994
1995*
1996*
1997
1998
1999
2000*
2001*
2002
2003
2004
2005
2006
2007
Data sources:
Figure 79: Time trends in penile cancer incidence in Switzerland (cancer registry data)
5
(per 100,000)
4
3
●
All ages
2 ● ●
●
●
● ●
● ● ● ● ● ● 15−44 yrs
1 ● ●
0 45−74 yrs
1993*
1994*
1995*
1996*
1997
1998
1999*
2000
2001*
2002
2003*
2004
2005
2006
2007

Data sources:
Figure 80: Time trends in penile cancer incidence in United Kingdom (cancer registry data)
5
(per 100,000)
4
3
All ages
2 ● ● ● ● ●
● ●
● ● ● ● ● ●
●
●
15−44 yrs
1
0 45−74 yrs
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007

Data sources:

NOTE.

available data.

3.3 Head and neck cancers

The majority of head and neck cancers are associated with high tobacco and alcohol consumption. How-
ever, increasing trends in the incidence at specific sites suggest that other aetiological factors are in-
volved, 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 can-
cer 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 81: Age-standardised incidence rates of head and neck cancer in Europe (estimates for 2012)

Head and neck cancer cases (oropharynx, oral cavity and larynx).

- For Albania, Greece, Hungary, Republic of Moldova, Macedonia, Montenegro: No data.
- For Austria, Belgium, Bulgaria, Belarus, Cyprus, Czech Republic, Denmark, Estonia, Finland, United Kingdom, Croatia, Ireland, Iceland, Lithuania, Latvia, Malta, Netherlands, Norway,
Slovakia, Slovenia, Sweden, Ukraine: High quality national data or high quality regional (coverage greater than 50%).
- For Bosnia & Herzegovina, Luxembourg, Russian Federation: National data (rates).
- For Switzerland, Germany, Spain, France, Italy, Serbia: High quality regional (coverage between 10% and 50%).
- For Albania, Greece, Hungary, Luxembourg, Republic of Moldova, Macedonia, Portugal, Romania, Serbia: Estimated from national mortality estimates by modelling using incidence
- For Austria, Bulgaria, Belarus, Czech Republic, Germany, Denmark, Estonia, Finland, United Kingdom, Croatia, Ireland, Iceland, Lithuania, Latvia, Malta, Netherlands, Norway, Russian
Federation, Slovakia, Slovenia, Sweden: Rates projected to 2012
- For Belgium, Bosnia & Herzegovina, Cyprus, Ukraine: Most recent rates applied to 2012 population
- For Switzerland, Spain, France, Italy, Poland: Estimated from national mortality by modelling using incidence mortality ratios derived from recorded data in country-specific cancer
registries

Figure 82: Age-standardised incidence rate of head and neck cancer cases attributable to HPV by
country in Europe (estimates for 2012)
Hungary 3.0
Slovakia 2.1
Romania 2.0
France 1.9
Germany 1.8
Belgium 1.7
Moldova 1.5
Denmark 1.5
Czech Rep. 1.4
Belarus 1.4
Poland 1.3
Luxembourg 1.3
Switzerland 1.3
Austria 1.3
Ukraine 1.2
Lithuania 1.2
Russia 1.0
Portugal 1.0
UK 1.0
Bulgaria 1.0
Netherlands 0.9
Latvia 0.9
Ireland 0.9
Estonia 0.9
Slovenia 0.8
Serbia 0.8
Norway 0.8
Croatia 0.8
Sweden 0.7
Montenegro 0.7
Finland 0.6
Spain 0.6
Malta 0.5
Italy 0.5
Iceland 0.5
Bosnia & H. 0.5
Macedonia 0.4
Albania 0.4
Greece 0.3
Cyprus 0.2
San Marino**
Monaco**
Liechtenstein**
Andorra**
0 2.5 5
Age−standardised incidence rate per 100,0000 women

World Standard



Head and neck cancer cases (oropharynx, oral cavity and larynx).

- 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 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
- 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 2012
- 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
3.3.1 Oropharyngeal cancer
Table 11: Cancer incidence of the oropharynx in Europe and its regions by sex. Includes ICD-10 codes:
C09-10 (estimates for 2018).
MALE FEMALE
Area N cases Crudea ASRa Cum riskb N cases Crudea ASRa Cum riskb
rate (%) ages rate (%) ages
0-74 0-74
Europe 21414 6.00 3.60 0.45 6560 1. 7 0.9 0.11
Eastern Europe 8477 6.20 4.10 0.50 1965 1. 3 0.7 0.09
Belarus 471 10.70 7.30 0.88 29 0. 6 0.3 0.04
Bulgaria 81 2.40 1.40 0.17 24 0. 7 0.3 0.03
Czech Rep. 405 7.80 4.70 0.56 157 2. 9 1.6 0.19
Hungary 518 11.20 7.30 0.83 216 4. 3 2.4 0.30
Moldova 182 9.40 6.90 0.85 11 0. 5 0.3 0.03
Poland 1243 6.80 4.30 0.52 501 2. 5 1.4 0.18
Romania 1160 12.20 7.80 0.94 152 1. 5 0.8 0.09
Russia 2736 4.10 2.80 0.35 642 0. 8 0.5 0.06
Slovakia 266 10.00 6.60 0.79 35 1. 2 0.7 0.09
Ukraine 1415 7.00 4.70 0.57 198 0. 8 0.5 0.05
Northern Europe 3103 6.00 3.90 0.46 998 1. 9 1.1 0.13
Denmark 333 11.60 7.00 0.85 100 3. 5 2.0 0.24
Estonia 27 4.40 2.80 0.38 4 0. 6 0.4 0.04
Finland 33 1.20 0.60 0.07 34 1. 2 0.6 0.06
Iceland 5 2.90 2.00 0.20 - − − −
Ireland 73 3.10 2.10 0.25 22 0. 9 0.6 0.07
Latvia 33 3.70 2.30 0.30 7 0. 7 0.3 0.04
Lithuania 67 5.10 3.20 0.40 9 0. 6 0.3 0.04
Norway 140 5.20 3.30 0.41 30 1. 1 0.7 0.08
Sweden 70 1.40 0.70 0.08 55 1. 1 0.6 0.06
UK 2313 7.00 4.60 0.55 736 2. 2 1.3 0.16
Southern Europe 2943 3.90 2.20 0.27 668 0. 9 0.4 0.05
Albania 15 1.00 0.60 0.07 11 0. 8 0.4 0.06
Andorra - − − − - − − −
Bosnia & H. 29 1.70 1.00 0.12 5 0. 3 0.1 0.01
Croatia 108 5.40 3.20 0.39 15 0. 7 0.4 0.04
Cyprus - − − − - − − −
Greece 51 0.90 0.50 0.06 11 0. 2 0.1 0.01
Italy 1099 3.80 1.90 0.24 320 1. 1 0.5 0.06
Macedonia - − − − - − − −
Malta 6 2.80 1.50 0.23 - − − −
Montenegro 20 6.40 4.10 0.52 11 3. 5 1.9 0.24
Portugal 317 6.50 4.00 0.44 24 0. 4 0.2 0.02
San Marino - − − − - − − −
Serbia 193 4.50 3.10 0.34 58 1. 3 0.7 0.09
Slovenia 114 11.00 6.40 0.75 18 1. 7 1.0 0.13
Spain 972 4.30 2.40 0.31 193 0. 8 0.4 0.06
Western Europe 6891 7.20 4.00 0.51 2929 3. 0 1.6 0.20
Austria 270 6.30 3.70 0.44 80 1. 8 1.0 0.13
Belgium 370 6.50 3.80 0.50 127 2. 2 1.3 0.15
France 3322 10.40 6.50 0.78 1332 4. 0 2.4 0.28


MALE FEMALE
0-74 0-74
Germany 2367 5.80 2.90 0.39 1088 2. 6 1.2 0.17
Liechtenstein - − − − - − − −
Luxembourg 19 6.40 4.00 0.57 3 1. 0 0.7 0.09
Monaco - − − − - − − −
Netherlands 313 3.70 2.00 0.25 167 1. 9 1.0 0.13
Switzerland 227 5.40 3.00 0.37 132 3. 1 1.7 0.21
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:
Table 12: Cancer mortality of the oropharynx in Europe and its regions by sex. Includes ICD-10 codes:
C09-10 (estimates for 2018).
MALE FEMALE
0-74 0-74
Europe 10708 3.00 1.70 0.22 2283 0. 6 0.3 0.03
Eastern Europe 4970 3.60 2.40 0.30 738 0. 5 0.2 0.03
Belarus 277 6.30 4.30 0.52 14 0. 3 0.2 0.02
Bulgaria 72 2.10 1.20 0.15 11 0. 3 0.1 0.01
Czech Rep. 154 2.90 1.70 0.21 39 0. 7 0.3 0.04
Hungary 267 5.80 3.70 0.43 73 1. 4 0.8 0.10
Moldova 123 6.30 4.60 0.59 6 0. 3 0.2 0.01
Poland 652 3.50 2.20 0.27 182 0. 9 0.5 0.06
Romania 608 6.40 4.00 0.49 61 0. 6 0.3 0.03
Russia 1688 2.50 1.70 0.22 242 0. 3 0.2 0.02
Slovakia 194 7.30 4.60 0.61 23 0. 8 0.4 0.05
Ukraine 935 4.60 3.10 0.38 87 0. 4 0.2 0.02
Northern Europe 1008 2.00 1.00 0.14 309 0. 6 0.3 0.04
Denmark 99 3.50 1.80 0.23 32 1. 1 0.5 0.07
Estonia 16 2.60 1.50 0.18 2 0. 3 0.2 0.02
Finland 29 1.10 0.50 0.08 9 0. 3 0.1 0.01
Iceland - − − − - − − −
Ireland 35 1.50 0.90 0.12 10 0. 4 0.2 0.04
Latvia 35 3.90 2.40 0.30 4 0. 4 0.3 0.03
Lithuania 61 4.60 2.90 0.36 9 0. 6 0.3 0.03
Norway 23 0.90 0.40 0.06 8 0. 3 0.2 0.02
Sweden 54 1.10 0.50 0.07 16 0. 3 0.1 0.02
UK 653 2.00 1.00 0.14 219 0. 6 0.3 0.04
Southern Europe 1557 2.10 1.10 0.13 317 0. 4 0.2 0.02
Albania 11 0.70 0.40 0.05 6 0. 4 0.2 0.03
Andorra - − − − - − − −
Bosnia & H. 20 1.20 0.70 0.10 2 0. 1 0.0 0.01
Croatia 87 4.30 2.50 0.31 12 0. 6 0.3 0.03
Cyprus - − − − - − − −
Greece 31 0.60 0.30 0.03 8 0. 1 0.1 0.01
Italy 541 1.90 0.80 0.11 154 0. 5 0.2 0.02
Macedonia - − − − - − − −
Malta 2 0.92 0.54 0.07 - − − −
Montenegro - − − − - − − −
Portugal 165 3.40 1.90 0.22 17 0. 3 0.1 0.01
San Marino - − − − - − − −
Serbia 113 2.60 1.60 0.19 22 0. 5 0.2 0.03
Slovenia 64 6.20 3.30 0.41 8 0. 8 0.3 0.04
Spain 514 2.30 1.20 0.15 87 0. 4 0.2 0.02
Western Europe 3173 3.30 1.70 0.22 919 0. 9 0.4 0.06
Austria 172 4.00 2.10 0.27 33 0. 7 0.3 0.04
Belgium 187 3.30 1.80 0.23 36 0. 6 0.3 0.04
France 901 2.80 1.60 0.20 289 0. 9 0.4 0.05
Germany 1713 4.20 2.10 0.27 461 1. 1 0.5 0.06
Liechtenstein - − − − - − − −


MALE FEMALE
0-74 0-74
Luxembourg 2 0.67 0.48 0.07 - − − −
Monaco - − − − - − − −
Netherlands 126 1.50 0.70 0.09 61 0. 7 0.3 0.04
Switzerland 72 1.70 0.90 0.11 39 0. 9 0.4 0.06
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:

4 HPV-RELATED STATISTICS - 74 -
4 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. This section presents the HPV
burden at each of the anogenital tract sites. 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 within 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 re-
sults 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 HPV DNA detection in cervical cells (fresh tissue, paraffin embedded or exfoliated cells).
The prevalence of HPV increases with lesion severity. HPV causes virtually 100% of cervical cancer
cases, and an underestimation of HPV prevalence in cervical cancer is most likely due to the limitations
of study methodologies. Worldwide, HPV16 and 18 (the two vaccine-preventable types) contribute to
over 70% of all cervical cancer cases, between 41% and 67% of high-grade cervical lesions and 16-32%
of low-grade cervical lesions. After HPV16/18, 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, Vaccine 2006;24(S3):26).
Methods: Prevalence and type distribution of human papillomavirus in cervical carcinoma,

low-grade cervical lesions, high-grade cervical lesions and normal cytology: systematic re-
view 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 high-
grade cervical lesions and 100 cases for normal cytology and a detailed description of HPV DNA detec-
tion 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.

4.1.1 HPV prevalence in women with normal cervical cytology
Figure 83: Prevalence of HPV among women with normal cervical cytology in Europe
Data updated on 14 Jun 2019 (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.

Figure 84: Crude age-specific HPV prevalence (%) and 95% confidence interval in women with normal
cervical cytology in Europe and its regions

40 40
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
<25 25−34 35−44 45−54 55−64 65+ <25 25−34 35−44 45−54 55−64 65+

40 40
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
<25 25−34 35−44 45−54 55−64 65+ <25 25−34 35−44 45−54 55−64 65+
Northern Europe
40
35
30
25
20
15
10
5
0
<25 25−34 35−44 45−54 55−64 65+


Figure 85: 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) 15−63 322 23.6 (19.3−28.5)
Belgium Depuydt 2010 (Flanders)a 14−97 57,876 14.8 (14.5−15.1)
Arbyn 2009 (Antwerp) 15−85 8,729 11.9 (11.3−12.6)
Merckx 2014a,b 4−18 4,180 15.7 (14.6−16.8)
Baay 2005 (Antwerp) 20−50 2,293 6.9 (5.9−8.0)
Depuydt 2012 30−65 1,139 8.2 (6.7−9.9)
Schmitt 2013 (Flanders) 15−86 913 33.3 (30.3−36.4)
Weyn 2013 (Brussels) >=20 906 10.8 (9.0−13.0)
Depuydt 2003 (Flanders) 17−85 287 24.0 (19.5−29.3)
Baay 2001 (Antwerp) 17−78 286 10.8 (7.7−15.0)
Croatia Kaliterna 2007a,c 18−62 570 35.1 (31.3−39.1)
Grahovac 2007 (Zagreb,Rijeka) − 205 35.6 (29.4−42.4)
Czech Rep. Tachezy 2013 14−79 1,302 25.6 (23.3−28.0)
Denmark Kjær 2014 (Copenhagen)d 14−95 37,958 17.0 (16.6−17.4)
Nielsen 2012 (Copenhagen)e 14−95 37,958 6.3 (6.1−6.5)
Nielsen 2008 (Copenhagen) 20−29 10,220 15.9 (15.2−16.6)
f 16−89 4,671 33.4 (32.1−34.8)
Bonde 2014
Nielsen 2008 (Copenhagen) 40−50 1,443 4.4 (3.4−5.5)
Svare 1998 20−39 119 21.8 (15.4−30.1)
Estonia Uusküla 2010 (Tartu)a 18−35 326 36.8 (31.8−42.2)
g
Europe Paavonen 2008 16−24 9,162 15.9 (15.2−16.7)
Finland Leinonen 2008 (Uusimaa) 25−65 16,895 7.5 (7.2−7.9)
a
Auvinen 2005 (Helsinki) 19−47 1,469 33.0 (30.7−35.5)
France Clavel 2001 (Reims) 15−76 7,339 10.5 (9.9−11.3)
Monsonego 2011 (Paris) 20−65 4,004 12.6 (11.6−13.7)
Boulanger 2004 (Amiens) 20−62 3,617 12.6 (11.6−13.7)
h − 3,023 13.7 (12.5−15.0)
Heard 2013
Vaucel 2011 (Nantes) 17−86 980 13.1 (11.1−15.3)
Baudu 2014 (Franche−Comté) 15−23 948 24.1 (21.4−26.9)
Dalstein 2003 (Besançon) 16−76 652 27.0 (23.7−30.5)
Beby−Defaux 2004 (Poitiers) 17−77 613 5.2 (3.7−7.3)
i 16−76 426 25.1 (21.2−29.4)
Riethmuller 1999
Casalegno 2011 (Lyon) 15−88 302 48.3 (42.8−54.0)
Pannier−Stockman 2008 (Amiens) 18−78 289 28.7 (23.8−34.2)
Monsonego 2005 (Paris) 19−79 221 28.5 (23.0−34.8)
Germany Luyten 2009 (Wolfsburg) >=30 16,386 4.8 (4.5−5.1)
j
Petry 2003 30−85 7,832 5.9 (5.4−6.4)
Schneider 2000 (East Thuringia) 18−70 4,604 7.1 (6.4−7.9)
Iftner 2010 10−30 1,692 22.3 (20.4−24.3)
de Jonge 2013k >=20 1,463 29.8 (27.5−32.2)
0% 10% 20% 30% 40% 50% 60%

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 Flanders and Brussels
c Split and Dalmatian County
d HPV prevalence for high-risk HPV types
e Few HPV types tested: 6, 11, 42, 43, 44 only
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
k Nordrhein-Westfalen, Niedersachsen, Schleswig-Holstein, Bremen and Hamburg

study (continued)

Greece Agorastos 2009a − 4,139 5.9 (5.2−6.7)
Argyri 2013 (Athens) 14−70 2,218 15.7 (14.2−17.3)
Tsiodras 2011 − 1,348 39.5 (36.9−42.1)
Agorastos 2004b 17−69 1,272 2.0 (1.4−3.0)
Tsiodras 2010 (Athens) 21−45 1,029 10.2 (8.5−12.2)
Paraskevaidis 2001 (Ioannina) 17−79 738 6.4 (4.8−8.4)
Panotopoulou 2007 (Athens) 18−48 639 26.4 (23.2−30.0)
Hungary Nyári 2006 20−60 491 5.5 (3.8−7.9)
Ireland Anderson 2013 (Northern Ireland) 20−64 5,068 13.2 (12.3−14.2)
Keegan 2007 (Dublin) 16−72 886 11.4 (9.5−13.7)
Italy Ronco 2006c 35−60 15,361 5.5 (5.2−5.9)
Agarossi 2009 15−73 9,148 11.3 (10.7−12.0)
Ronco 2006c 25−34 5,334 9.6 (8.8−10.4)
d
Giorgi Rossi 2011 25−64 3,151 9.7 (8.8−10.8)
Tenti 1997 (Pavia) 16−47 1,064 12.3 (10.5−14.4)
Ronco 2005 (Turin) 25−70 997 7.8 (6.3−9.7)
e
Giambi 2013 18−26 907 13.6 (11.5−15.9)
Ammatuna 2008 (Sicily) 18−24 894 22.4 (19.8−25.2)
Del Prete 2008 (Apulia)a >=20 871 23.2 (20.5−26.1)
Verteramo 2009 (Rome) 17−57 737 21.7 (18.9−24.8)
f 16−26 566 18.2 (15.2−21.6)
Panatto 2013
Centurioni 2005 (Genova) 20−81 500 15.4 (12.5−18.8)
Sammarco 2013 (Molise) 18−63 398 32.4 (28.0−37.2)
Carozzi 2000 (Florence) 25−64 332 5.1 (3.2−8.0)
Masia 2009 (Sardinia) 18−46 309 17.8 (13.9−22.5)
Piana 2011 (North Sardinia) 15−54 242 32.2 (26.7−38.4)
Zappacosta 2009 (Molise) 21−64 220 6.4 (3.8−10.4)
Astori 1997 (Udine) 18−67 197 20.3 (15.3−26.5)
Tornesello 2006 (Milan, Naples) 18−63 183 19.7 (14.6−26.0)
Tornesello 2008 (Naples) − 107 11.2 (6.5−18.6)
Latvia Silins 2004a 18−89 237 8.0 (5.2−12.2)
a
Lithuania Kliucinskas 2006 18−50 1,001 25.1 (22.5−27.9)
Gudleviciene 2005 (Vilnius) 16−64 332 24.1 (19.8−29.0)
Simanaviciene 2014 (Vilnius) 18−81 277 24.2 (19.5−29.6)
Netherlands Rijkaart 2012 (Utrecht) 29−61 25,196 4.1 (3.8−4.3)
Bulkmans 2004 (Amsterdam) 30−60 21,245 3.6 (3.3−3.9)
Rijkaart 2012 30−56 19,373 4.0 (3.7−4.2)
Jacobs 2000 (Amsterdam) 16−68 3,299 4.4 (3.8−5.2)
Rozendaal 2000 (Amsterdam) 34−54 2,250 5.4 (4.5−6.4)
Lenselink 2008a,g 18−29 2,065 19.0 (17.4−20.8)
0% 10% 20% 30% 40% 50%

to the sample size.
a Women from the general population, including some with cytological cervical abnormalities


b Thessaloniki, Thermi, Mihaniona, Corfu, Veria and Serres
c Turin, Trento, Veneto, Emilia Romagna, Florence and Lazio
d Abruzzo, Campania, Lazio, Sardinia and Sicily
e Abruzzo, Campania, Lazio, Tuscany, Emilia-Romagna and Piedmont
f Turin, Milan and Genoa
g Arnhem, Nijmegen, and Den Bosch

study (continued)

Netherlands Boers 2014 30−60 900 3.8 (2.7−5.2)
Hesselink 2013 (Utrecht region) 31−60 858 8.2 (6.5−10.2)
Zielinski 2001 (Zeeland) 34−54 114 6.1 (3.0−12.1)
Norway Molden 2005 (Oslo) 30−69 3,970 9.3 (8.4−10.2)
a,b
Skjeldestad 2008 16−24 896 25.9 (23.1−28.9)
Molden 2006 (Oslo) <=30 275 30.9 (25.7−36.6)
Gjøoen 1996 (Oslo) 20−44 222 15.3 (11.2−20.6)
Poland Bardin 2008 (Warsaw) 18−59 799 14.4 (12.1−17.0)
Portugal Pista 2011 18−64 2,172 16.5 (15.0−18.1)
Vieira 2013 18−76 464 17.0 (13.9−20.7)
Pista 2011c 18−67 425 25.4 (21.5−29.8)
b
Dutra 2008 (Açores) 16−81 286 10.5 (7.4−14.6)
Romania Moga 2014 (Brasov County) 17−57 801 34.3 (31.1−37.7)
Ursu 2011 (Northeast) − 164 25.6 (19.5−32.8)
Russia Bdaizieva 2010 (Moscow)b 15−69 33,112 25.7 (25.2−26.1)
Kubanov 2005 (Moscow) − 8,533 15.0 (14.3−15.8)
Goncharevskaya 2011 (Moscow) 15−77 5,182 13.4 (12.5−14.4)
d
Rogovskaya 2013 16−76 833 25.9 (23.1−29.0)
Shipitsyna 2011 (St Petersburg) 30−65 741 9.9 (7.9−12.2)
Komarova 2010 (Moscow) 16−76 352 48.3 (43.1−53.5)
Alexandrova 1999e 15−45 309 29.1 (24.3−34.4)
Shargorodskaya 2011 (Moscow) 18−30 266 28.2 (23.1−33.9)
Shipulina 2011 (Moscow) 13−19 177 40.1 (33.2−47.5)
Slovenia Ucakar 2012 20−64 4,199 10.7 (9.8−11.7)
Ucakar 2014 20−64 944 8.8 (7.1−10.8)
Spain Castellsagué 2012 18−65 3,059 13.0 (11.9−14.2)
Martorell 2010 (Valencia)b 18−64 1,956 13.0 (11.6−14.5)
Bernal 2008 (Zaragoza) − 1,200 17.5 (15.5−19.8)
Dillner 2008 (Maresme) 14−82 939 7.3 (5.8−9.2)
de Sanjose 2003 (Barcelona) 14−75 847 1.3 (0.7−2.3)
Ortiz 2006 (Madrid and Alicante)b 14−67 818 10.8 (8.8−13.1)
González 2006 (Alicante) − 703 7.8 (6.1−10.0)
f 18−75 329 5.2 (3.3−8.1)
Muñoz 1996
g
Sweden Naucler 2007 29−46 5,877 5.5 (4.9−6.1)
b,g 32−38 5,772 9.7 (9.0−10.5)
Elfström 2014
Ylitalo 2000 (Uppsala) 15−49 617 5.8 (4.2−8.0)
h
Kjellberg 1998 20−63 295 4.1 (2.3−7.0)
Stenvall 2007 (Uppsala)b 35−50 117 25.6 (18.6−34.2)
Switzerland Bigras 2005i 17−93 13,349 6.3 (5.9−6.7)
UK Kitchener 2006 (Manchester) 20−64 21,380 10.4 (10.0−10.8)
0% 10% 20% 30% 40% 50% 60%

to the sample size.
a Oslo, Trondheim, and Levanger


b Women from the general population, including some with cytological cervical abnormalities
c Lisbon area and southern region
d Moscow and Novgorod
e St. Petersburg
f Alava, Girona, Guipuzcoa, Murcia, Navarra, Salamanca, Sevilla, Vizcaya, Zaragoza
g Gothenburg, Malmö, Uppsala, Umeå, and Stockholm
h Västerbotten County
i Geneve, Vaud, Neuchatel, Fribourg, Valais and Tessin

study (continued)

UK Hibbitts 2014 (Wales) 20−22 10,890 20.6 (19.9−21.4)
Cuzick 2003a 30−60 9,709 5.5 (5.1−6.0)
Hibbitts 2008 (South Wales) 20−65 8,434 7.0 (6.5−7.6)
Peto 2004 (Manchester) 15−64 6,128 7.2 (6.6−7.9)
Cuschieri 2004 (Edinburgh) 16−78 3,089 12.7 (11.6−13.9)
Cuzick 1999 (London) 34−70 2,855 3.3 (2.7−4.0)
b 25−64 2,404 10.2 (9.0−11.5)
Howell−Jones 2010
Cuzick 1995 (London) 17−59 1,818 3.5 (2.8−4.5)
Herbert 2007 (London) 20−49 813 12.9 (10.8−15.4)
Grainge 2005 (Nottingham) 21−51 656 13.6 (11.2−16.4)
0% 10% 20% 30%

to the sample size.
a Birmingham, Edinburg, London, Manchester and Mansfield
b Gateshead, Birmingham, London, Gloucestershire and Norfolk

4.1.2 HPV type distribution among women with normal cervical cytology, precancerous cer-
vical lesions and cervical cancer
Table 13: Prevalence of HPV 16/18 in women with normal cytology, precancerous cervical lesions and
invasive cervical cancer in Europe
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)
Europe 180,090 3.8 (3.7-3.9) 19,401 27.1 (26.5-27.7) 21,140 54.5 (53.8-55.2) 18,406 74.0 (73.4-74.6)
Eastern Europe 7,818 9.7 (9.1-10.4) 1,058 31.8 (29.0-34.6) 661 60.5 (56.7-64.2) 1,677 84.7 (82.9-86.3)
Belarus 322 7.1 (4.8-10.5) 94 35.1 (26.2-45.2) 91 56.0 (45.8-65.8) 26 65.4 (46.2-80.6)
Bulgaria - -- - -- - -- 127 80.3 (72.6-86.3)
Czech Rep. 1,302 6.6 (5.4-8.1) 676 33.7 (30.3-37.4) 311 63.3 (57.9-68.5) 270 79.3 (74.0-83.7)
Hungary - -- - -- 75 61.3 (50.0-71.5) 38 94.7 (82.7-98.5)
Moldova - -- - -- - -- - --
Poland 799 3.4 (2.3-4.9) - -- - -- 1,010 88.1 (86.0-90.0)
Romania 801 10.1 (8.2-12.4) 194 16.0 (11.5-21.8) 93 48.4 (38.5-58.4) - --
Russia 2,140 9.4 (8.2-10.7) 94 35.1 (26.2-45.2) 91 56.0 (45.8-65.8) 206 73.8 (67.4-79.3)
Slovakia - -- - -- - -- - --
Ukraine - -- - -- - -- - --
Northern Europe 86,821 4.2 (4.1-4.3) 4,949 30.6 (29.3-31.9) 8,448 54.9 (53.8-56.0) 5,921 77.0 (75.9-78.1)
Denmark 27,135 6.5 (6.2-6.8) 414 27.1 (23.0-31.5) 2,460 57.4 (55.4-59.3) 348 74.1 (69.3-78.5)
Estonia - -- - -- - -- - --
Finland - -- - -- - -- 460 88.5 (85.2-91.1)
Iceland - -- - -- 441 59.0 (54.3-63.5) 140 72.1 (64.2-78.9)
Ireland 5,647 4.3 (3.8-4.9) 104 42.3 (33.3-51.9) 353 78.8 (74.2-82.7) 97 74.2 (64.7-81.9)
Latvia - -- 94 35.1 (26.2-45.2) 91 56.0 (45.8-65.8) 247 70.0 (64.1-75.4)
Lithuania 609 6.1 (4.4-8.3) 15 6.7 (1.2-29.8) 186 53.2 (46.1-60.3) 266 62.8 (56.8-68.4)
Norway 4,192 2.4 (2.0-2.9) 60 13.3 (6.9-24.2) 1,607 38.7 (36.4-41.1) 450 78.2 (74.2-81.8)
Sweden 6,789 2.4 (2.1-2.8) 1,494 32.9 (30.6-35.4) 383 48.0 (43.1-53.0) 773 70.5 (67.2-73.6)
UK 42,449 3.2 (3.0-3.4) 2,768 29.6 (27.9-31.3) 2,927 58.6 (56.8-60.4) 3,140 79.0 (77.6-80.4)
Southern Europe 31,831 3.8 (3.6-4.0) 10,519 25.4 (24.6-26.2) 5,866 53.2 (51.9-54.5) 4,037 68.0 (66.5-69.4)
Albania - -- - -- - -- - --
Andorra - -- - -- - -- - --
Bosnia & H. - -- - -- - -- 297 68.0 (62.5-73.1)
Croatia 205 18.0 (13.4-23.9) 1,271 13.5 (11.8-15.5) 941 20.6 (18.2-23.3) 117 82.9 (75.1-88.7)
Cyprus - -- - -- - -- - --
Greece 6,506 2.8 (2.4-3.2) 1,983 21.7 (19.9-23.6) 368 55.4 (50.3-60.4) 331 52.3 (46.9-57.6)
Italy 15,093 4.1 (3.8-4.4) 4,638 29.2 (27.9-30.5) 2,553 64.6 (62.7-66.4) 1,372 72.2 (69.8-74.5)
Macedonia - -- - -- - -- - --
Malta - -- - -- - -- - --
Montenegro - -- - -- - -- - --
Portugal 425 5.6 (3.8-8.3) 444 45.3 (40.7-49.9) 875 56.3 (53.0-59.6) 168 81.5 (75.0-86.7)
San Marino - -- - -- - -- - --
Serbia - -- - -- - -- - --
Slovenia 4,199 4.8 (4.2-5.5) - -- 261 67.0 (61.1-72.5) 264 77.7 (72.3-82.3)
Spain 5,403 2.7 (2.3-3.2) 2,183 23.7 (21.9-25.5) 868 46.3 (43.0-49.6) 1,488 63.1 (60.6-65.5)
Western Europe 56,074 2.6 (2.5-2.7) 2,875 25.2 (23.7-26.8) 3,062 59.4 (57.7-61.1) 3,028 78.7 (77.2-80.1)
Austria - -- - -- 204 60.3 (53.4-66.8) 200 78.5 (72.3-83.6)
Belgium 13,414 3.6 (3.3-3.9) 1,205 26.4 (24.0-29.0) 463 51.8 (47.3-56.4) 111 81.1 (72.8-87.3)
France 4,764 4.7 (4.1-5.3) 639 26.3 (23.0-29.8) 688 60.6 (56.9-64.2) 1,434 75.6 (73.3-77.7)
Germany 10,988 3.2 (2.9-3.5) 688 21.2 (18.3-24.4) 819 50.5 (47.1-54.0) 68 76.5 (65.1-85.0)
Liechtenstein - -- - -- - -- - --
Luxembourg - -- - -- - -- 58 89.7 (79.2-95.2)
Monaco - -- - -- - -- - --
Netherlands 26,908 1.5 (1.4-1.7) 207 22.7 (17.5-28.9) 855 70.2 (67.0-73.1) 1,157 82.1 (79.8-84.2)
Switzerland - -- 136 30.9 (23.7-39.1) 33 75.8 (59.0-87.2) - --
Data updated on 14 Jun 2019 (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;

Figure 89: Prevalence of HPV 16 among women with normal cervical cytology in Europe by country and
study
Country Study N % (95% CI)

Belarus Rogovskaya 2013 322 7.1 (4.8−10.5)
Belgium Arbyn 2009 8,729 2.3 (2.1−2.7)
Baay 2005 2,293 2.1 (1.6−2.8)
Schmitt 2013 913 5.6 (4.3−7.3)
Weyn 2013 906 2.1 (1.3−3.3)
Depuydt 2003 287 4.2 (2.4−7.2)
Baay 2001 286 2.8 (1.4−5.4)
Croatia Grahovac 2007 205 15.6 (11.3−21.2)
Czech Rep. Tachezy 2013 1,302 4.8 (3.8−6.1)
Denmark Nielsen 2008 11,663 4.0 (3.6−4.3)
Kjaer 2008 10,918 4.8 (4.4−5.2)
Bonde 2014 4,435 5.3 (4.7−6.0)
Svare 1998 119 8.4 (4.6−14.8)
France Heard 2013 3,023 3.0 (2.5−3.7)
Vaucel 2011 980 3.6 (2.6−4.9)
Casalegno 2011 302 10.6 (7.6−14.6)
Pannier−Stockman 2008 289 9.3 (6.5−13.3)
Beby−Defaux 2004 170 1.8 (0.6−5.1)
Germany Klug 2007 7,833 1.1 (0.9−1.4)
Iftner 2010 1,692 6.6 (5.5−7.8)
de Jonge 2013 1,463 4.9 (3.9−6.2)
Greece Argyri 2013 2,218 2.6 (2.0−3.4)
Tsiodras 2011 1,348 4.0 (3.1−5.2)
Agorastos 2004 1,272 0.4 (0.2−0.9)
Tsiodras 2010 1,029 0.0 (0.0−0.4)
Panotopoulou 2007 639 0.5 (0.2−1.4)
Ireland Anderson 2013 5,068 3.2 (2.7−3.7)
Keegan 2007 579 1.7 (0.9−3.1)
Italy Agarossi 2009 9,148 3.0 (2.7−3.4)
Giorgi Rossi 2011 3,151 2.1 (1.7−2.7)
Ronco 2005 997 2.7 (1.9−3.9)
Panatto 2013 566 2.8 (1.7−4.5)
Centurioni 2005 500 8.8 (6.6−11.6)
Sammarco 2013 244 6.6 (4.1−10.4)
Astori 1997 197 5.1 (2.8−9.1)
Tornesello 2006 183 8.7 (5.5−13.7)
Tornesello 2008 107 2.8 (1.0−7.9)
Lithuania Gudleviciene 2005 332 6.9 (4.7−10.2)
Simanaviciene 2014 277 4.3 (2.5−7.4)
Netherlands Bulkmans 2007 21,245 1.0 (0.9−1.1)
0% 10% 20% 30%

to the sample size.

Figure 90: Prevalence of HPV 16 among women with normal cervical cytology in Europe by country and
study (continued)

Netherlands Jacobs 2000 3,299 0.9 (0.7−1.3)
Rozendaal 2000 2,250 2.7 (2.1−3.4)
Zielinski 2001 114 1.8 (0.5−6.2)
Norway Molden 2005 3,970 1.3 (1.0−1.7)
Gjøoen 1996 222 6.3 (3.8−10.3)
Poland Bardin 2008 799 2.8 (1.8−4.1)
Portugal Pista 2011 425 5.2 (3.4−7.7)
Romania Moga 2014 801 7.5 (5.9−9.5)
Russia Rogovskaya 2013 833 7.1 (5.5−9.0)
Shipitsyna 2011 741 2.7 (1.8−4.1)
Alexandrova 1999 309 7.4 (5.0−10.9)
Komarova 2010 257 24.1 (19.3−29.7)
Slovenia Ucakar 2012 4,199 3.7 (3.2−4.3)
Spain Castellsagué 2012 3,059 2.5 (2.0−3.1)
de Sanjose 2003 847 0.4 (0.1−1.0)
Dillner 2008 721 3.1 (2.0−4.6)
González 2006 447 1.3 (0.6−2.9)
Muñoz 1996 329 1.8 (0.8−3.9)
Sweden Naucler 2007 5,877 1.7 (1.4−2.0)
Ylitalo 2000 617 5.8 (4.2−8.0)
Kjellberg 1998 295 1.0 (0.3−2.9)
UK Sargent 2008 21,364 1.5 (1.3−1.7)
Hibbitts 2014 10,890 4.3 (3.9−4.7)
Cuschieri 2004 3,089 4.4 (3.7−5.2)
Cuzick 1999 2,855 0.1 (0.0−0.3)
Cuzick 1995 1,818 1.3 (0.9−2.0)
Hibbitts 2006 1,777 1.4 (0.9−2.0)
Grainge 2005 656 1.4 (0.7−2.6)
0% 10% 20% 30%

to the sample size.

Figure 91: Prevalence of HPV 16 among women with low-grade cervical lesions in Europe by country
and study

Belarus Kulmala 2007 94 35.1 (26.2−45.2)
Belgium Depuydt 2003 369 20.3 (16.5−24.7)
Beerens 2005 324 18.5 (14.7−23.1)
Arbyn 2009 243 23.5 (18.6−29.2)
Weyn 2013 211 10.0 (6.6−14.7)
Baay 2001 58 24.1 (15.0−36.5)
Croatia Grce 2001 1,028 11.6 (9.8−13.7)
Grce 1997 183 6.0 (3.4−10.4)
Grce 2004 60 8.3 (3.6−18.1)
Czech Rep. Tachezy 2011 676 28.4 (25.1−31.9)
Denmark Kjær 2014 287 17.1 (13.2−21.9)
Kjaer 2008 86 12.8 (7.3−21.5)
Hording 1995 41 31.7 (19.6−47.0)
France Prétet 2008 397 21.4 (17.7−25.7)
Vaucel 2011 117 14.5 (9.3−22.0)
Bergeron 1992 48 20.8 (11.7−34.3)
Humbey 2002 40 30.0 (18.1−45.4)
Monsonego 2008 37 5.4 (1.5−17.7)
Germany de Jonge 2013 441 17.5 (14.2−21.3)
Meyer 2001 130 13.1 (8.3−19.9)
Klug 2007 52 11.5 (5.4−23.0)
Nindl 1999 49 12.2 (5.7−24.2)
Merkelbach−Bruse 1999 16 68.8 (44.4−85.8)
Greece Argyri 2013 821 14.5 (12.3−17.1)
Panotopoulou 2007 516 6.8 (4.9−9.3)
Tsiodras 2011 314 17.8 (14.0−22.4)
Kroupis 2007 235 23.4 (18.4−29.2)
Labropoulou 1997 51 11.8 (5.5−23.4)
Mammas 2008 46 21.7 (12.3−35.6)
Ireland Keegan 2014 49 40.8 (28.2−54.8)
Murphy 2003 29 72.4 (54.3−85.3)
Butler 2000 26 0.0 (0.0−12.9)
Italy Voglino 2000 1,499 24.7 (22.6−27.0)
Spinillo 2014 1,240 25.6 (23.2−28.1)
Chironna 2010 385 13.0 (10.0−16.7)
Agarossi 2009 383 19.8 (16.2−24.1)
Spinillo 2009 343 36.7 (31.8−42.0)
Capra 2008 149 11.4 (7.2−17.5)
Astori 1997 111 24.3 (17.3−33.1)
Tornesello 2006 101 36.6 (27.9−46.4)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

95% CI: 95% Confidence Interval; Low-grade lesions: LSIL or CIN-1; N: number of women tested;
to the sample size.

and study (continued)

Italy Agodi 2009 96 32.3 (23.8−42.2)
Gargiulo 2007 83 15.7 (9.4−25.0)
Giorgi Rossi 2010 76 21.1 (13.4−31.5)
Sandri 2009 47 21.3 (12.0−34.9)
Zerbini 2001 43 14.0 (6.6−27.3)
Venturoli 2002 40 7.5 (2.6−19.9)
Laconi 2000 20 30.0 (14.5−51.9)
Menegazzi 2009 12 16.7 (4.7−44.8)
Venturoli 2008 10 20.0 (5.7−51.0)
Latvia Kulmala 2007 94 35.1 (26.2−45.2)
Netherlands Bollen 1997 134 12.7 (8.1−19.4)
Prinsen 2007 38 7.9 (2.7−20.8)
Reesink−Peters 2001 35 28.6 (16.3−45.1)
Norway Roberts 2006 40 5.0 (1.4−16.5)
Molden 2005 20 25.0 (11.2−46.9)
Portugal Medeiros 2005 416 44.2 (39.5−49.0)
Nobre 2010 28 10.7 (3.7−27.2)
Romania Ursu 2011 107 5.6 (2.6−11.7)
Anton 2011 87 11.5 (6.4−19.9)
Russia Kulmala 2007 94 35.1 (26.2−45.2)
Spain de Oña 2010 1,356 12.2 (10.6−14.1)
Martín 2011 387 24.8 (20.8−29.3)
Herraez−Hernandez 2013 236 39.8 (33.8−46.2)
García−Sierra 2009 108 17.6 (11.6−25.8)
Conesa−Zamora 2009 75 29.3 (20.2−40.4)
Doménech−Peris 2010 21 23.8 (10.6−45.1)
Sweden Söderlund−Strand 2011 1,035 24.2 (21.6−26.9)
Brismar−Wendel 2009 223 20.6 (15.8−26.4)
Kalantari 1997 141 17.7 (12.3−24.9)
Andersson 2005 50 20.0 (11.2−33.0)
Zehbe 1996 45 40.0 (27.0−54.5)
Switzerland Dobec 2011 136 25.0 (18.5−32.9)
UK Sargent 2008 878 17.3 (15.0−20.0)
Howell−Jones 2010 697 20.5 (17.7−23.7)
Anderson 2013 417 24.0 (20.1−28.3)
Cuschieri 2004 243 28.0 (22.7−33.9)
Hibbitts 2008 126 27.8 (20.7−36.2)
Giannoudis 1999 118 12.7 (7.9−19.9)
Jamison 2009 97 27.8 (19.9−37.5)
0% 10% 20% 30% 40% 50% 60%

to the sample size.


UK Woo 2010 60 41.7 (30.1−54.3)
Cuzick 1999 50 12.0 (5.6−23.8)
Southern 2001 49 10.2 (4.4−21.8)
Arends 1993 20 15.0 (5.2−36.0)
Cuzick 1994 13 23.1 (8.2−50.3)
0% 10% 20% 30% 40% 50% 60%

to the sample size.

Figure 94: Prevalence of HPV 16 among women with high-grade cervical lesions in Europe by country
and study

Austria Rössler 2013 204 55.9 (49.0−62.5)
Belarus Kulmala 2007 91 56.0 (45.8−65.8)
Belgium Depuydt 2003 134 50.0 (41.7−58.3)
Beerens 2005 123 43.1 (34.7−51.9)
Arbyn 2009 109 34.9 (26.6−44.2)
Baay 2001 97 56.7 (46.8−66.1)
Croatia Grce 2001 783 17.1 (14.6−19.9)
Grce 2004 158 20.3 (14.7−27.2)
Denmark Kjær 2014 1,156 52.1 (49.2−54.9)
Thomsen 2015 732 35.8 (32.4−39.3)
Kirschner 2013 225 46.2 (39.8−52.7)
Kjaer 2008 177 48.0 (40.8−55.3)
Bonde 2014 106 34.9 (26.5−44.4)
Sebbelov 1994 34 85.3 (69.9−93.6)
Hording 1995 30 50.0 (33.2−66.8)
Europe Tjalma 2013 3,103 47.2 (45.5−49.0)
France Prétet 2008 493 62.3 (57.9−66.4)
Vaucel 2011 141 42.6 (34.7−50.8)
Monsonego 2008 54 33.3 (22.2−46.6)
Germany Meyer 2001 288 46.2 (40.5−52.0)
de Jonge 2013 247 34.4 (28.8−40.5)
Merkelbach−Bruse 1999 88 61.4 (50.9−70.9)
Nindl 1997 85 36.5 (27.0−47.1)
Nindl 1999 65 56.9 (44.8−68.2)
Klug 2007 46 54.3 (40.2−67.8)
Greece Argyri 2013 78 37.2 (27.3−48.3)
Panotopoulou 2007 60 36.7 (25.6−49.3)
Tsiodras 2011 54 50.0 (37.1−62.9)
Labropoulou 1997 50 36.0 (24.1−49.9)
Agorastos 2005 43 58.1 (43.3−71.6)
Daponte 2006 29 51.7 (34.4−68.6)
Paraskevaidis 2001 28 35.7 (20.7−54.2)
Kroupis 2007 26 50.0 (32.1−67.9)
Hungary Szoke 2003 75 57.3 (46.1−67.9)
Iceland Sigurdsson 2007 441 51.2 (46.6−55.9)
Ireland Keegan 2014 242 69.4 (63.4−74.9)
Murphy 2003 64 78.1 (66.6−86.5)
Butler 2000 27 70.4 (51.5−84.1)
O'Leary 1998 20 95.0 (76.4−99.1)
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

95% CI: 95% Confidence Interval; High-grade lesions: CIN-2, CIN-3, CIS or HSIL; N: number of women tested;
to the sample size.


Italy Spinillo 2014 1,344 48.4 (45.8−51.1)
Carozzi 2010 529 62.9 (58.8−67.0)
Carozzi 2014 204 53.9 (47.1−60.6)
Zerbini 2001 89 50.6 (40.4−60.7)
Sandri 2009 76 73.7 (62.8−82.3)
Agarossi 2009 73 53.4 (42.1−64.4)
Gargiulo 2007 67 38.8 (28.0−50.8)
Tornesello 2006 65 47.7 (36.0−59.6)
Venturoli 2008 56 60.7 (47.6−72.4)
Laconi 2000 36 50.0 (34.5−65.5)
Capra 2008 14 42.9 (21.4−67.4)
Latvia Kulmala 2007 91 56.0 (45.8−65.8)
Lithuania Simanaviciene 2014 157 51.6 (43.8−59.3)
Gudleviciene 2005 29 48.3 (31.4−65.6)
Netherlands Tang 2009 253 70.8 (64.9−76.0)
Bulkmans 2005 236 60.6 (54.2−66.6)
Reesink−Peters 2001 216 56.9 (50.3−63.4)
Cornelissen 1992 89 52.8 (42.5−62.8)
Prinsen 2007 41 51.2 (36.5−65.7)
van Duin 2003 20 65.0 (43.3−81.9)
Norway Roberts 2006 885 44.1 (40.8−47.4)
Sjoeborg 2010 630 20.6 (17.7−24.0)
Kraus 2004 67 49.3 (37.7−60.9)
Molden 2005 25 28.0 (14.3−47.6)
Portugal Pista 2013 518 55.6 (51.3−59.8)
Pista 2011 191 27.7 (21.9−34.5)
Medeiros 2005 132 74.2 (66.2−80.9)
Nobre 2010 34 32.4 (19.1−49.2)
Romania Anton 2011 52 48.1 (35.1−61.3)
Ursu 2011 41 31.7 (19.6−47.0)
Russia Kulmala 2007 91 56.0 (45.8−65.8)
Slovenia Kovanda 2009 261 62.5 (56.4−68.1)
Spain de Oña 2010 306 28.8 (24.0−34.1)
Bosch 1993 157 49.0 (41.3−56.8)
Muñoz 1992 157 51.0 (43.2−58.7)
Martín 2011 82 48.8 (38.3−59.4)
Conesa−Zamora 2009 39 33.3 (20.6−49.0)
Darwich 2011 34 61.8 (45.0−76.1)
García−Sierra 2009 25 36.0 (20.2−55.5)
10% 20% 30% 40% 50% 60% 70% 80% 90%

to the sample size.


Sweden Kalantari 1997 164 35.4 (28.5−42.9)
Andersson 2005 116 37.1 (28.8−46.1)
Zehbe 1996 103 50.5 (41.0−59.9)
Switzerland Dobec 2011 33 57.6 (40.8−72.8)
UK Howell−Jones 2010 1,425 54.1 (51.5−56.7)
Sargent 2008 562 46.8 (42.7−50.9)
Cuzick 2014 354 31.1 (26.5−36.1)
Geraets 2014 99 43.4 (34.1−53.3)
Cuschieri 2004 94 48.9 (39.1−58.9)
Hibbitts 2008 93 40.9 (31.4−51.0)
Cuzick 1994 73 63.0 (51.5−73.2)
Anderson 2013 72 56.9 (45.4−67.7)
Jamison 2009 51 49.0 (35.9−62.3)
Arends 1993 40 50.0 (35.2−64.8)
Herrington 1995 38 57.9 (42.2−72.1)
Southern 1998 26 61.5 (42.5−77.6)
20% 30% 40% 50% 60% 70% 80%

to the sample size.

Figure 97: Prevalence of HPV 16 among women with invasive cervical cancer in Europe by country and
study

Austria Bachtiary 2002 106 65.1 (55.6−73.5)
Widschwendter 2003 94 75.5 (66.0−83.1)
Belarus Kulmala 2007 26 65.4 (46.2−80.6)
Belgium Baay 2001 111 68.5 (59.3−76.4)
Bulgaria Todorova 2010 127 70.9 (62.4−78.1)
Croatia Hadzisejdic 2006 66 30.3 (20.6−42.2)
Dabic 2008 51 62.7 (49.0−74.7)
Slama 2009 49 61.2 (47.2−73.6)
Tachezy 1999 49 59.2 (45.2−71.8)
Denmark Kirschner 2013 245 60.8 (54.6−66.7)
Hording 1997 50 18.0 (9.8−30.8)
Sebbelov 2000 34 70.6 (53.8−83.2)
Kjær 2014 19 57.9 (36.3−76.9)
Europe Tjalma 2013 2,881 55.9 (54.1−57.7)
de Sanjose 2010(a) 2,302 57.4 (55.4−59.4)
Finland Iwasawa 1996 460 63.5 (59.0−67.7)
France Prétet 2008 516 72.9 (68.9−76.5)
de Cremoux 2009 515 55.5 (51.2−59.8)
Lombard 1998 297 50.5 (44.8−56.1)
Riou 1990 106 54.7 (45.2−63.9)
Germany Milde−Langosch 1995 51 51.0 (37.7−64.1)
Bosch 1995 17 76.5 (52.7−90.4)
Greece Panotopoulou 2007 165 24.2 (18.3−31.3)
Dokianakis 1999 75 2.7 (0.7−9.2)
Koffa 1994 39 35.9 (22.7−51.6)
Labropoulou 1997 35 54.3 (38.2−69.5)
Adamopoulou 2009 17 47.1 (26.2−69.0)
Hungary Kónya 1995 38 63.2 (47.3−76.6)
Iceland Sigurdsson 2007 140 57.1 (48.9−65.0)
Ireland Skyldberg 1999 38 23.7 (13.0−39.2)
Butler 2000 29 93.1 (78.0−98.1)
O'Leary 1998 20 80.0 (58.4−91.9)
Fay 2009 10 80.0 (49.0−94.3)
Italy Sideri 2009 268 63.4 (57.5−69.0)
Carozzi 2010 193 67.9 (61.0−74.1)
Spinillo 2014 176 54.5 (47.2−61.7)
Tornesello 2011 171 58.5 (51.0−65.6)
Voglino 2000 145 71.0 (63.2−77.8)
Ciotti 2006 102 57.8 (48.1−67.0)
0 10 20 30 40 50 60 70 80 90 100

to the sample size.
a Includes cases from Bosnia-Herzegovina, Croatia, Czech Republic, France, Greece, Italy, Netherlands, Poland, Portugal, and Spain

study (continued)

Italy Tornesello 2006 65 60.0 (47.9−71.0)
Del Mistro 2006 40 75.0 (59.8−85.8)
Garzetti 1998 32 50.0 (33.6−66.4)
Gargiulo 2007 31 61.3 (43.8−76.3)
Rolla 2009 18 66.7 (43.7−83.7)
Latvia Silins 2004 221 60.6 (54.1−66.8)
Kulmala 2007 26 65.4 (46.2−80.6)
Simanaviciene 2014 75 50.7 (39.6−61.7)
Luxembourg Ressler 2007 58 79.3 (67.2−87.7)
Netherlands Tang 2009 340 63.5 (58.3−68.5)
Baay 1996 162 61.7 (54.1−68.9)
Bulk 2006 153 54.2 (46.3−61.9)
Krul 1999 128 58.6 (49.9−66.8)
Baalbergen 2013 113 32.7 (24.8−41.8)
De Boer 2005 105 43.8 (34.7−53.4)
Zielinski 2003 77 32.5 (23.1−43.5)
Van Den Brule 1991 50 84.0 (71.5−91.7)
Resnick 1990 29 75.9 (57.9−87.8)
Norway Karlsen 1996 361 68.4 (63.5−73.0)
Bertelsen 2006 89 52.8 (42.5−62.8)
Poland Kwasniewska 2009 570 58.4 (54.3−62.4)
Baay 2009 113 85.8 (78.2−91.1)
Biesaga 2012 85 80.0 (70.3−87.1)
Bardin 2008 84 75.0 (64.8−83.0)
Pirog 2000 82 36.6 (27.0−47.4)
Dybikowska 2002 53 47.2 (34.4−60.3)
Bosch 1995 23 78.3 (58.1−90.3)
Portugal Pista 2013 64 70.3 (58.2−80.1)
Medeiros 2005 60 80.0 (68.2−88.2)
Nobre 2010 44 61.4 (46.6−74.3)
Russia Kleter 1999 180 64.4 (57.2−71.1)
Kulmala 2007 26 65.4 (46.2−80.6)
Slovenia Jancar 2009 264 65.2 (59.2−70.6)
Spain Muñoz 1992 159 54.1 (46.3−61.6)
Martró 2012 73 47.9 (36.9−59.2)
Darwich 2011 72 79.2 (68.4−86.9)
Rodriguez 1998 54 61.1 (47.8−73.0)
Bosch 1995 46 54.3 (40.2−67.8)
Mazarico 2012 37 43.2 (28.7−59.1)
20 30 40 50 60 70 80 90 100

to the sample size.

study (continued)

Spain González−Bosquet 2008 21 52.4 (32.4−71.7)
Sweden Du 2011 154 58.4 (50.5−65.9)
Andersson 2001 131 23.7 (17.2−31.6)
Graflund 2004 110 79.1 (70.6−85.6)
Wallin 1999 104 47.1 (37.8−56.6)
Andersson 2003 82 34.1 (24.8−44.9)
Hagmar 1992 71 38.0 (27.6−49.7)
Andersson 2005 45 66.7 (52.1−78.6)
Skyldberg 1999 38 23.7 (13.0−39.2)
Zehbe 1997 38 63.2 (47.3−76.6)
UK Mesher 2015 1,235 63.0 (60.3−65.6)
Howell−Jones 2010 555 62.5 (58.4−66.5)
Cuschieri 2014 370 55.9 (50.9−60.9)
Cuschieri 2010 363 56.5 (51.3−61.5)
Powell 2009 269 67.7 (61.9−73.0)
Tawfik El−Mansi 2006 119 46.2 (37.5−55.2)
Cuzick 2000 116 65.5 (56.5−73.5)
Arends 1993 47 53.2 (39.2−66.7)
Giannoudis 1999 43 81.4 (67.4−90.3)
Crook 1992 23 73.9 (53.5−87.5)
10 20 30 40 50 60 70 80 90 100

to the sample size.

Figure 100: Comparison of the ten most frequent HPV oncogenic types among women with and without
cervical lesions in Europe and its regions
Europe Eastern Europe Northern Europe
16 2.8 16 8.0 16 3.0

Normal cytology
31 1.5 31 4.2 31 1.8

51 1.3 39 2.5 52 1.8
1.2 2.0 1.6
HPV−type
52 56 51
53 1.1 52 1.9 66 1.4
18 1.0 33 1.7 70 1.3
70 1.0 45 1.7 18 1.2
66 0.9 18 1.7 39 1.1
39 0.9 51 1.3 53 1.0
56 0.8 53 1.2 45 1.0
16 20.7 16 25.9 16 21.9

Low−grade lesions
51 10.0 33 6.1 51 10.6

31 9.9 18 5.9 31 10.5
8.7 5.5 9.6
HPV−type
53 31 53
66 7.7 45 4.1 18 8.7
52 7.6 58 3.9 66 8.7
56 6.6 51 3.6 56 8.2
18 6.4 56 3.1 52 7.3
39 5.2 35 2.5 39 7.0
58 4.8 66 2.1 33 6.2
16 47.4 16 55.1 16 46.4

High−grade lesions
31 12.4 33 10.4 31 14.3

33 8.8 31 9.2 33 10.5
8.5 5.4 10.0
HPV−type
52 18 52
18 7.1 58 3.5 18 8.5
51 5.8 45 3.3 51 6.6
58 4.5 56 2.6 45 5.0
53 4.1 52 2.6 58 5.0
45 3.5 51 2.5 39 4.8
39 3.4 39 1.9 66 3.6
16 58.8 16 64.6 16 59.4

Cervical Cancer
18 15.2 18 20.1 18 17.6

33 4.4 45 7.4 45 4.4
4.3 3.7 4.2
HPV−type
45 31 33
31 3.8 33 3.3 31 3.6
52 1.9 58 1.8 52 1.9
35 1.4 56 1.7 35 1.5
39 1.2 52 1.5 39 1.3
58 1.2 39 0.9 59 0.9
73 0.9 73 0.9 68 0.9
0 20 40 60 0 20 40 60 0 20 40 60
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;

Figure 101: Comparison of the ten most frequent HPV oncogenic types among women with and without
cervical lesions in Europe and its regions (continued)
Southern Europe Western Europe
16 2.9 16 2.0
Normal cytology
31 1.3 53 1.4
51 1.1 31 1.1
18 0.9 51 1.0
52 0.9 18 0.6
53 0.9 66 0.6
66 0.9 56 0.6
56 0.8 70 0.6
39 0.8 52 0.6
58 0.7 59 0.5
16 20.1 16 18.6
Low−grade lesions
31 10.1 53 12.1
51 9.7 51 11.6
52 9.1 66 10.9
53 8.3 31 9.9
66 6.0 52 7.2
56 5.9 39 6.8
18 5.3 18 6.6
58 4.8 56 6.1
33 4.1 33 4.6
16 45.4 16 53.0
High−grade lesions
31 13.0 31 12.5
52 11.6 33 9.3
18 7.8 51 7.0
51 7.3 52 6.5
33 6.3 18 6.4
53 5.3 58 4.8
58 4.8 35 4.1
39 3.4 53 3.8
45 3.2 39 3.4
16 57.2 16 60.0
Cervical Cancer
18 10.8 18 18.7
31 5.3 33 4.4
33 4.8 45 3.5
45 4.0 31 3.1
52 2.6 52 1.3
51 2.0 58 1.3
35 1.9 68 1.1
58 1.5 73 1.1
56 1.5 59 0.8
0 20 40 60 0 20 40 60
Prevalence (%) Prevalence (%)

High-grade lesions: CIN-2, CIN-3, CIS or HSIL; Low-grade lesions: LSIL or CIN-1;

Figure 102: Comparison of the ten most frequent HPV oncogenic types among women with invasive
cervical cancer by histology in Europe and its regions
Europe Eastern Europe Northern Europe
16 58.8 16 64.6 16 59.4

18 15.2 18 20.1 18 17.6
Any Histology
33 4.4 45 7.4 45 4.4

4.3 3.7 4.2
HPV−type
45 31 33
31 3.8 33 3.3 31 3.6
52 1.9 58 1.8 52 1.9
35 1.4 56 1.7 35 1.5
39 1.2 52 1.5 39 1.3
58 1.2 39 0.9 59 0.9
73 0.9 73 0.9 68 0.9
Squamous cell carcinoma
16 61.7 16 66.9 16 64.0

18 11.4 18 18.4 18 13.9
33 4.6 45 7.8 33 4.5
4.0 4.6 4.2
HPV−type
45 31 45
31 4.0 33 4.4 31 3.9
52 2.1 56 2.7 52 2.1
35 1.3 58 2.0 39 1.4
58 1.3 52 1.6 58 1.1
39 1.2 39 0.7 68 1.0
56 1.1 35 0.5 59 1.0
16 38.4 18 41.5 18 37.1

Adenocarcinoma
18 35.3 16 37.7 16 35.0

45 6.0 45 8.3 45 6.7
2.3 1.5 1.6
HPV−type
31 52 33
33 1.5 31 1.5 31 1.4
51 1.4 33 0.8 39 1.1
52 1.0 35 0.8 52 0.9
39 1.0 8th* 68 0.4
35 0.5 9th* 59 0.4
82 0.2 10th* 51 0.4
16 63.7 16 72.2 16 63.7

18 14.2 18 11.4 18 13.4
Unespecified
33 6.9 45 5.6 33 6.3

4.8 2.8 4.7
HPV−type
31 31 35
45 4.2 58 2.5 31 3.8
35 2.9 33 1.9 45 3.4
52 1.5 39 1.9 39 2.2
58 1.4 35 1.4 52 1.9
39 1.3 52 1.2 56 0.6
59 0.9 56 0.6 82 0.5
0 30 60 90 0 30 60 90 0 30 60 90
Prevalence (%) Prevalence (%) Prevalence (%)
*No data available. No more types than shown were tested or were positive.

Figure 103: Comparison of the ten most frequent HPV oncogenic types among women with invasive
cervical cancer by histology in Europe and its regions (continued)
Southern Europe Western Europe
16 57.2 16 60.0
18 10.8 18 18.7
Any Histology
31 5.3 33 4.4
33 4.8 45 3.5
45 4.0 31 3.1
52 2.6 52 1.3
51 2.0 58 1.3
35 1.9 68 1.1
58 1.5 73 1.1
56 1.5 59 0.8
Squamous cell carcinoma
16 57.4 16 65.5
18 8.0 18 12.0
33 4.9 31 3.6
31 4.5 33 3.5
45 3.8 45 2.9
52 2.7 52 1.6
35 1.9 58 1.4
56 1.8 68 1.4
51 1.7 39 0.9
58 1.5 35 0.8
16 47.7 18 45.6
Adenocarcinoma
18 25.6 16 37.3
31 6.2 45 5.9
51 5.3 31 1.1
45 4.0 39 0.7
33 3.3 35 0.7
52 3.1 58 0.5
39 2.2 52 0.5
35 1.2 33 0.2
66 0.9 51 0.2
16 62.5 16 61.7
18 12.9 18 17.2
Unespecified
31 8.0 33 14.6
33 5.3 45 3.7
45 4.8 31 3.4
35 2.1 59 3.1
58 1.7 58 1.5
52 1.7 68 0.8
56 1.1 52 0.5
51 1.1 51 0.5
0 30 60 90 0 30 60 90
Prevalence (%) Prevalence (%)
*No data available. No more types than shown were tested or were positive.

Table 14: Type-specific HPV prevalence in women with normal cervical cytology, precancerous cervical
lesions and invasive cervical cancer in Europe
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
16 180,090 2.8 (2.7-2.8) 19,401 20.7 (20.1-21.2) 21,140 47.4 (46.8-48.1) 18,406 58.8 (58.1-59.5)
18 178,318 1.0 (0.9-1.0) 18,972 6.4 (6.0-6.7) 20,697 7.1 (6.7-7.4) 18,328 15.2 (14.7-15.7)
31 164,983 1.5 (1.4-1.6) 18,505 9.9 (9.5-10.3) 20,002 12.4 (11.9-12.9) 16,082 3.8 (3.6-4.2)
33 164,623 0.7 (0.7-0.7) 18,233 4.8 (4.5-5.1) 20,312 8.8 (8.4-9.2) 16,704 4.4 (4.1-4.8)
35 153,819 0.4 (0.3-0.4) 14,105 3.2 (3.0-3.5) 17,923 3.0 (2.7-3.2) 15,013 1.4 (1.2-1.6)
39 152,061 0.9 (0.8-0.9) 12,984 5.2 (4.8-5.6) 17,575 3.4 (3.2-3.7) 13,552 1.2 (1.0-1.3)
45 155,359 0.7 (0.7-0.8) 14,489 3.6 (3.3-3.9) 17,944 3.5 (3.3-3.8) 14,711 4.3 (4.0-4.6)
51 154,244 1.3 (1.2-1.4) 11,648 10.0 (9.5-10.6) 17,104 5.8 (5.4-6.1) 13,589 0.9 (0.8-1.1)
52 153,700 1.2 (1.1-1.2) 12,892 7.6 (7.2-8.1) 17,530 8.5 (8.1-8.9) 14,152 1.9 (1.7-2.1)
56 153,487 0.8 (0.8-0.9) 12,792 6.6 (6.2-7.0) 17,595 2.5 (2.3-2.8) 13,301 0.9 (0.8-1.1)
58 155,224 0.7 (0.6-0.7) 13,272 4.8 (4.4-5.2) 17,174 4.5 (4.2-4.8) 14,085 1.2 (1.0-1.4)
59 150,513 0.7 (0.6-0.7) 11,034 4.2 (3.8-4.5) 15,866 1.5 (1.3-1.7) 13,153 0.7 (0.6-0.8)
Probable/possible carcinogen
26 19,838 0.0 (0.0-0.1) 4,439 0.3 (0.2-0.5) 5,108 0.3 (0.2-0.5) 5,751 0.1 (0.0-0.2)
30 3,184 0.3 (0.1-0.5) 1,242 0.4 (0.2-0.9) 1,077 0.0 (0.0-0.4) 2,986 0.2 (0.1-0.4)
34 10,695 0.1 (0.1-0.2) 2,045 0.1 (0.0-0.4) 1,767 0.2 (0.1-0.5) 3,993 0.1 (0.0-0.2)
53 48,490 1.1 (1.1-1.2) 9,586 8.7 (8.2-9.3) 10,426 4.1 (3.7-4.5) 8,175 0.7 (0.6-1.0)
66 92,854 0.9 (0.9-1.0) 11,953 7.7 (7.2-8.1) 15,331 2.4 (2.2-2.7) 11,552 0.4 (0.3-0.5)
67 7,882 0.3 (0.2-0.4) 3,855 1.9 (1.6-2.4) 3,790 0.5 (0.3-0.8) 4,702 0.2 (0.1-0.3)
68 151,288 0.6 (0.5-0.6) 10,908 2.4 (2.2-2.7) 14,286 2.1 (1.8-2.3) 12,165 0.8 (0.7-1.0)
69 5,342 0.0 (0.0-0.1) 3,812 0.3 (0.1-0.5) 3,730 0.2 (0.1-0.4) 4,472 0.0 (0.0-0.1)
70 60,471 1.0 (0.9-1.1) 7,420 2.4 (2.1-2.8) 7,319 1.8 (1.5-2.1) 7,295 0.2 (0.1-0.3)
73 24,040 0.3 (0.3-0.4) 6,275 2.7 (2.4-3.2) 6,992 1.5 (1.3-1.8) 6,345 0.9 (0.7-1.1)
82 24,702 0.2 (0.1-0.2) 6,338 1.3 (1.1-1.6) 6,972 1.0 (0.8-1.3) 6,538 0.1 (0.1-0.3)
85 2,580 0.0 (0.0-0.2) 1,056 0.1 (0.0-0.5) 1,165 0.2 (0.0-0.6) - -
97 1,479 0.0 (0.0-0.3) - - - - 370 0.3 (0.0-1.5)
NON-ONCOGENIC HPV TYPES
6 135,895 1.0 (1.0-1.1) 12,720 7.0 (6.5-7.4) 10,473 3.4 (3.1-3.7) 8,735 0.7 (0.6-0.9)
11 126,704 0.4 (0.4-0.4) 12,119 3.2 (2.9-3.6) 9,537 1.3 (1.1-1.6) 8,579 0.5 (0.4-0.7)
32 4,795 0.1 (0.1-0.3) 549 0.0 (0.0-0.7) - - 600 0.0 (0.0-0.6)
40 64,728 0.2 (0.2-0.3) 2,490 1.9 (1.4-2.5) 2,841 0.5 (0.3-0.8) 4,728 0.0 (0.0-0.1)
42 75,738 0.8 (0.8-0.9) 2,490 11.7 (10.5-13.0) 2,175 3.0 (2.4-3.8) 4,797 0.2 (0.1-0.4)
43 73,183 0.3 (0.3-0.4) 2,334 2.0 (1.5-2.6) 2,464 0.6 (0.4-1.0) 4,002 0.0 (0.0-0.1)
44 78,797 1.0 (1.0-1.1) 3,289 8.8 (7.8-9.8) 3,302 4.2 (3.6-5.0) 4,603 0.3 (0.2-0.5)
54 60,726 0.7 (0.6-0.8) 1,121 2.3 (1.6-3.4) 2,382 0.8 (0.5-1.2) 5,136 0.4 (0.3-0.6)
55 - - - - - - - -
57 14,231 0.0 (0.0-0.1) 549 0.0 (0.0-0.7) 829 0.0 (0.0-0.5) 928 0.0 (0.0-0.4)
61 14,155 0.5 (0.4-0.6) 941 1.2 (0.7-2.1) 1,180 1.4 (0.8-2.2) 3,960 0.1 (0.0-0.3)
62 8,033 0.6 (0.4-0.8) 941 1.2 (0.7-2.1) 1,180 1.7 (1.1-2.6) 1,128 0.3 (0.1-0.8)
64 - - - - - - - -
71 10,787 0.0 (0.0-0.1) 834 0.8 (0.4-1.7) 1,180 0.0 (0.0-0.3) 1,541 0.0 (0.0-0.2)
72 12,418 0.1 (0.0-0.1) 834 0.4 (0.1-1.1) 1,180 0.3 (0.1-0.9) 1,356 0.0 (0.0-0.3)
74 48,207 1.0 (0.9-1.1) 836 1.3 (0.7-2.3) 2,031 0.9 (0.6-1.5) 3,522 0.1 (0.0-0.2)
81 12,418 0.3 (0.2-0.4) 834 1.4 (0.8-2.5) 1,180 1.1 (0.6-1.9) 1,440 0.1 (0.0-0.5)
83 15,477 0.2 (0.2-0.3) 598 0.3 (0.1-1.2) 1,112 0.3 (0.1-0.8) 1,273 0.0 (0.0-0.3)
84 16,479 0.2 (0.2-0.3) 941 1.4 (0.8-2.3) 1,180 0.3 (0.1-0.7) 1,128 0.4 (0.1-0.9)
86 2,278 0.0 (0.0-0.2) - - - - - -
87 1,479 0.5 (0.3-1.1) 549 0.0 (0.0-0.7) - - - -
89 12,022 0.3 (0.2-0.4) 785 1.7 (1.0-2.8) 897 0.3 (0.1-1.0) 1,287 0.1 (0.0-0.4)
90 3,014 1.0 (0.7-1.4) 549 0.0 (0.0-0.7) - - 420 0.0 (0.0-0.9)
91 913 0.5 (0.2-1.3) 549 0.0 (0.0-0.7) - - 2,722 0.0 (0.0-0.2)
Data updated on 14 Jun 2019 (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;

Table 15: Type-specific HPV prevalence among invasive cervical cancer cases in Europe 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 18,406 58.8 (58.1-59.5) 13,161 61.7 (60.9-62.6) 2,570 38.4 (36.6-40.3) 2,815 63.7 (61.9-65.4)
18 18,328 15.2 (14.7-15.7) 13,161 11.4 (10.9-12.0) 2,570 35.3 (33.5-37.2) 2,737 14.2 (12.9-15.5)
31 16,082 3.8 (3.6-4.2) 11,877 4.0 (3.6-4.3) 2,123 2.3 (1.7-3.0) 2,222 4.8 (4.0-5.7)
33 16,704 4.4 (4.1-4.8) 12,419 4.6 (4.3-5.0) 2,242 1.5 (1.1-2.1) 2,183 6.9 (5.9-8.1)
35 15,013 1.4 (1.2-1.6) 11,517 1.3 (1.1-1.5) 1,882 0.5 (0.3-0.9) 1,754 2.9 (2.2-3.8)
39 13,552 1.2 (1.0-1.3) 10,831 1.2 (1.0-1.4) 1,812 1.0 (0.6-1.6) 1,049 1.3 (0.8-2.2)
45 14,711 4.3 (4.0-4.6) 11,195 4.0 (3.7-4.4) 2,047 6.0 (5.0-7.1) 1,609 4.2 (3.3-5.3)
51 13,589 0.9 (0.8-1.1) 10,731 0.8 (0.7-1.0) 1,832 1.4 (0.9-2.0) 1,166 0.7 (0.3-1.3)
52 14,152 1.9 (1.7-2.1) 11,038 2.1 (1.8-2.3) 1,926 1.0 (0.7-1.6) 1,328 1.5 (1.0-2.3)
56 13,301 0.9 (0.8-1.1) 10,426 1.1 (0.9-1.3) 1,721 0.1 (0.0-0.4) 1,294 0.8 (0.4-1.4)
58 14,085 1.2 (1.0-1.4) 11,126 1.3 (1.1-1.5) 1,754 0.2 (0.1-0.6) 1,345 1.4 (0.9-2.2)
59 13,153 0.7 (0.6-0.8) 10,398 0.8 (0.6-0.9) 1,779 0.2 (0.1-0.5) 1,116 0.9 (0.5-1.6)
Probable/possible carcinogen
26 5,751 0.1 (0.0-0.2) - - - - - -
30 2,986 0.2 (0.1-0.4) 2,494 0.2 (0.1-0.5) 260 0.0 (0.0-1.5) 232 0.0 (0.0-1.6)
34 3,993 0.1 (0.0-0.2) 3,212 0.1 (0.0-0.3) 401 0.0 (0.0-0.9) 380 0.0 (0.0-1.0)
53 8,175 0.7 (0.6-1.0) - - - - - -
66 11,552 0.4 (0.3-0.5) 9,141 0.4 (0.3-0.6) 1,563 0.1 (0.0-0.5) 848 0.5 (0.2-1.2)
67 4,702 0.2 (0.1-0.3) 3,893 0.2 (0.1-0.3) 502 0.0 (0.0-0.8) 307 0.7 (0.2-2.3)
68 12,165 0.8 (0.7-1.0) 9,762 1.0 (0.8-1.2) 1,488 0.1 (0.0-0.4) 915 0.5 (0.2-1.3)
69 4,472 0.0 (0.0-0.1) - - - - - -
70 7,295 0.2 (0.1-0.3) - - - - - -
73 6,345 0.9 (0.7-1.1) - - - - - -
82 6,538 0.1 (0.1-0.3) 5,128 0.1 (0.0-0.2) 647 0.2 (0.0-0.9) 763 0.4 (0.1-1.1)
97 370 0.3 (0.0-1.5) 370 0.3 (0.0-1.5) - - - -
NON-ONCOGENIC HPV TYPES
6 8,735 0.7 (0.6-0.9) - - - - - -
11 8,579 0.5 (0.4-0.7) - - - - - -
32 600 0.0 (0.0-0.6) - - - - - -
40 4,728 0.0 (0.0-0.1) - - - - - -
42 4,797 0.2 (0.1-0.4) 4,061 0.1 (0.1-0.3) 377 0.0 (0.0-1.0) 359 1.1 (0.4-2.8)
43 4,002 0.0 (0.0-0.1) - - - - - -
44 4,603 0.3 (0.2-0.5) 3,858 0.3 (0.2-0.5) 423 0.5 (0.1-1.7) 322 0.6 (0.2-2.2)
54 5,136 0.4 (0.3-0.6) - - - - - -
55 - - - - - - - -
57 928 0.0 (0.0-0.4) - - - - - -
61 3,960 0.1 (0.0-0.3) - - - - - -
62 1,128 0.3 (0.1-0.8) - - - - - -
64 - - - - - - - -
71 1,541 0.0 (0.0-0.2) - - - - - -
72 1,356 0.0 (0.0-0.3) - - - - - -
74 3,522 0.1 (0.0-0.2) - - - - - -
81 1,440 0.1 (0.0-0.5) - - - - - -
83 1,273 0.0 (0.0-0.3) - - - - - -
84 1,128 0.4 (0.1-0.9) - - - - - -
89 1,287 0.1 (0.0-0.4) - - - - - -
90 420 0.0 (0.0-0.9) - - - - - -
91 2,722 0.0 (0.0-0.2) - - - - - -
95% CI: 95% Confidence Interval;

4.1.3 HPV type distribution among HIV+ women with normal cervical cytology
Table 16: European studies on HPV prevalence among HIV women with normal cytology
HPV detection
method and targeted HPV prevalence
Country Study HPV types No. Tested % (95% CI)
Denmark Melbye 1996 PCR-L1, TS (HPV 6, 11, 16, 18, 31, 33, 52 46.2 (32.2-60.5)
35, 39, 45, 51, 52)
Germany Kuhler-Obbarius 1994 PCR-MY11/MY09, No genotyping 34 52.9 (35.1-70.2)
Germany Weissenborn 2003 PCR-GP5+/GP6+, TS (HPV 16, 18, 31, 212 57.5 (50.6-64.3)
33, 45, 56)
Italy Ammatuna 2000 PCR- (MY09/MY11, GP5/GP6), No 51 33.3 (20.8-47.9)
genotyping
Italy Cappiello 1997 PCR-MY09/MY11, RFLP, (HPV 6, 86 20.9 (12.9-31.0)
11,16, 18, 26, 30-35, 39, 40, 42, 44, 45,
51-59, 61, 62, 64, 66-73, 77, 81-84)
Italy Del mistro 2001 PCR-MY09/MY11, RFLP, (HPV 6, 11, 72 23.6 (14.4-35.1)
16, 18, 26, 30-35, 39, 40, 42, 44, 45,
51-59, 61, 62, 64, 66-73, 77, 81-84)
Italy Tanzi 2009 PCR-MY09/MY11, RFLP, (HPV 6, 11, 103 39.8 (30.3-49.9)
16, 18, 26, 30-35, 39, 40, 42, 44, 45,
51-59, 61, 62, 64, 66-73, 77, 81-84)
Italy Branca 2000 PCR-MY09/MY11, RFLP,(HPV 6, 11, 155 22.6 (16.3-30.0)
16, 18, 26, 30-35, 39, 40, 42, 44, 45,
51-59, 61, 62, 64, 66-73, 77, 81-84)
Italy Uberti-Foppa 1998 HC2 (HPV 6, 11, 16, 18, 31, 33, 35, 39, 111 51.4 (41.7-61.0)
42, 43, 44, 45, 51, 52, 56, 58, 59, 68),
No genotyping
Italy Tornesello 2008 PCR-(GP5+/GP6+, MY09/MY11), 79 20.3 (12.0-30.8)
sequencing (DSA)
Netherlands Jong 2008 PCR-SPF10, RHA, (HPV 6, 11, 16, 18, 19 36.8 (16.3-61.6)
31, 33-35, 39, 40, 42-45, 51-54, 56, 58,
59, 66, 68, 70, 71, 74)
Netherlands Van Doornum 1993 PCR-,TS (HPV 6/11, 16, 18, 33), DBH 25 32.0 (14.9-53.5)
Spain Cañadas 2010 PCR (E6/E7), TS, (HPV 6, 11, 16, 18, 168 38.7 (31.3-46.5)
31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)
Spain Gonzalez 2008 PCR (E6/E7), HC2, TS, (HPV 6, 11, 16, 7 42.9 (9.9-81.6)
18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59,
68)
Spain De Sanjose 2000 PCR (MY09/11),EIA, DBH, (HPV6, 11, 52 34.6 (22.0-49.1)
16, 18, 31, 33, 35, 39, 40, 41, 45, 51, 52,
53, 54, 56, 58, 59, 66, 73, 81)
United Kingdom Cubie 2000 HC2 (HPV 6, 11, 16, 18, 31, 33, 35, 39, 44 25.0 (13.2-40.3)
42, 43, 44, 45, 51, 52, 56, 58, 59, 68),
No genotyping
Data updated on 31 Jul 2013 (data as of 31 Dec 2011). Only for European countries.
DBH: Dot Blot Hybridization; EIA: Enzyme ImmunoAssay; HC2: Hybrid Capture 2; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; RHA: Reverse
Hybridization Assay; SPF: Short Primer Fragment; TS: Type Specific;

4.1.4 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 ab-
normal 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 sur-
face 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.

4.2 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 on the worldwide HPV-prevalence and type dis-
tribution 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 mini-
mum 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.
4.2.1 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: 1626-36). In this section, the HPV prevalence among anal cancer
cases and precancerous anal lesions in Europe are presented.
Table 17: European 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 (%)
Tachezy 2011 PCR L1-Consensus primer, , 26 73.1 (53.9-86.3) HPV 16 (73.1%)
(Czech Rep.) 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)
Serup-Hansen PCR-E6, PCR-E7, PCR- 137 87.6 (81.0-92.1) HPV 16 (81.0%)
2014 (Denmark) MULTIPLEX (HPV 16, 18, 31, HPV 33 (5.1%)
33, 45, 52, 58) HPV 18 (2.2%)
HPV 58 (0.7%)
Alemany 2015a PCR-SPF10, EIA, (HPV 6, 11, 169 87.6 (81.8-91.7) HPV 16 (73.4%)
(Europe) 16, 18, 26, 30, 31, 33, 34, 35, 39, HPV 6 (3.6%)
40, 42, 43, 44, 45, 51, 52, 53, 54, HPV 18 (3.6%)
56, 58, 59, 61, 66, 67, 68, 69, 70, HPV 11 (3.0%)
73, 74, 82, 83, 87, 89, 91) HPV 33 (2.4%)
Abramowitz 2011 PCR-SPF10, (HPV 6, 11, 16, 18, 728 96.7 (95.1-97.8) HPV 16 (75.5%)
(France) 26, 31, 33, 35, 39, 40, 43, 44, 45, HPV 18 (5.9%)
51, 52, 53, 54, 56, 58, 59, 66, 68, HPV 11 (3.7%)
69, 70, 71, 73, 82) HPV 6 (3.0%)
HPV 52 (2.6%)


Valmary-Degano PCR-E6, (HPV 6, 11, 16, 18, 26, 73 98.6 (92.6-99.8) HPV 16 (89.0%)
2013 (France) 31, 33, 35, 39, 40, 43, 44, 45, 51, HPV 39 (4.1%)
52, 53, 54, 56, 58, 59, 66, 68, 69, HPV 33 (2.7%)
70, 71, 73, 74, 82) HPV 6 (1.4%)
HPV 11 (1.4%)
Vincent-Salomon PCR L1-Consensus primer, 27 74.1 (55.3-86.8) HPV 16 (63.0%)
1996 (France) PCR-E6, TS (HPV 6, 11, 16, 18, HPV 18 (7.4%)
33)
Rödel 2015 (Ger- PCR-SPF10, PCR- MULTIPLEX, 91 100.0 (95.9-100.0) HPV 16 (94.5%)
many) (HPV 6, 11, 16, 18, 26, 31, 33, 35, HPV 11 (2.2%)
39, 40, 42, 43, 44, 45, 51, 52, 53, HPV 31 (2.2%)
54, 56, 58, 59, 66, 68, 69, 70, 71, HPV 35 (2.2%)
73, 74, 81, 82) HPV 18 (1.1%)
Varnai 2006 (Ger- PCR-MY09/11, TS, Sequencing 47 83.0 (69.9-91.1) HPV 16 (74.5%)
many) (HPV 6, 11, 16, 18, 31, 33, 45, 58) 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) 14 64.3 (38.8-83.7) HPV 16 (42.9%)
(Italy)
Laytragoon-Lewin PCR-MY09/11, Sequencing (HPV 72 90.3 (81.3-95.2) HPV 16 (69.4%)
2007 (Sweden) 16, 18, 33) HPV 18 (34.7%)
HPV 33 (2.8%)
Baricevic 2015 PCR-L1C1/C2, PCR 151 95.4 (90.7-97.7) HPV 16 (88.7%)
(UK) L1-Consensus primer, PCR-E6, HPV 6 (11.9%)
PCR-E7, PCR- MULTIPLEX HPV 33 (6.6%)
(HPV 6, 11, 16, 18, 31, 33, 45, 52, HPV 18 (4.6%)
58) HPV 58 (4.6%)
EIA: Enzyme ImmunoAssay; PCR: Polymerase Chain Reaction; SPF: Short Primer Fragment; TS: Type Specific;
a Includes cases from Bosnia-Herzegovina, Czech Republic, France, Germany, Poland, Portugal, Slovenia, Spain and United Kingdom
Table 18: European studies on HPV prevalence among AIN 2/3 cases (male and female)
(Europe) 16, 18, 26, 30, 31, 33, 34, 35, 39, HPV 6 (8.7%)
40, 42, 43, 44, 45, 51, 52, 53, 54, HPV 18 (8.7%)
56, 58, 59, 61, 66, 67, 68, 69, 70, HPV 51 (8.7%)
73, 74, 82, 83, 87, 89, 91) HPV 74 (8.7%)
Hampl 2006 (Ger- , PCR-MY09/11, Sequencing 16 87.5 (64.0-96.5) -
many) (HPV 6, 11, 20, 21, 22, 23, 26, 30,
32)
Silling 2012b PCR- MULTIPLEX (HPV 6, 11, 42 100.0 (91.6-100.0) HPV 16 (69.0%)
(Germany) 16, 18, 26, 30, 31, 33, 34, 35, 39, HPV 11 (23.8%)
40, 42, 43, 44, 45, 51, 52, 53, 54, HPV 18 (23.8%)
56, 57, 58, 59, 61, 66, 67, 68, 70, HPV 6 (19.0%)
71, 72, 73, 81, 82, 83, 84, 89) HPV 67 (19.0%)
Varnai 2006 (Ger- , PCR-MY09/11, TS, Sequencing 24 95.8 (79.8-99.3) HPV 16 (70.8%)
many) (HPV 6, 11, 16, 18, 31, 33, 45, 58) HPV 11 (12.5%)
HPV 6 (8.3%)
HPV 58 (4.2%)


Wieland 2006b PCR, EIA (HPV 6, 11, 16, 18, 31, 18 100.0 (82.4-100.0) HPV 16 (88.9%)
(Germany) 33, 34, 35, 42, 44, 45, 52, 53, 54, HPV 18 (44.4%)
56, 58, 59, 66, 68, 70, 72, 73, 81, HPV 83 (38.9%)
82, 83, 84, 89) HPV 52 (33.3%)
HPV 58 (27.8%)
Tanzi 2009b PCR-MY09/11, PCR 62 91.9 (82.5-96.5) HPV 6 (38.7%)
(Italy) L1-Consensus primer, RFLP HPV 16 (37.1%)
(HPV 6, 11, 16, 18, 20, 21, 22, 23, HPV 11 (27.4%)
26, 30, 31, 32, 33, 34, 35, 38, 39, HPV 58 (8.1%)
40, 42, 43, 44, 45, 51, 52, 53, 54, HPV 18 (4.8%)
56, 57, 58, 59, 60, 61, 62, 66, 67,
68, 69, 70, 71, 72, 81, 83, 84)
Richel 2014b PCR L1-Consensus primer, 17 100.0 (81.6-100.0) HPV 16 (58.8%)
(Netherlands) PCR-SPF10, EIA, (HPV 6, 11, HPV 31 (17.6%)
16, 18, 26, 31, 33, 34, 35, 39, 40, HPV 18 (11.8%)
42, 43, 44, 45, 51, 52, 53, 54, 56, HPV 53 (11.8%)
58, 59, 66, 67, 68, 69, 70, 73, 74) HPV 58 (11.8%)
García-Espinosa PCR-GP5/6, PCR L1-Consensus 20 100.0 (83.9-100.0) HPV 16 (50.0%)
2013b (Spain) primer, DBH (HPV 6, 11, 16, 18, HPV 44 (35.0%)
26, 31, 33, 35, 39, 40, 42, 43, 44, HPV 58 (35.0%)
45, 51, 52, 53, 54, 56, 57, 58, 59, HPV 6 (30.0%)
61, 66, 68, 70, 71, 72, 73, 81, 82, HPV 31 (30.0%)
84)
Sirera 2013b PCR- MULTIPLEX (HPV 6, 11, 69 84.1 (73.7-90.9) HPV 16 (55.1%)
(Spain) 16, 18, 31, 33, 35, 39, 45, 51, 52, HPV 58 (34.8%)
56, 58, 59, 68) HPV 33 (29.0%)
HPV 51 (23.2%)
HPV 18 (21.7%)
Torres 2013b LBA (HPV 6, 11, 16, 18, 26, 31, 44 97.7 (88.2-99.6) HPV 16 (59.1%)
(Spain) 33, 34, 35, 39, 40, 42, 44, 45, 51, HPV 6 (34.1%)
52, 53, 54, 56, 58, 59, 61, 62, 66, HPV 66 (31.8%)
67, 68, 69, 70, 71, 72, 73, 81, 82, HPV 52 (29.5%)
83, 84) HPV 53 (29.5%)
Fox 2005b (UK) , PCR-MY09/11, (HPV 16, 18, 31, 74 97.3 (90.7-99.3) HPV 16 (64.9%)
33, 35, 39, 45, 51, 52, 56, 58, 59) HPV 18 (25.7%)
HPV 33 (24.3%)
HPV 58 (21.6%)
HPV 31 (18.9%)
95% CI: 95% Confidence Interval; AIN 2/3: Anal intraepithelial neoplasia of grade 2/3;
DBH: Dot Blot Hybridization; EIA: Enzyme ImmunoAssay; LBA: Line-Blot Assay; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; SPF: Short Primer
Fragment; TS: Type Specific;
b HIV positive cases

Figure 104: Comparison of the ten most frequent HPV types in anal cancer cases in Europe and the
World
Europe (a) World (b)
16 73.4 16 71.4
6 3.6 18 4.2
18 3.6 33 3.0
11 3.0 6 2.4
33 2.4 31 2.0
35 1.8 35 1.6
74 1.8 58 1.6
31 1.2 11 1.4
30 0.6 39 1.2
52 0.6 52 1.2
0 10 20 30 40 50 60 70 80 0 10 20 30 40 50 60 70 80
Type−specific HPV prevalence (%) of

anal cancer cases
Data updated on 09 Feb 2017 (data as of 30 Jun 2014).

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)
Figure 105: Comparison of the ten most frequent HPV types in AIN 2/3 cases in Europe and the World
74 8.7 6 9.3
16 65.2 16 72.1
18 8.7 11 7.0
51 8.7 18 4.7
6 8.7 31 4.7
11 4.3 51 4.7
31 4.3 74 4.7
35 4.3 35 2.3
44 4.3 44 2.3
45 4.3 45 2.3
0 10 20 30 40 50 60 70 80 0 10 20 30 40 50 60 70 80

AIN 2/3 cases

AIN 2/3: Anal intraepithelial neoplasia of grade 2/3;
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)

4.2.2 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) basa-
loid/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 dif-
ferentiated 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; 124:1626-36). In this section, the HPV prevalence among
vulvar cancer cases and precancerous vulvar lesions in Europe are presented.
Table 19: European studies on HPV prevalence among vulvar cancer cases
(Czech Rep.) Sequencing (HPV 6, 11, 16, 18, HPV 33 (8.7%)
20, 21, 22, 23, 26, 30, 31, 32, 33, HPV 6 (2.2%)
34, 35, 38, 39, 40, 42, 43, 44, 45, HPV 42 (2.2%)
51, 52, 53, 54, 56, 57, 58, 59, 60, HPV 45 (2.2%)
61, 62, 66, 67, 68, 69, 70, 71, 72,
73, 74, 80, 81, 82, 83, 84, 85, 86,
87, 89, 90, 91)
Bryndorf 2004 PCR-SPF10, (HPV 6, 11, 16, 18, 10 60.0 (31.3-83.2) HPV 16 (40.0%)
(Denmark) 31, 33, 35, 42, 44, 45, 51, 52, 56, HPV 33 (20.0%)
58) HPV 56 (10.0%)
Hørding 1993 PCR-E6, PCR-E7, TS (HPV 6, 62 30.6 (20.6-43.0) HPV 16 (21.0%)
(Denmark) 11, 16, 18, 33) HPV 18 (4.8%)
HPV 33 (4.8%)
Hørding 1994 PCR-E6, PCR-E7, TS (HPV 6, 78 30.8 (21.6-41.7) HPV 16 (28.2%)
(Denmark) 11, 16, 18, 33) HPV 33 (3.8%)
Madsen 2008 EIA, (HPV 6, 11, 16, 18, 31, 33, 60 51.7 (39.3-63.8) HPV 16 (36.7%)
(Denmark) 35, 42, 44, 45, 51, 52, 56, 58, 61, HPV 33 (11.7%)
67, 73) HPV 73 (3.3%)
HPV 6 (1.7%)
HPV 51 (1.7%)
de Sanjosé 2013a PCR-SPF10, EIA, (HPV 6, 11, 903 19.3 (16.8-22.0) HPV 16 (13.8%)
(Europe) 16, 18, 26, 30, 31, 33, 34, 35, 39, HPV 33 (1.2%)
40, 42, 43, 44, 45, 51, 52, 53, 54, HPV 18 (0.6%)
56, 58, 59, 61, 66, 67, 68, 69, 70, HPV 31 (0.6%)
73, 74, 82, 83, 87, 89, 91) HPV 44 (0.4%)
Iwasawa 1997 PCR-MY09/11, PCR 74 36.5 (26.4-47.9) HPV 16 (25.7%)
(Finland) L1-Consensus primer, PCR-E6, HPV 18 (12.2%)
TS (HPV 6, 11, 16, 18, 33) HPV 33 (1.4%)
Choschzick 2011 PCR-MY09/11, Sequencing (HPV 39 46.2 (31.6-61.4) HPV 16 (43.6%)
(Germany) 6, 11, 16, 18, 33) HPV 33 (2.6%)
Hampl 2006 (Ger- PCR-MY09/11, Sequencing (HPV 48 60.4 (46.3-73.0) HPV 16 (39.6%)
many) 16, 18, 20, 21, 22, 23, 26, 30, 31, HPV 33 (8.3%)
32, 33, 35, 42, 44, 45, 51, 52, 56, HPV 31 (4.2%)
58, 61, 67, 73, 91) HPV 18 (2.1%)
Milde-Langosch PCR-MY09/11, TS (HPV 6, 11, 40 27.5 (16.1-42.8) HPV 16 (25.0%)
1995 (Germany) 16, 18, 31, 33, 35)


Reuschenbach PCR- MULTIPLEX (HPV 6, 11, 183 43.7 (36.7-51.0) HPV 16 (36.1%)
2013 (Germany) 16, 18, 31, 33, 35, 39, 42, 43, 44, HPV 18 (2.7%)
45, 51, 52, 56, 58, 59, 68, 70, 71, HPV 33 (1.1%)
73, 82) HPV 6 (0.5%)
HPV 11 (0.5%)
Bonvicini 2005 PCR-MY09/11 (HPV 16, 18, 31, 16 0.0 (0.0-19.4) -
(Italy) 33, 35, 45, 52, 58)
Kagie 1997 PCR-CPI/CPIIG, Sequencing 66 19.7 (11.9-30.8) HPV 16 (16.7%)
(Netherlands) (HPV 6, 11, 16, 31, 33, 45) HPV 33 (1.5%)
HPV 45 (1.5%)
Trietsch 2013 PCR, (HPV 6, 11, 16, 18, 26, 31, 108 16.7 (10.8-24.8) HPV 16 (10.2%)
(Netherlands) 33, 35, 39, 40, 43, 44, 45, 51, 52, HPV 33 (5.6%)
53, 54, 56, 58, 59, 66, 68, 69, 70, HPV 18 (1.9%)
71, 73, 74, 82)
van de Nieuwen- PCR L1-Consensus primer, 130 34.6 (27.0-43.1) HPV 16 (15.4%)
hof 2009 (Nether- (HPV 6, 11, 16, 18, 31, 33, 35, 42, HPV 33 (5.4%)
lands) 45, 51, 52, 53, 54, 56, 58, 66, 73) HPV 18 (2.3%)
HPV 52 (1.5%)
HPV 54 (1.5%)
van der Avoort PCR L1-Consensus primer, 16 0.0 (0.0-19.4) -
2006 (Nether- PCR-SPF10, (HPV 6, 11, 16, 18,
lands) 31, 33, 35, 42, 44, 45, 51, 52, 56,
58)
Bujko 2012 PCR, LBA (HPV 6, 11, 16, 18, 44 34.1 (21.9-48.9) HPV 16 (20.5%)
(Poland) 26, 31, 33, 34, 35, 39, 40, 42, 43, HPV 11 (11.4%)
44, 45, 51, 52, 53, 54, 56, 57, 58, HPV 44 (4.5%)
59, 61, 66, 68, 70, 71, 72, 73, 81, HPV 52 (4.5%)
82, 83, 84) HPV 58 (4.5%)
Liss 1998 (Poland) PCR-MY09/11, PCR 18 16.7 (5.8-39.2) HPV 16 (16.7%)
L1-Consensus primer, PCR-E6,
PCR-E7, RFLP (HPV 6, 11, 16,
18, 31, 33, 35, 45, 52, 58)
Alonso 2011 PCR-SPF10, (HPV 6, 11, 16, 18, 98 19.4 (12.8-28.3) HPV 16 (14.3%)
(Spain) 31, 33, 35, 42, 45, 51, 52, 53, 54, HPV 33 (2.0%)
56, 58, 66) HPV 31 (1.0%)
HPV 51 (1.0%)
HPV 52 (1.0%)
Guerrero 2011 PCR L1-Consensus primer, 30 16.7 (7.3-33.6) HPV 59 (10.0%)
(Spain) (HPV 6, 11, 16, 18, 26, 31, 33, 34, HPV 6 (3.3%)
35, 39, 40, 42, 43, 44, 45, 51, 52, HPV 16 (3.3%)
53, 54, 56, 57, 58, 59, 61, 66, 68, HPV 18 (3.3%)
70, 71, 72, 73, 81, 82, 83, 84)
Lerma 1999 PCR L1-Consensus primer, TS 57 12.3 (6.1-23.2) HPV 16 (12.3%)
(Spain) (HPV 16, 18)
Larsson 2012 PCR-E6, (HPV 6, 11, 16, 18, 31, 130 30.8 (23.5-39.2) HPV 16 (23.8%)
(Sweden) 33, 39, 45, 51, 52, 56, 58, 59) HPV 33 (3.8%)
HPV 18 (1.5%)
HPV 56 (0.8%)
HPV 59 (0.8%)
Lindell 2010 PCR-CPI/CPIIG, TS, Sequencing 75 30.7 (21.4-41.8) HPV 16 (21.3%)
(Sweden) (HPV 6, 11, 16, 18, 33, 52) HPV 18 (2.7%)
HPV 33 (2.7%)
HPV 52 (1.3%)
Abdel-Hady 2001 TS (HPV 6, 11, 16, 18, 31, 33) 11 27.3 (9.7-56.6) HPV 16 (27.3%)
(UK) HPV 33 (18.2%)
HPV 18 (9.1%)


Riethdorf 2004b PCR L1-Consensus primer, TS 71 87.3 (77.6-93.2) HPV 16 (87.3%)
(World) (HPV 16)
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 Austria, Belarus, Bosnia-Herzegovina, Czech Republic, France, Germany, Greece, Italy, Poland, Portugal, Spain and United Kingdom
b Includes cases from Germany and United States of America
Table 20: European studies on HPV prevalence among VIN 2/3 cases
(Czech Rep.) Sequencing (HPV 6, 11, 16, 18, HPV 33 (8.5%)
20, 21, 22, 23, 26, 30, 31, 32, 33, HPV 18 (5.3%)
34, 35, 38, 39, 40, 42, 43, 44, 45, HPV 6 (4.3%)
51, 52, 53, 54, 56, 57, 58, 59, 60, HPV 11 (2.1%)
61, 62, 66, 67, 68, 69, 70, 71, 72,
73, 74, 80, 81, 82, 83, 84, 85, 86,
87, 89, 90, 91)
Junge 1995 (Den- PCR-E6, PCR-E7, TS (HPV 6, 58 87.9 (77.1-94.0) HPV 16 (77.6%)
mark) 11, 16, 18, 31, 33) HPV 33 (10.3%)
de Sanjosé 2013a PCR-SPF10, EIA, (HPV 6, 11, 312 86.9 (82.7-90.2) HPV 16 (69.6%)
(Europe) 16, 18, 26, 30, 31, 33, 34, 35, 39, HPV 33 (11.2%)
40, 42, 43, 44, 45, 51, 52, 53, 54, HPV 18 (2.2%)
56, 58, 59, 61, 66, 67, 68, 69, 70, HPV 6 (1.6%)
73, 74, 82, 83, 87, 89, 91) HPV 52 (1.3%)
many) 6, 11, 16, 18, 20, 21, 22, 23, 26, HPV 33 (10.7%)
30, 31, 32, 33, 35, 42, 44, 45, 51, HPV 31 (4.2%)
52, 56, 58, 61, 67, 73, 74, 91) HPV 18 (3.0%)
Tsimplaki 2012 (HPV 6, 11, 16, 18, 31, 33, 35, 40, 14 78.6 (52.4-92.4) HPV 16 (64.3%)
(Greece) 42, 43, 44, 45, 51, 52, 53, 56, 58, HPV 18 (7.1%)
59, 66, 73) HPV 51 (7.1%)
HPV 52 (7.1%)
HPV 53 (7.1%)
Bonvicini 2005 PCR-MY09/11 (HPV 16, 18, 31, 25 44.0 (26.7-62.9) HPV 16 (36.0%)
(Italy) 33, 35, 45, 52, 58) HPV 35 (8.0%)
HPV 33 (4.0%)
HPV 52 (4.0%)
van Beurden 1995 PCR-CPI/CPIIG, Sequencing 46 95.7 (85.5-98.8) HPV 16 (89.1%)
(Netherlands) (HPV 6, 11, 16, 18, 20, 21, 22, 23, HPV 33 (2.2%)
26, 30, 31, 32, 33, 45) HPV 45 (2.2%)
van der Avoort PCR L1-Consensus primer, 32 56.3 (39.3-71.8) HPV 16 (40.6%)
2006 (Nether- PCR-SPF10, (HPV 6, 11, 16, 18, HPV 6 (6.3%)
lands) 31, 33, 35, 42, 43, 44, 45, 51, 52, HPV 31 (6.3%)
56, 58, 59, 74) HPV 33 (3.1%)
van Esch 2014 TS (HPV 16, 18, 33, 73) 43 100.0 (91.8-100.0) HPV 16 (81.4%)
(Netherlands) HPV 33 (14.0%)
HPV 73 (2.3%)
Lerma 1999 PCR L1-Consensus primer, TS 18 27.8 (12.5-50.9) HPV 16 (27.8%)
(Spain) (HPV 16, 18)
Abdel-Hady 2001 TS (HPV 06/11, 16, 18, 31, 33) 32 71.9 (54.6-84.4) HPV 16 (62.5%)
(UK) HPV 6/11 (18.8%)
HPV 31 (3.1%)
HPV 33 (3.1%)


Baldwin 2003 PCR L1-Consensus primer, 11 100.0 (74.1-100.0) HPV 16 (90.9%)
(UK) Sequencing (HPV 6, 11, 16, 18, HPV 33 (9.1%)
31, 33)
Bryant 2011 (UK) PCR- MULTIPLEX (HPV 6, 11, 49 81.6 (68.6-90.0) HPV 16 (67.3%)
16, 18, 31, 33, 35, 40, 42, 43, 44, HPV 33 (16.3%)
45, 51, 52, 53, 56, 58, 59, 66, 73) HPV 6 (10.2%)
HPV 18 (2.0%)
HPV 31 (2.0%)
Daayana 2010 EIA, (HPV 6, 11, 16, 26, 31, 33, 19 78.9 (56.7-91.5) HPV 16 (73.7%)
(UK) 34, 35, 39, 40, 42, 43, 44, 45, 51, HPV 33 (5.3%)
52, 53, 54, 56, 57, 58, 59, 61, 66, HPV 42 (5.3%)
68, 70, 71, 72, 73, 81, 82, 83, 84) HPV 84 (5.3%)
Winters 2008 EIA, (HPV 6, 11, 16, 18, 26, 31, 20 85.0 (64.0-94.8) HPV 16 (75.0%)
(UK) 33, 34, 35, 39, 40, 42, 43, 44, 45, HPV 18 (5.0%)
51, 52, 53, 54, 56, 57, 58, 59, 61, HPV 33 (5.0%)
66, 68, 70, 71, 72, 73, 81, 82, 83,
84)
Riethdorf 2004b PCR L1-Consensus primer, TS 60 68.3 (55.8-78.7) HPV 16 (68.3%)
(World) (HPV 16)
95% CI: 95% Confidence Interval; 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 Germany and United States of America
Figure 106: Comparison of the ten most frequent HPV types in cases of vulvar cancer in Europe and
the World
16 13.8 16 19.4
33 1.2 33 1.8
18 0.6 18 1.5
31 0.6 45 0.9
44 0.4 6 0.6
51 0.4 31 0.6
53 0.3 44 0.6
58 0.3 52 0.5
74 0.3 51 0.4
35 0.2 56 0.4
0 10 20 0 10 20

vulvar cancer cases

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)

Figure 107: Comparison of the ten most frequent HPV types in VIN 2/3 cases in Europe and the World
16 69.6 16 67.1
33 11.2 33 10.2
18 2.2 6 2.4
6 1.6 18 2.4
52 1.3 31 1.9
56 1.3 52 1.4
44 1.0 51 1.2
66 1.0 56 0.9
74 1.0 74 0.9
31 0.6 66 0.7
0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70

VIN 2/3 cases

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 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)

4.2.3 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:
1626-36). In this section, the HPV prevalence among vaginal cancer cases and precancerous vaginal
lesions in Europe are presented.
Table 21: European studies on HPV prevalence among vaginal cancer cases
Madsen 2008 EIA, (HPV 6, 11, 16, 18, 31, 33, 27 88.9 (71.9-96.1) HPV 16 (77.8%)
(Denmark) 35, 39, 40, 42, 44, 45, 51, 52, 56, HPV 33 (7.4%)
58) HPV 18 (3.7%)
HPV 39 (3.7%)
HPV 45 (3.7%)
(Europe) 16, 18, 26, 30, 31, 33, 35, 39, 42, HPV 18 (3.3%)
45, 51, 52, 53, 56, 58, 59, 66, 67, HPV 73 (3.3%)
68, 69, 73, 82) HPV 33 (2.6%)
HPV 56 (2.6%)
Ferreira 2008 PCR, (HPV 6, 11, 16, 18, 31, 33, 21 81.0 (60.0-92.3) HPV 16 (33.3%)
(Portugal) 35, 40, 42, 44, 45, 51, 52, 56, 58) HPV 31 (28.6%)
HPV 40 (14.3%)
HPV 6 (9.5%)
HPV 18 (9.5%)
Fuste 2010 PCR-SPF10, (HPV 6, 11, 16, 18, 32 78.1 (61.2-89.0) HPV 16 (56.3%)
(Spain) 31, 33, 35, 39, 40, 42, 45, 51, 52, HPV 52 (6.3%)
56, 58, 59, 68) HPV 35 (3.1%)
HPV 51 (3.1%)
HPV 58 (3.1%)
Larsson 2013 PCR-E6, (HPV 6, 11, 16, 18, 31, 69 53.6 (42.0-64.9) HPV 16 (37.7%)
(Sweden) 33, 35, 39, 45, 51, 52, 56, 58, 59) HPV 18 (2.9%)
HPV 31 (2.9%)
HPV 33 (2.9%)
HPV 52 (2.9%)
EIA: Enzyme ImmunoAssay; PCR: Polymerase Chain Reaction; SPF: Short Primer Fragment;
a Includes cases from Austria, Belarus, Czech Republic, France, Germany, Greece, Poland, Spain and United Kingdom
Table 22: European studies on HPV prevalence among VaIN 2/3 cases
Alemany 2014 PCR-SPF10, EIA, (HPV 6, 11, 96 97.9 (92.7-99.4) HPV 16 (65.6%)
(Europe) 16, 18, 26, 30, 31, 33, 35, 39, 42, HPV 33 (7.3%)
45, 51, 52, 53, 56, 58, 59, 66, 67, HPV 18 (5.2%)
68, 69, 73, 82) HPV 52 (3.1%)
HPV 73 (3.1%)


many) 6, 11, 16, 18, 20, 21, 22, 23, 26,
30, 31, 32, 33, 35, 40, 44, 52, 56,
58)
Tsimplaki 2012 (HPV 6, 11, 16, 18, 31, 33, 35, 39, 10 40.0 (16.8-68.7) HPV 16 (20.0%)
(Greece) 40, 42, 44, 45, 51, 52, 53, 56, 58, HPV 33 (20.0%)
66, 70)
Frega 2007 (Italy) PCR, TS (HPV 16, 18) 30 100.0 (88.6-100.0) HPV 16 (86.7%)
HPV 18 (13.3%)
95% CI: 95% Confidence Interval; VAIN 2/3: Vaginal intraepithelial neoplasia of grade 2/3;
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 ICO HPV Information Centre has updated data until June 2015. 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 | Frega A, Cancer Lett 2007; 249: 235 | Hampl M, Obstet Gynecol 2006; 108: 1361 | Tsimplaki E, J Oncol 2012; 2012: 893275
Figure 108: Comparison of the ten most frequent HPV types in vaginal cancer cases in Europe and the
World
16 47.4 16 43.6
18 3.3 31 3.9
73 3.3 18 3.7
33 2.6 33 3.7
56 2.6 45 2.7
58 2.6 58 2.7
31 2.0 52 2.2
35 1.3 51 1.7
45 1.3 73 1.7
52 1.3 39 1.5
0 10 20 30 40 50 0 10 20 30 40 50

vaginal cancer cases

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)

Figure 109: Comparison of the ten most frequent HPV types in VaIN 2/3 cases in Europe and the World
16 65.6 16 56.1
33 7.3 18 5.3
18 5.2 52 5.3
52 3.1 73 4.8
73 3.1 33 4.2
35 2.1 59 3.7
53 2.1 56 2.6
56 2.1 51 2.1
59 2.1 6 1.6
30 1.0 35 1.6
0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70

VaIN 2/3 cases

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); Asia (Bangladesh, India, Israel, South Korea, Kuwait, Philippines, Taiwan and Turkey); and Oceania
(Australia)

4.2.4 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 Europe
are presented.
Table 23: European studies on HPV prevalence among penile cancer cases
Mannweiler 2013 PCR L1-Consensus primer, 123 58.5 (49.7-66.9) HPV 16 (45.5%)
(Austria) PCR-SPF10, (HPV 6, 11, 16, 18, HPV 33 (4.9%)
26, 31, 33, 35, 39, 40, 43, 44, 45, HPV 18 (4.1%)
51, 52, 53, 54, 56, 58, 59, 66, 68, HPV 45 (3.3%)
69, 70, 71, 72, 73, 74, 82) HPV 6 (0.8%)
D’Hauwers 2012 PCR-E6, PCR-E7, qPCR (HPV 6, 36 61.1 (44.9-75.2) HPV 16 (47.2%)
(Belgium) 11, 16, 18, 31, 33, 35, 39, 45, 51, HPV 59 (5.6%)
52, 53, 56, 58, 59, 66, 67, 68) HPV 6 (2.8%)
HPV 11 (2.8%)
HPV 33 (2.8%)
(Europe) 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%)
Humbey 2003 PCR-MY09/11, PCR 36 66.7 (50.3-79.8) HPV 16 (25.0%)
(France) L1-Consensus primer, TS (HPV
6, 11, 16, 18, 31, 33, 35, 45, 51,
52, 58, 68)
Perceau 2003 TS (HPV 16, 18, 31, 33) 17 17.6 (6.2-41.0) HPV 16 (17.6%)
(France)
Poetsch 2011 PCR- MULTIPLEX, TS (HPV 52 38.5 (26.5-52.0) HPV 16 (32.7%)
(Germany) 06/11, 16, 18) HPV 6/11 (3.8%)
HPV 18 (1.9%)
Barzon 2014 qPCR, , TS (HPV 16, 18, 26, 31, 54 29.6 (19.1-42.8) HPV 16 (25.9%)
(Italy) 33, 35, 39, 43, 44, 45, 51, 52, 53, HPV 45 (1.9%)
54, 56, 58, 59, 66, 68, 69, 70, 71, HPV 68 (1.9%)
73, 74, 82)
Gentile 2006 PCR-MY09/11, PCR 11 72.7 (43.4-90.3) HPV 16 (45.5%)
(Italy) L1-Consensus primer, HPV 18 (18.2%)
Sequencing (HPV 16, 18, 53) HPV 53 (9.1%)
Tornesello 2008 PCR-MY09/11, PCR-L1C1/C2, 61 47.5 (35.5-59.8) HPV 16 (42.6%)
(Italy) PCR-E6, PCR-E7, Sequencing HPV 18 (3.3%)
(HPV 6, 16, 18, 33, 35) HPV 35 (1.6%)
Heideman 2007 PCR-E6, PCR-E7, EIA, (HPV 6, 171 29.2 (22.9-36.5) HPV 16 (22.8%)
(Netherlands) 11, 16, 18, 26, 31, 33, 34, 35, 39, HPV 18 (2.3%)
42, 43, 44, 45, 51, 52, 53, 54, 56, HPV 45 (1.8%)
57, 58, 59, 61, 66, 68, 70, 71, 72, HPV 33 (1.2%)
73, 81, 82, 83, 84) HPV 56 (0.6%)


Ferrándiz-Pulido PCR-SPF10, EIA, (HPV 6, 11, 78 37.2 (27.3-48.3) HPV 16 (26.9%)
2013 (Spain) 16, 18, 31, 33, 34, 35, 39, 40, 42, HPV 58 (3.8%)
43, 44, 45, 51, 52, 53, 54, 56, 58, HPV 6 (2.6%)
59, 66, 68, 70, 73, 74) HPV 33 (1.3%)
HPV 45 (1.3%)
Guerrero 2008 (HPV 6, 11, 16, 18, 26, 31, 33, 34, 24 45.8 (27.9-64.9) HPV 16 (45.8%)
(Spain) 35, 39, 40, 42, 43, 44, 45, 51, 52, HPV 39 (4.2%)
53, 54, 56, 57, 58, 59, 61, 66, 68,
70, 71, 72, 73, 81, 82, 83, 84)
Pascual 2007 PCR-MY09/11, PCR 49 77.6 (64.1-87.0) HPV 16 (65.3%)
(Spain) L1-Consensus primer, HPV 18 (8.2%)
Sequencing (HPV 6, 11, 16, 18)
Stankiewicz 2011 PCR L1-Consensus primer, 102 55.9 (46.2-65.1) HPV 16 (45.1%)
(UK) PCR-SPF10 (HPV 6, 11, 16, 18, HPV 11 (9.8%)
26, 31, 33, 35, 39, 40, 43, 44, 45, HPV 6 (5.9%)
51, 52, 53, 54, 56, 58, 59, 66, 68, HPV 45 (5.9%)
69, 70, 71, 73, 74, 82) HPV 31 (4.9%)
Table 24: European studies on HPV prevalence among PeIN 2/3 cases
Study Method No. Tested % (95% CI) HPV type (%)
Mannweiler 2013 PCR L1-Consensus primer, 43 76.7 (62.3-86.8) HPV 16 (62.8%)
(Austria) PCR-SPF10, (HPV 6, 11, 16, 18, HPV 18 (9.3%)
26, 31, 33, 35, 39, 40, 43, 44, 45, HPV 33 (2.3%)
51, 52, 53, 54, 56, 58, 59, 66, 68, HPV 73 (2.3%)
69, 70, 71, 72, 73, 74, 82)
D’Hauwers 2012 PCR-E6, PCR-E7, qPCR (HPV 6, 13 84.6 (57.8-95.7) HPV 16 (61.5%)
(Belgium) 11, 16, 18, 31, 33, 35, 39, 45, 51, HPV 18 (23.1%)
52, 53, 56, 58, 59, 66, 67, 68) HPV 11 (15.4%)
HPV 53 (15.4%)
HPV 56 (15.4%)
(Europe) 16, 18, 26, 30, 31, 32, 33, 35, 39, HPV 33 (6.3%)
40, 42, 43, 44, 45, 51, 52, 53, 54, HPV 6 (3.1%)
56, 58, 59, 61, 66, 67, 68, 69, 70, HPV 18 (3.1%)
73, 74, 82, 83, 87, 89, 90, 91) HPV 31 (3.1%)
Wikström 2012 PCR-MY09/11, PCR 28 85.7 (68.5-94.3) HPV 16 (39.3%)
(Sweden) L1-Consensus primer (HPV 6, HPV 6 (21.4%)
11, 16, 18, 26, 31, 33, 35, 39, 42, HPV 31 (7.1%)
43, 44, 45, 51, 52, 53, 56, 58, 59, HPV 33 (7.1%)
66, 68, 70, 73, 82) HPV 45 (7.1%)
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;

Figure 110: Comparison of the ten most frequent HPV types in penile cancer cases in Europe and the
World
16 23.4 16 22.8
52 1.2 6 1.6
6 1.0 33 1.2
33 1.0 35 1.0
45 0.7 45 1.0
58 0.7 52 0.9
18 0.5 11 0.7
31 0.5 18 0.7
35 0.5 59 0.7
44 0.5 74 0.6
0 10 20 30 0 10 20 30

penile cancer cases

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.
Figure 111: Comparison of the ten most frequent HPV types in PeIN 2/3 cases in Europe and the World
16 73.4 16 69.4
33 6.3 33 5.9
6 3.1 58 4.7
18 3.1 31 3.5
31 3.1 51 3.5
45 3.1 52 3.5
51 3.1 6 2.4
52 3.1 18 2.4
58 3.1 45 2.4
43 1.6 53 2.4
0 10 20 30 40 50 60 70 80 0 10 20 30 40 50 60 70 80

PeIN 2/3 cases

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.

4.3 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 sub-
groups 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 Europe 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, 2015. 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.
Table 25: European studies on anogenital HPV prevalence among men

Anatomic sites HPV detection Age HPV prevalence
Country Study samples method Population (years) No % (95% CI)
Croatia Grce 1996 Urethra Filter Family planning - 79 26.6 (17.3-37.7)
hybridization clinic attendees
(slot-blot, TS
6,11,16,18)
Vardas Penis RT-PCR-Multiplex Heterosexual men Median 3132 21.2 (19.8-22.7)
2011a or Biplex enrolled in a HPV 20 (15-
vaccine trial 24)
Denmark Hebnes Coronal sulcus, HC2 Male employees Mean 23 2436 22.2 (20.6-24.0)
2015 glans, preputial and conscripts at (18-65)
cavity, scrotum, military barracks
shaft and
perineum
PCR-LIPAv2 Male employees Mean 23 2436 41.8 (39.9-43.8)
and conscripts at (18-65)
military barracks
Kjaer 2005 Glans and PCR-GP5+/6+ TS Military conscripts 18-29 337 33.8 (28.8-39.2)
corona sulcus oligoprobes
Finland Hippeläinen Glans, prepuce, PCR-MY09/11 TS Voluntary Mean 20 285 16.5 (12.4-21.3)
1993 corona sulcus, 6,11,16,18,31,33 conscripts
urethral meatus
Kero 2011 Urethra PCR-MY09/11 and Sexual partners of 19-46 128 22.7 (15.7-30.9)
GP5+/6+ pregnant women
Germany Grussendorf- Coronal sulcus ISH Blood donors or 16-79 530 5.8 (4.0-8.2)
Conen and glans patients from
1987 department of
dermatology


vaccine trial 24)
Italy Lorenzon Coronal sulcus, PCR-Roche Linear Heterosexual men 18-68 378 40.5 (35.5-45.6)
2014 shaft, prepuce, Array HPV for routine HPV
and urethral Genotyping test testing
Nasca Penis PCR-MY09/11 and Hospital based 27-79 46 8.7 (2.4-20.8)
2006 GP5+/6+ controls attending
clinic for
nongenital
complaints
Spain Franceschi Glans, corona, PCR-GP5+/6+ Husbands of 24-78 168 3.6 (1.3-7.6)
2002 urethra control women
vaccine trial 24)
Sweden Forslund Urethra PCR-TS Military conscripts 20-23 138 8.7 (4.6-14.7)
1993 (6,11,16,18,31,33,35)
and unespecified
consensus primer
Kataoka Urethra PCR-TS Army conscripts 18-23 66 12.1 (5.4-22.5)
1991 6,11,16,18,33 with normal
epithelium
Data updated on 14 Jun 2019 (data as of 31 Oct 2015).
HC2: Hybrid Capture 2; ISH: In Situ Hybridization; PCR: Polymerase Chain Reaction; RT-PCR: Real Time Polymerase Chain Reaction; TS: Type Specific;
a Includes cases from Australia, Brazil, Canada, Croatia, Germany, Mexico, Spain, and USA.
Table 26: European studies on anogenital HPV prevalence among men from special subgroups
Croatia Goldstone Anus RT-PCR-Multiplex HIV- MSM Median 602 42.4 (38.4-46.4)
2011 or Biplex 22 (16-
27)
Penis RT-PCR-Multiplex HIV- MSM Median 602 18.4 (15.4-21.8)
or Biplex 22 (16-
27)
Denmark Svare Coronal sulcus, PCR-GP5+/6+ and STD clinic >=18 198 44.9 (37.9-52.2)
2002 glans, perianal TS attendees
area, scrotum, 6,11,16,18,31,33
and shaft
France Aynaud Meatal urethra PCR-TS Men with normal Mean 30 34 2.9 (0.1-15.3)
2003 6,11,42,16,18,33 peniscopy whose
female partners
have genital HPV
lesions


Men with penile Mean 29 55 87.3 (75.5-94.7)
and urethral
lesions whose
female partners
have genital HPV
lesions
Damay Anal canal PCR- HIV+ MSM Median 67 74.6 (62.5-84.5)
2010 PapilloCheck® 45 (39-
49.5)
Philibert Anus PCR-Cobas HIV- MSM Mean 16 75 (47.6-92.7)
2014 HR-HPV 46.4
(SD=9.4)
HIV+ MSM Mean 82 76.8 (66.2-85.4)
46.4
(SD=9.4)
Piketty Anal canal PCR-MY09/11 HIV+ MSM 27-62 45 80 (65.4-90.4)
2004
Germany Goldstone Anus RT-PCR-Multiplex HIV- MSM Median 602 42.4 (38.4-46.4)
2011 or Biplex 22 (16-
27)
or Biplex 22 (16-
27)
Schneider Glans, prepuce, Filter Sexual partners of Mean 156 39.1 (31.4-47.2)
1988 fossa hybridization women with HPV 36.5
navicularis, DNA/DNA associated lesions
shaft of the cervix
Wieland Anus PCR-Multiplex HIV+ MSM 18-80 801 91.5 (89.4-93.3)
2015 and hybridization
Greece HadjivassiliouUrethra HC2 HR, LR HIV- STD clinic 15-65 64 20.3 (11.3-32.2)
2007 attendees without
genital warts and
sexual partners of
women with
genital warts
Ireland Sadlier Anus PCR-TS 16,18,31 HIV- MSM Mean 32 80 61.3 (49.7-71.9)
2014 (SD=8)
HIV+ MSM Mean 40 83 77.1 (66.6-85.6)
(SD=10)
Italy Barzon Glans, corona, PCR-General Men referred for 20-72 947 41.7 (38.5-44.9)
2010 shaft, perianal primers for L1 HPV testing.
area, urethra, (MY09/11, GP5 + Indications for
and semen /6+) testing: STD
screening, HPV
suspected lesions,
HPV-positive
partners
Benevolo Coronal sulcus, PCR-L1 Male partners of 20-61 71 35.2 (24.2-47.5)
2008 urethra, women with CIN
prepuce, shaft and/or positive
HPV


Chiarini Urethra PCR-Generic Men with - 247 31.2 (25.5-37.4)
1998 primers in E1 symptoms of
nongonococcal
urethritis
Della Urethra PCR-TS Partners of women - 64 21.9 (12.5-34.0)
Torre 1992 6,11,16,18 with HPV
Dona 2015 Anus PCR-Linear Array HIV- MSM Median 437 72.1 (67.6-76.2)
32
(IQR=27-
39)
HIV+ MSM Median 172 93 (88.1-96.3)
41
(IQR=33-
47)
Garbuglia Anus PCR-MY09/11 HIV+ MSM Median 220 88.6 (83.7-92.5)
2015 39
(IQR=33-
44)
Giovannelli Coronal sulcus, PCR-LiPA, Partners of women 23-58 47 68.1 (52.9-80.9)
2007 frenulum, glans, GP5+/6+ and with HPV
prepuce, shaft MY09/11
Orlando Anus HC2 HIV+ Median 233 87.1 (82.1-91.1)
2008 34
(IQR=30-
42)
Pierangeli Anal canal PCR-MY09/11 HIV- MSM 28-62 9 88.9 (51.8-99.7)
2008
HIV+ MSM 25-65 18 94.4 (72.7-99.9)
Sammarco Anus PCR-Multiplex HIV+ MSM Mean 38 50 56 (41.3-70.0)
2016 and RFLP and (IQR=20-
sequencing 53)
Coronal sulcus PCR-Multiplex HIV+ MSM Mean 38 50 22 (11.5-36.0)
and RFLP and (IQR=20-
sequencing 53)
Urethra PCR-Multiplex HIV+ MSM Mean 38 50 10 (3.3-21.8)
and RFLP and (IQR=20-
sequencing 53)
Nether- Bleeker Glans, corona, PCR-GP5+/6+ Partners of women 24-58 119 58.8 (49.4-67.8)
lands 2002 frenulum, with CIN
prepuce
Bleeker Corona, PCR-GP5+/6+ Men visiting 22.8-73.2 83 25.3 (16.4-36.0)
2005a frenulum, glans, department of
inner prepuce dermatology for
non-STI
complaints
Bleeker Corona, PCR-GP5+/6+ Partners of women 22.5-57.7 181 72.9 (65.8-79.3)
2005b frenulum, glans, with dyskaryosis
inner prepuce and/or CIN
van der Coronal sulcus PCR-TS primers HIV- MSM 19-76 241 15.8 (11.4-21.0)
Snoek and LiPA
2003
HIV+ MSM 29-59 17 23.5 (6.8-49.9)
Perianal area PCR-TS primers HIV- MSM 19-76 241 32.8 (26.9-39.1)
and LiPA


HIV+ MSM 29-59 17 64.7 (38.3-85.8)
Van Door- Corona, PCR-TS STD clinic Mean 37 85 28.2 (19.0-39.0)
num 1994 urethra, anus, 6/11,16,18,33 attendees
rectum
van Rijn Anal canal PCR-LIPA TS HIV- MSM Median 441 33.6 (29.2-38.2)
2014 16,18,31,33,45,52,58 37.6
(IQR=33.6-
42.2)
HIV+ MSM Median 306 56.9 (51.1-62.5)
45.6
(IQR=39.4-
52.5)
Penile shaft PCR-LIPA TS HIV- MSM Median 441 11.1 (8.3-14.4)
16,18,31,33,45,52,58 37.6
(IQR=33.6-
42.2)
HIV+ MSM Median 306 23.2 (18.6-28.3)
45.6
(IQR=39.4-
52.5)
Vriend Anal canal PCR-LIPA MSM STD clinic Median 56 3.6 (0.4-12.3)
2013 attendees 22 (16-
24)
MSW STD clinic Median 124 33.1 (24.9-42.1)
attendees 22 (16-
24)
Penis PCR-LIPA MSM STD clinic Median 56 26.8 (15.8-40.3)
attendees 22 (16-
24)
MSW STD clinic Median 124 16.1 (10.1-23.8)
attendees 22 (16-
24)
Welling Anus PCR-SPF DEIA HIV- MSM Median 461 60.1 (55.5-64.6)
2015 LIPA 38
(IQR=33-
42)
HIV+ MSM Median 317 78.2 (73.3-82.7)
46
(IQR=39-
53)
Penis PCR-SPF DEIA HIV- MSM Median 461 29.5 (25.4-33.9)
LIPA 38
(IQR=33-
42)
HIV+ MSM Median 317 49.5 (43.9-55.2)
46
(IQR=39-
53)
Russia Wirtz 2015 Anus PCR-TS HIV- MSM Median 65 30.8 (19.9-43.4)
6,11,16,18,31,33 29 (19-
50)
HIV+ MSM Median 58 50 (36.6-63.4)
29 (19-
50)


Slovenia Golob 2014 Penis PCR-Linear Array Men from infertile Mean 33 299 37.1 (31.6-42.9)
couples
Milosevic Anal canal PCR-Linear Array HIV- MSM 16-80 116 75 (66.1-82.6)
2010
HIV+ MSM 20-57 20 95 (75.1-99.9)
Spain Álvarez- Anus PCR-General STD clinic 17-87 123 49.6 (40.5-58.8)
Argüelles primers in L1 attendees
2013 (MY09/11, GP5 +
/6+), PCR with TS
primers in E6/E7
for typing
Balanopreputial PCR-General STD clinic 17-87 1318 36.9 (34.3-39.5)
primers in L1 attendees
(MY09/11, GP5 +
/6+), PCR with TS
primers in E6/E7
for typing
Franceschi Glans, corona, PCR-GP5+/6+ Husbands of 22-76 102 21.6 (14.0-30.8)
2002 urethra women with
cervical carcinoma
in situ
Husbands of 25-74 84 11.9 (5.9-20.8)
women with
invasive cervical
cancer
Goldstone Anus RT-PCR-Multiplex HIV- MSM Median 602 42.4 (38.4-46.4)
2011 or Biplex 22 (16-
27)
or Biplex 22 (16-
27)
Hidalgo- Anus PCR-GeneAmp HIV+ MSM Mean 197 80.2 (73.9-85.5)
Tenorio HR-HPV 37.4
2015 (SD=9.5)
Sendagorta Anus PCR-Genomic HIV+ >=18 298 93 (89.4-95.6)
2014 amplification MSM/bisexual men
Sendagorta Anus PCR-HR Clart HIV+ MSM Median 101 82.2 (73.3-89.1)
2015 HPV2 42
(IQR=33-
50)
Torres Anus PCR-Roche Linear HIV+ MSM IQR=28.2- 1439 95.8 (94.6-96.7)
2013 Array HPV 40.1
Genotyping test
Videla Anus PCR-TS primers HIV+ Heterosexual 40-48 195 41.5 (34.5-48.8)
2013 in E6/E7 men attending an
F-HPVTM typing outpatient HIV
(Molgentix SL, clinic
Spain)
HIV+ MSM 36-47 538 84.2 (80.8-87.2)
attending an
outpatient HIV
clinic


Coronal sulcus, PCR-TS primers HIV+ Heterosexual 40-48 191 27.2 (21.0-34.1)
glans, urethra, in E6/E7 men attending an
shaft F-HPVTM typing outpatient HIV
(Molgentix SL, clinic
Spain)
HIV+ MSM 36-47 457 24.9 (21.0-29.2)
attending an
outpatient HIV
clinic
Sweden Kataoka Urethra PCR-TS Army conscripts 18-23 39 25.6 (13.0-42.1)
1991 6,11,16,18,33 with aceto-white
epithelium
Löwhagen Anus PCR-MY09/11 HIV- MSM 26-62 13 53.8 (25.1-80.8)
1999
HIV+ MSM 27-54 17 94.1 (71.3-99.9)
Strand Coronal sulcus, PCR-MY09/11 and STD clinic 20-53 65 29.2 (18.6-41.8)
1993 glans, GP5+/6+ attendees
preputium, and
shaft
Voog 1997 Glans and PCR-MY09/11 and STD clinic 19-67 20 25 (8.7-49.1)
prepuce GP5+/6+ attendees
Wikström Coronal sulcus, PCR-TS primers STD clinic 17-58 228 53.9 (47.2-60.5)
1991 inner part of the followed by dot attendees
prepuce, blot
urethra
Wikström Corona, glans, PCR-GP5+/6+ STD clinic 18-54 235 13.2 (9.1-18.2)
2000 and prepuce attendees
UK Bissett Glans, prepuce, PCR-General Genitourinary - 87 49.4 (38.5-60.4)
2011 shaft, scrotum primers (GP5 + clinic attendees
/6+), Bio-Plex with multiple
array technology sexual partners or
for typing diagnosis of genital
warts within 6
months
Cuschieri Shaft PCR-INNO-LiPA Drop-in sexual 16-25 117 29.1 (21.0-38.2)
2011 health service
attendees
Hillman Urethra PCR-GP5+/6+ Men infected with 17-55.6 100 18 (11.0-26.9)
1993 gonorrhea
Jalal 2007 Urethra PCR-General Genitourinary 15-77 437 20.8 (17.1-24.9)
primers for L1 clinic attendees
(MY09/11, GP5 +
/6+) and RLH
King 2015 Anus PCR-Multiplex MSM Median 454 40.1 (35.5-44.8)
and Bio-Plex Any 30
nonavalent (IQR=25-
vaccine HPV types 35)
Coronal sulcus, PCR-Multiplex MSM Median 446 36.1 (31.6-40.7)
glans, penis and Bio-Plex Any 30
shaft, scrotum nonavalent (IQR=25-
and perianal vaccine HPV types 35)
area
Lacey Anal canal PCR-GP5+/6+ HIV+ MSM 19-62 57 84.2 (72.1-92.5)
1999


Data updated on 14 Jun 2019 (data as of 31 Oct 2015).
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
4.4 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 can-
cer 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 expla-
nation 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 Europe is presented.
4.4.1 Burden of oral HPV infection in healthy population
Table 27: European studies on oral HPV prevalence among healthy population
Method HPV detection Prev. of 5 most
specimen method frequent
collection and and targeted Age No. HPV prevalence HPVs
Study anatomic site HPV types Population (years) Tested % (95% CI) HPV type (%)
MEN
Eike 1995 Oral smear taken PCR-MY09/11. Patients with 20-79 31 0.0 (0.0-11.2) -
(Denmark) with a wooden Genotyping by unrelated disease
stick, used on the amplification with TS (otosclerosis, nasal
right border of the primers (6, 11, 16, complaints)and
tongue and right 18) and RFLP their accompanying
buccal mucosa relatives
Kero 2012 Cytobrush from the PCR-GP5+/GP6+ and Fathers-to-be of - 131 18.3 (12.1-26.0) HPV 16 (9.2%)
(Finland) buccal mucosa MY09/MY11. cohort study HPV 33 (2.3%)
Genotyping with HPV 82 (2.3%)
Multimerix kit (6, 11, HPV 6 (0.8%)
16, 18, 31, 33, 39, 42, HPV 11 (0.8%)
43, 44, 45, 51, 52, 58,
59, 68, 70, 73, 82)
Montaldo Saliva samples PCR-MY09/MY11 Dental clinic 4-77 69 14.5 (7.2-25.0) HPV 16 (13.0%)
2007 (Italy) and GP5+N. visitors HPV 31 (1.5%)
Genotyping by
sequencing
Kujan 2006 Two brushes: PCR-Roche master Healthy volunteers - 26 3.9 (0.1-19.6) -
(UK) 1.-cervex brush into mix and HC2 digene from university
each side of buccal (both able to detect dental hospital.
mucosa and the following HR
2.-cytobrush lateral types: 16, 18, 31, 33,
border of the 35, 39, 45, 51, 52, 56,
tongue 58, 59 and 68). No
further genotyping
WOMEN


Kero 2011 Cytobrush from the PCR-GP5+/GP6+ and Spouses in 3rd - 128 17.2 (11.1-24.9) HPV 16 (13.3%)
(Finland) buccal mucosa MY09/MY11. trimestres of HPV 6 (2.3%)
Genotyping with pregnancy of the HPV 58 (0.8%)
Multimerix kit (6, 11, fathers-to-be of
16, 18, 31, 33, 39, 42, cohort study
43, 44, 45, 51, 52, 58,
59, 68, 70, 73, 82)
Leimola- Oral smears PCR-GP5/GP6. No Post-menopausal 55 131 10.7 (6.0-17.3) -
Virtanen collected from three genotyping women
1996 sites of clinically participating in
(Finland) healthy oral annual
mucosa (i.e., buccal mass-screening
surface, palate, and program for the
tongue) with use of detection of cervical
a sterile precancerous
interdental brush lesions
Genotyping by
sequencing
Cañadas Toothbrush on the PCR-MY09/MY11. Female sex workers - 188 8.5 (4.9-13.5) HPV 6 (2.7%)
2004 (Spain) oral cavity Genotyping by DBH who attended a HPV 16 (2.1%)
with TS probes (6, dermatology or HPV 11 (0.5%)
11, 16, 18, 26, 31-33, STD clinic.
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)
border of the 35, 39, 45, 51, 52, 56,
further genotyping
BOTH OR UNSPECIFIED
Kero 2011 Cytobrush from the PCR-GP5+/GP6+ and Spouses in 3rd - 128 17.2 (11.1-24.9) HPV 16 (13.3%)
(Finland) buccal mucosa MY09/MY11. trimestres of HPV 6 (2.3%)
Genotyping with pregnancy of the HPV 58 (0.8%)
Multimerix kit (6, 11, fathers-to-be of
16, 18, 31, 33, 39, 42, cohort study
43, 44, 45, 51, 52, 58,
59, 68, 70, 73, 82)
Kero 2012 Cytobrush from the PCR-GP5+/GP6+ and Fathers-to-be of - 131 18.3 (12.1-26.0) HPV 16 (9.2%)
(Finland) buccal mucosa MY09/MY11. cohort study HPV 33 (2.3%)
Genotyping with HPV 82 (2.3%)
Multimerix kit (6, 11, HPV 6 (0.8%)
16, 18, 31, 33, 39, 42, HPV 11 (0.8%)
43, 44, 45, 51, 52, 58,
59, 68, 70, 73, 82)
Leimola- Oral smears PCR-GP5/GP6. No Post-menopausal 55 131 10.7 (6.0-17.3) -
Virtanen collected from three genotyping women
1996 sites of clinically participating in
(Finland) healthy oral annual
mucosa (i.e., buccal mass-screening
surface, palate, and program for the
tongue) with use of detection of cervical
a sterile precancerous
interdental brush lesions
Lambropou- Cytobrush from the PCR-MY09/MY11. Healthy population 14-85 169 9.5 (5.5-14.9) HPV 6 (3.6%)
los 1997 buccal mucosa Genotyping by SBH receiving routine HPV 16 (2.4%)
(Greece) with TS probes (6, oral examination HPV 11 (0.6%)
11, 16, 18, 33)


Migaldi 2012 Cytobrush from the PCR-GP5+/GP6+, Patients 49-77 81 1.2 (0.0-6.7) HPV 90 (1.2%)
(Italy) buccal mucosa MY09/11, undergoing to
LCRS/E7AS, pU-1M routine oral
and pU-2R. examination
Genotyping by
sequencing
Genotyping by
sequencing
Cañadas Toothbrush on the PCR-MY09/MY11. Female sex workers - 188 8.5 (4.9-13.5) HPV 6 (2.7%)
2004 (Spain) oral cavity Genotyping by DBH who attended a HPV 16 (2.1%)
with TS probes (6, dermatology or HPV 11 (0.5%)
11, 16, 18, 26, 31-33, STD clinic.
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)
border of the 35, 39, 45, 51, 52, 56,
further genotyping
Data updated on 15 Dec 2014 (data as of 29 Feb 2012). Only for European countries.
DBH: Dot Blot Hybridization; HC2: Hybrid Capture 2; PCR: Polymerase Chain Reaction; RFLP: Restriction Fragment Length Polymorphism; SBH: Southern Blot Hybridization; TS: Type
Specific;
4.4.2 HPV burden in head and neck cancers
Table 28: European studies on HPV prevalence among cases of oral cavity cancer
MEN
Nemes 2006 MY09/MY11 (L1) Hybridization 67 44.8 (33.5-56.6) -
(Hungary) with TS probes (16. 18. 31. 33.
45. 51. 52. 58)
Herrero 2003 (Ire- GP5+/GP6+ (L1) Hybridization 22 4.5 (0.8-21.8) HPV 16 (4.5%)
land) with EIA oligonucleotide probes
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Herrero 2003 GP5+/GP6+ (L1) Hybridization 32 0.0 - -
(Italy) with EIA oligonucleotide probes
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Cruz 1996 GP5+/GP6+ (L1) and CPI/CPII 22 63.6 (43.0-80.3) HPV 16 (54.5%)
(Netherlands) (L1) Amplification with TS HPV 6 (4.5%)
primers and hybridization with
TS probes (2. 4. 6. 10. 11. 13.
16. 18. 25. 31. 33. 46. 51. 52)


(Poland) with EIA oligonucleotide probes
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Kozomara 2005 TS-PCR E6 for 16. L1 for 18. E4 42 61.9 (46.8-75.0) -
(Serbia) for 31 and E1 for 33
Amplification with TS primers
(16. 18. 31. 33)
Kansky 2003 PGMY09/11 (L1). GP5+/GP6+ 48 4.2 (1.2-14.0) HPV 33 (2.1%)
(Slovenia) (L1) and WD72/76/66/67/154 HPV 58 (2.1%)
(E6) RFLP
Herrero 2003 GP5+/GP6+ (L1) Hybridization 140 5.7 (2.9-10.9) HPV 16 (5.7%)
(Spain) with EIA oligonucleotide probes
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Llamas-Martínez WD-66/67/72/76/154 (E6) RFLP 19 47.4 (27.3-68.3) -
2008 (Spain) (6 . 11 . 16 . 18 . 31 . 33 . 39 . 42
. 45 . 52)
Dahlgren 2004 GP5+/GP6+ (L1) and CPI/CPII 51 3.9 (1.1-13.2) -
(Sweden) (L1) Amplification with TS
primers (16. 18. 33) and
sequencing
WOMEN
Nemes 2006 MY09/MY11 (L1) Hybridization 12 25.0 (8.9-53.2) -
(Hungary) with TS probes (16. 18. 31. 33.
45. 51. 52. 58)
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
(Netherlands) (L1) Amplification with TS
TS probes (2. 4. 6. 10. 11. 13.
16. 18. 25. 31. 33. 46. 51. 52)
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Kozomara 2005 TS-PCR E6 for 16. L1 for 18. E4 8 75.0 (40.9-92.9) -
(Serbia) for 31 and E1 for 33
(16. 18. 31. 33)
(Slovenia) (L1) and WD72/76/66/67/154
(E6) RFLP


(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Llamas-Martínez WD-66/67/72/76/154 (E6) RFLP 14 35.7 (16.3-61.2) -
2008 (Spain) (6 . 11 . 16 . 18 . 31 . 33 . 39 . 42
. 45 . 52)
Dahlgren 2004 GP5+/GP6+ (L1) and CPI/CPII 34 0.0 - -
sequencing
BOTH OR UNSPECIFIED
Koskinen 2003 SPF10 (L1) LiPA 25 28 64.3 (45.8-79.3) HPV 16 (46.4%)
(Finland) HPV 33 (21.4%)
Klussmann 2001 A10/A5-A6/A8 (L1) and 22 18.2 (7.3-38.5) HPV 16 (13.6%)
(Germany) CP62/70-CP65/69a (L1) HPV 19 (4.5%)
Sequencing
Ostwald 2003 TS-PCR E6 for 6/11/16/18 118 43.2 (34.6-52.2) HPV 16 (29.7%)
(Germany) Hybridization with TS probes HPV 18 (13.6%)
(6/11. 16. 18)
Weiss 2011 (Ger- RT-PCR E6/E7 for 16 34 2.9 (0.5-14.9) HPV 16 (2.9%)
many) Hybridization with TS probes
(16)
Aggelopoulou L1 consensus primers and 81 49.4 (38.8-60.0) HPV 18 (27.2%)
1999 (Greece) TS-PCR E7 for 16/18 HPV 16 (6.2%)
(16. 18)
Romanitan 2008 GP5+/GP6+ (L1). CPI/CPIIG 75 1.3 (0.2-7.2) -
(Greece) (E1) and TS-PCR E6/E7 for 16
(16)
Nemes 2006 MY09/MY11 (L1) Hybridization 79 41.8 (31.5-52.8) HPV 16 (34.2%)
(Hungary) with TS probes (16. 18. 31. 33. HPV 18 (6.3%)
45. 51. 52. 58) HPV 31 (3.8%)
HPV 33 (2.5%)
Szarka 2009 MY09/MY11 (L1) and 65 47.7 (36.0-59.6) HPV 16 (27.7%)
(Hungary) GP5+/GP6+ (L1) RFLP HPV 11 (6.2%)
HPV 18 (6.2%)
HPV 33 (3.1%)
HPV 31 (1.5%)
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Badaracco 2000 MY09/MY11 (L1) Amplification 38 26.3 (15.0-42.0) HPV 18 (13.2%)
(Italy) with TS primers (6 . 16) and HPV 6 (10.5%)
hybridization with TS probes (11 HPV 16 (10.5%)
. 16 . 18 . 31 . 45 . 56 . 57) HPV 11 (5.3%)
HPV 56 (5.3%)
Badaracco 2007 MY09/MY11 (L1) and 53 11.3 (5.3-22.6) HPV 16 (7.5%)
(Italy) GP5+/GP6+ (L1) Sequencing HPV 33 (1.9%)
HPV 58 (1.9%)


(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Rittà 2009 (Italy) MY09/MY11 (L1) and 25 36.0 (20.2-55.5) HPV 16 (36.0%)
GP5+/GP6+ (L1) Sequencing
Scapoli 2009 RT-PCR for 16/18/31/45 247 1.2 (0.4-3.5) HPV 16 (1.2%)
(Italy) Hybridization with TS probes
(16. 18. 31. 45)
Braakhuis 2004 GP5+/GP6+ (L1) and TS-PCR 106 9.4 (5.2-16.5) HPV 16 (9.4%)
(Netherlands) RLBH (6. 11. 16. 18. 26. 31. 33.
34. 35. 39. 40. 42. 43. 44. 45. 51.
52. 53. 54. 55. 56. 57. 58. 59. 61.
66. 68 . 70 . 72 . 73. 82/MM4. 83.
84. 82/IS39. 71/CP8061.
81/CP8304. 89)
(Netherlands) (L1) Amplification with TS HPV 6 (2.9%)
TS probes (2. 4. 6. 10. 11. 13.
16. 18. 25. 31. 33. 46. 51. 52)
Mork 2001a GP5+/GP6+ (L1) and CPI/CPII 91 7.7 (3.8-15.0) HPV 16 (4.4%)
(Northern Eu- (L1) Amplification with TS HPV 6 (1.1%)
rope) primers (6. 11. 16. 18. 33) HPV 11 (1.1%)
HPV 33 (1.1%)
Matzow 1998 GP5+/GP6+ (L1). CPI/CPIIG 30 0.0 - -
(Norway) (E1) and TS-PCR for
6/16/18/31/33 Amplification with
TS primers (6. 16. 18. 31. 33)
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Snietura 2010 Real-time High Risk HPV test 45 4.4 (1.2-14.8) HPV 16 (4.4%)
(Poland) (Abbott Molecular) using L1
consensus primers Amplification
with TS primers (16. 18. 31. 33.
35. 39. 45. 51. 52. 56. 58. 59. 66
and 68 - the technique only
differentiates 16-18-other)
Kozomara 2005 TS-PCR E6 for 16. L1 for 18. E4 50 64.0 (50.1-75.9) HPV 31 (32.0%)
(Serbia) for 31 and E1 for 33 HPV 16 (26.0%)
Amplification with TS primers HPV 18 (26.0%)
(16. 18. 31. 33)
(Slovenia) (L1) and WD72/76/66/67/154 HPV 33 (1.8%)
(E6) RFLP HPV 58 (1.8%)
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Llamas-Martínez WD-66/67/72/76/154 (E6) RFLP 33 42.4 (27.2-59.2) HPV 16 (33.3%)
2008 (Spain) (6 . 11 . 16 . 18 . 31 . 33 . 39 . 42 HPV 6 (30.3%)
. 45 . 52) HPV 31 (9.1%)


Dahlgren 2004 GP5+/GP6+ (L1) and CPI/CPII 85 2.4 (0.6-8.2) HPV 16 (2.4%)
sequencing
Sand 2000 (Swe- MY09/MY11 (L1) Amplification 24 12.5 (4.3-31.0) HPV 16 (4.2%)
den) with TS primers (6b/11. 16. 18) HPV 18 (4.2%)
Lopes 2011 (UK) GP5+/GP6+ (L1) and qPCR for 142 3.5 (1.5-8.0) HPV 16 (2.1%)
16/18 Hybridization with TS HPV 18 (2.1%)
probes (16. 18)
Snijders 1996 GP5+/GP6+ (L1) Amplification 25 20.0 (8.9-39.1) HPV 16 (20.0%)
(UK) with TS primers and SBH with
TS probes (6. 11. 16. 18. 31. 33)
Yeudall 1991 (UK) TS-PCR E6/E7 for 16. E6 for 18 39 46.2 (31.6-61.4) HPV 16 (25.6%)
and specific for 4 Hybridization HPV 18 (20.5%)
with TS probes (4. 16. 18)
Ribeiro 2011b PGMY09/11 (L1) Amplification 132 0.0 - -
(World) with TS primers (16)
Data updated on 14 Jun 2019 (data as of 31 Dec 2015).
EIA: Enzyme ImmunoAssay; 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 Norway, Sweden and Finland
b Includes cases from Argentina, Brazil, Cuba, Russia, Slovakia, Czech Republic, Romania and Poland
Table 29: European studies on HPV prevalence in cases of oropharyngeal cancer

MEN
Rotnáglová 2011 GP5+/GP6+ (L1) RBLH (6. 11. 90 64.4 (54.2-73.6) -
(Czech Rep.) 16. 18. 26. 31. 33. 34. 35. 39. 40.
42. 43. 44. 45. 51. 52. 53. 54. 55.
56. 57. 58. 59. 61. 66. 68. 70. 71.
72. 73. 81. 82. 83. 84. 89)
Charfi 2008 GP5+/GP6+ (L1) and TS-PCR for 36 55.6 (39.6-70.5) -
(France) 6/11/16/18/33 Amplification with
TS primers (6. 11. 16. 18. 33)
Hoffmann 2010 GP5+/GP6+ (L1). MY09/MY11 31 54.8 (37.8-70.8) HPV 16 (51.6%)
(Germany) (L1) and TS-PCR for 6/11/16/18 HPV 35 (6.5%)
Hybridization with TS probes -
Multiplex luminex*
Krupar 2014 (Ger- PCR-E6, PCR-E7, PCR- 34 50.0 (34.1-65.9) HPV 16 (50.0%)
many) MULTIPLEX (HPV 11, 16, 18,
31, 33, 35, 39, 42, 43, 44, 45, 51,
52, 56, 58, 59, 66, 68)
Reimers 2007 A10/A5-A6/A8 (L1) and 83 25.3 (17.2-35.6) -
(Germany) CP62/70-CP65/69a (L1)
Sequencing
(Italy) with EIA oligonucleotide probes HPV 33 (3.3%)
(2. 6. 11. 16. 18. 31. 33. 35. 39. HPV 35 (3.3%)
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Hannisdal 2010 GP5+/GP6+ (L1) Sequencing 99 56.6 (46.7-65.9) -
(Norway)


(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Attner 2010 (Swe- GP5+/GP6+ (L1). CPI/IIG (E1) 65 75.4 (63.7-84.2) -
den) and TS-PCR E6/7 for 16/33
(16. 33) and sequencing
sequencing
Hammarstedt GP5+/GP6+ (L1). CPI/CPIIG 145 48.3 (40.3-56.3) -
2006 (Sweden) (E1) and TS-PCR E6 for 16
Sequencing
Näsman 2009 GP5+/GP6+ (L1). CPI/CPIIG 76 81.6 (71.4-88.7) -
(Sweden) (E1) and TS-PCR E6 for 16
Sequencing
Lindel 2001 SPF10 (L1) Sequencing 75 8.0 (3.7-16.4) -
(Switzerland)
WOMEN
Rotnáglová 2011 GP5+/GP6+ (L1) RBLH (6. 11. 19 68.4 (46.0-84.6) -
(Czech Rep.) 16. 18. 26. 31. 33. 34. 35. 39. 40.
42. 43. 44. 45. 51. 52. 53. 54. 55.
56. 57. 58. 59. 61. 66. 68. 70. 71.
72. 73. 81. 82. 83. 84. 89)
Charfi 2008 GP5+/GP6+ (L1) and TS-PCR for 16 75.0 (50.5-89.8) -
(France) 6/11/16/18/33 Amplification with
TS primers (6. 11. 16. 18. 33)
(Germany) (L1) and TS-PCR for 6/11/16/18
Multiplex luminex*
Reimers 2007 A10/A5-A6/A8 (L1) and 23 39.1 (22.2-59.2) -
(Germany) CP62/70-CP65/69a (L1)
Sequencing
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Hannisdal 2010 GP5+/GP6+ (L1) Sequencing 38 39.5 (25.6-55.3) -
(Norway)
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Attner 2010 (Swe- GP5+/GP6+ (L1). CPI/IIG (E1) 30 73.3 (55.6-85.8) -
den) and TS-PCR E6/7 for 16/33
(16. 33) and sequencing


sequencing
Hammarstedt GP5+/GP6+ (L1). CPI/CPIIG 58 50.0 (37.5-62.5) -
2006 (Sweden) (E1) and TS-PCR E6 for 16
Sequencing
Näsman 2009 GP5+/GP6+ (L1). CPI/CPIIG 22 95.5 (78.2-99.2) -
(Sweden) (E1) and TS-PCR E6 for 16
Sequencing
Lindel 2001 SPF10 (L1) Sequencing 24 33.3 (18.0-53.3) -
(Switzerland)
BOTH OR UNSPECIFIED
Klozar 2008 GP5+/GP6+ (L1) RLBH (6. 11. 20 45.0 (25.8-65.8) HPV 16 (40.0%)
(Czech Rep.) 16. 18. 26. 31. 33. 34. 35. 39. 40. HPV 33 (5.0%)
42. 43. 44. 45. 51. 52. 53. 54. 55.
56. 57. 58. 59. 61. 66. 68. 70. 71.
72. 73. 81. 82. 83. 84. 89)
Rotnáglová 2011 GP5+/GP6+ (L1) RBLH (6. 11. 109 65.1 (55.8-73.4) HPV 16 (60.6%)
(Czech Rep.) 16. 18. 26. 31. 33. 34. 35. 39. 40. HPV 33 (1.8%)
42. 43. 44. 45. 51. 52. 53. 54. 55. HPV 18 (0.9%)
56. 57. 58. 59. 61. 66. 68. 70. 71. HPV 26 (0.9%)
72. 73. 81. 82. 83. 84. 89) HPV 52 (0.9%)
Jouhi 2015 (Fin- PCR-E6, PCR-E7, PCR- 35 51.4 (35.6-67.0) HPV 16 (45.7%)
land) MULTIPLEX (HPV 6, 11, 16, 18, HPV 18 (2.9%)
26, 31, 33, 35, 39, 42, 43, 44, 45, HPV 45 (2.9%)
51, 52, 53, 56, 58, 59, 66, 68, 70,
73, 82)
Charfi 2008 GP5+/GP6+ (L1) and TS-PCR for 52 61.5 (48.0-73.5) HPV 16 (51.9%)
(France) 6/11/16/18/33 Amplification with HPV 33 (1.9%)
TS primers (6. 11. 16. 18. 33)
Fonmarty 2015 PCR, LiPA (HPV 6, 11, 16, 18, 71 31.0 (21.4-42.5) HPV 16 (28.2%)
(France) 31, 33, 35, 39, 40, 43, 44, 45, 51, HPV 33 (2.8%)
52, 53, 54, 56, 58, 59, 66, 68, 69, HPV 6 (1.4%)
70, 71, 73, 74, 82)
Fouret 1997 TS-PCR E6 for 16/18/31/33/45 58 17.2 (9.6-28.9) HPV 16 (15.5%)
(France) Hybridization with TS probes
(16. 18. 31. 33. 45)
Andl 1998 (Ger- TS-PCR for 6/11/16/18 21 52.4 (32.4-71.7) HPV 16 (38.1%)
many) Hybridization with TS probes (6. HPV 33 (4.8%)
11. 16. 18) and cycle sequencing
system of BRL
Hoffmann 1998 MY09/MY11 (L1) and TS-PCR 23 26.1 (12.5-46.5) HPV 16 (8.7%)
(Germany) for 6/11/16/18/33 SBH (6. 11. 16. HPV 45 (8.7%)
18. 31. 33. 45) HPV 6 (4.3%)
(Germany) (L1) and TS-PCR for 6/11/16/18 HPV 35 (5.1%)
Multiplex luminex*
Holzinger 2012 PCR-GP5+/6+, PCR 199 50.3 (43.4-57.1) HPV 16 (48.7%)
(Germany) L1-Consensus primer, PCR- HPV 18 (0.5%)
MULTIPLEX (HPV 16, 18, 33, HPV 33 (0.5%)
35) HPV 35 (0.5%)


Sequencing HPV 33 (3.0%)
HPV 96 (3.0%)
Krupar 2014 (Ger- PCR-E6, PCR-E7, PCR- 34 50.0 (34.1-65.9) HPV 16 (50.0%)
31, 33, 35, 39, 42, 43, 44, 45, 51,
52, 56, 58, 59, 66, 68)
Reimers 2007 A10/A5-A6/A8 (L1) and 106 28.3 (20.6-37.5) HPV 16 (27.4%)
Sequencing
Weiss 2011 (Ger- RT-PCR E6/E7 for 16 86 38.4 (28.8-48.9) HPV 16 (38.4%)
many) Hybridization with TS probes
(16)
Wittekindt 2005 A10/A5-A6/A8 (L1) and (L1) 34 52.9 (36.7-68.5) HPV 16 (50.0%)
(Germany) Sequencing HPV 33 (2.9%)
Romanitan 2008 GP5+/GP6+ (L1). CPI/CPIIG 28 42.9 (26.5-60.9) HPV 16 (32.1%)
(Greece) (E1) and TS-PCR E6/E7 for 16
(16)
Boscolo-Rizzo MY09/MY11 (L1) RFLP* and 22 18.2 (7.3-38.5) HPV 16 (18.2%)
2009 (Italy) amplification with TS primers
E6/E2 for 16
(Italy) with EIA oligonucleotide probes HPV 33 (2.8%)
(2. 6. 11. 16. 18. 31. 33. 35. 39. HPV 35 (2.8%)
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Licitra 2006 RT-PCR E1 for 16/18 90 18.9 (12.1-28.2) HPV 16 (18.9%)
(Italy) Hybridization with TS probes
(16. 18)
Rittà 2009 (Italy) MY09/MY11 (L1) and 22 50.0 (30.7-69.3) HPV 16 (50.0%)
GP5+/GP6+ (L1) Sequencing
Braakhuis 2004 GP5+/GP6+ (L1) and TS-PCR 37 37.8 (24.1-53.9) HPV 16 (37.8%)
(Netherlands) RLBH (6. 11. 16. 18. 26. 31. 33.
34. 35. 39. 40. 42. 43. 44. 45. 51.
52. 53. 54. 55. 56. 57. 58. 59. 61.
66. 68 . 70 . 72 . 73. 82/MM4. 83.
84. 82/IS39. 71/CP8061.
81/CP8304. 89)
Henneman 2015 PCR-SPF10, LiPA (HPV 16, 18, 146 34.9 (27.7-43.0) HPV 16 (32.2%)
(Netherlands) 31, 33, 35, 39, 45, 51, 52, 56, 58, HPV 33 (2.1%)
59, 66, 68) HPV 35 (0.7%)
van Monsjou 2012 PCR, LiPA (HPV 6, 11, 16, 18, 20 65.0 (43.3-81.9) HPV 16 (60.0%)
(Netherlands) 26, 31, 33, 35, 39, 40, 43, 44, 45, HPV 35 (5.0%)
51, 52, 53, 54, 56, 58, 59, 66, 68,
69, 70, 71, 72, 73, 82)
Hannisdal 2010 GP5+/GP6+ (L1) Sequencing 137 51.8 (43.5-60.0) HPV 16 (48.9%)
(Norway) HPV 31 (2.9%)
HPV 18 (2.2%)
HPV 33 (0.7%)
HPV 67 (0.7%)


Snietura 2010 Real-time High Risk HPV test 14 50.0 (26.8-73.2) HPV 16 (50.0%)
consensus primers Amplification
with TS primers (16. 18. 31. 33.
35. 39. 45. 51. 52. 56. 58. 59. 66
and 68 - the technique only
differentiates 16-18-other)
Szkaradkiewicz MY09/MY11 (L1) Amplification 28 10.7 (3.7-27.2) -
2002 (Poland) with TS primers (16. 18)
(2. 6. 11. 16. 18. 31. 33. 35. 39.
40. 42. 43. 44. 45. 51. 52. 56. 58.
59. 66. 68)
Attner 2010 (Swe- GP5+/GP6+ (L1). CPI/IIG (E1) 95 74.7 (65.2-82.4) HPV 16 (64.2%)
den) and TS-PCR E6/7 for 16/33 HPV 33 (7.4%)
Amplification with TS primers HPV 35 (2.1%)
(16. 33) and sequencing HPV 58 (1.1%)
Dahlgren 2004 GP5+/GP6+ (L1) and CPI/CPII 25 40.0 (23.4-59.3) HPV 16 (28.0%)
(Sweden) (L1) Amplification with TS HPV 33 (4.0%)
primers (16. 18. 33) and HPV 35 (4.0%)
sequencing HPV 38 (4.0%)
Hammarstedt GP5+/GP6+ (L1). CPI/CPIIG 203 48.8 (42.0-55.6) HPV 16 (42.9%)
2006 (Sweden) (E1) and TS-PCR E6 for 16 HPV 33 (1.5%)
HPV 45 (0.5%)
Lindquist 2012 GP5+/GP6+ (L1) and CPI/CPIIG 56 64.3 (51.2-75.5) HPV 16 (64.3%)
(Sweden) (E1) Amplification with TS
primers (16) and Multiplex
Luminex (6. 11. 16. 18. 26. 31.
33. 35. 39. 42. 43. 44. 45. 51. 52.
53. 56. 58. 59. 66. 68. 70. 73. 82)
Näsman 2009 GP5+/GP6+ (L1). CPI/CPIIG 98 84.7 (76.3-90.5) HPV 16 (78.6%)
(Sweden) (E1) and TS-PCR E6 for 16 HPV 33 (1.0%)
HPV 59 (1.0%)
Lindel 2001 SPF10 (L1) Sequencing 99 14.1 (8.6-22.3) HPV 16 (11.1%)
(Switzerland) HPV 33 (1.0%)
HPV 35 (1.0%)
HPV 45 (1.0%)
Anderson 2007 GP5+/GP6+ (L1) Hybridization 36 22.2 (11.7-38.1) HPV 16 (19.4%)
(UK) with Roche LBA (6. 11. 16. 18. HPV 11 (2.8%)
26. 31. 33. 35. 39. 40. 42. 45. 51.
52. 53. 54. 55. 56. 58. 59. 61. 62.
64. 66. 67. 68. 69. 70. 71. 72. 73.
81. 82. 83. 84. 89)
Conway 2012 PCR-GP5+/6+, TS, Sequencing 20 40.0 (21.9-61.3) HPV 16 (40.0%)
(UK) (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, 83 83.1 (73.7-89.7) HPV 16 (80.7%)
16, 18, 31, 33, 35, 39, 40, 42, 43, HPV 18 (1.2%)
44, 45, 51, 52, 56, 58, 59, 66, 68) HPV 33 (1.2%)
HPV 56 (1.2%)


Schache 2011 TS-PCR E6 for 16 Amplification 98 40.8 (31.6-50.7) HPV 16 (40.8%)
(UK) with TS primers (16)
Thavaraj 2011 GP5+/GP6+ (L1) Luminex 200 IS 142 70.4 (62.5-77.3) HPV 16 (64.1%)
(UK) (16. 18. 26. 31. 33. 35. 39. 45. HPV 33 (2.1%)
51. 52. 53. 56. 58. 59. 66. 68. 73. HPV 18 (0.7%)
82) HPV 35 (0.7%)
Wells 2015 (UK) PCR- MULTIPLEX (HPV 16, 18, 57 50.9 (38.3-63.4) HPV 16 (45.6%)
35, 51, 82) HPV 18 (5.3%)
HPV 35 (1.8%)
HPV 51 (1.8%)
HPV 82 (1.8%)
Ribeiro 2011a PGMY09/11 (L1) Amplification 136 0.7 (0.1-4.0) HPV 16 (0.7%)
Data updated on 14 Jun 2019 (data as of 31 Dec 2015 / 31 Dec 2015).
EIA: Enzyme ImmunoAssay; 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
Table 30: European studies on HPV prevalence in cases of hypopharyngeal or laryngeal cancer
MEN
(Germany) for 6/11/16/18/33 Hybridization
with TS and consensus probes
and further confirmation by SBH
(6. 11. 16. 18. 31. 33. 45)
(Germany) for 6/11/16/18 Hybridization
(6. 11. 16. 18. 31. 33. 45)
Azzimonti 2004 GP5+/GP6+ (L1) Sequencing 23 56.5 (36.8-74.4) HPV 16 (43.5%)
(Italy) HPV 18 (13.0%)
Cattani 1998 MY09/MY11 (L1) and TS-PCR 70 30.0 (20.5-41.5) -
(Italy) for 33 Hybridization with TS
probes (6 . 11 . 16 . 18 . 31) and
amplification with TS primer
(33)
Gallo 2009 (Italy) MY09/MY11 (L1). LCRF1. 36 0.0 - -
LCRF2. LCRF3. LCRF4. E7R1.
E7R2. E7R3. E7R4 (E6) and
TS-PCR E1 for 6/11/16/18-31/33
Sequencing
Lie 1996 (Norway) CP (E1). MY09/MY11 (L1) and 38 7.9 (2.7-20.8) HPV 16 (2.6%)
GP5+/GP6+ (L1) Amplification
with TS primers (6 . 11 . 16 . 18 .
31 . 33 . 35)
Morshed 2008 SPF10 (L1) LiPA 25 78 34.6 (25.0-45.7) -
(Poland)


WOMEN
(6. 11. 16. 18. 31. 33. 45)
Hoffmann 2009 MY09/MY11 (L1) and TS-PCR 6 16.7 (3.0-56.4) -
(6. 11. 16. 18. 31. 33. 45)
(Italy)
Cattani 1998 MY09/MY11 (L1) and TS-PCR 28 21.4 (10.2-39.5) HPV 16 (21.4%)
(Italy) for 33 Hybridization with TS
probes (6 . 11 . 16 . 18 . 31) and
(33)
TS-PCR E1 for 6/11/16/18-31/33
Sequencing
Lie 1996 (Norway) CP (E1). MY09/MY11 (L1) and 10 0.0 - -
with TS primers (6 . 11 . 16 . 18 .
31 . 33 . 35)
Morshed 2008 SPF10 (L1) LiPA 25 15 40.0 (19.8-64.3) -
(Poland)
BOTH OR UNSPECIFIED
Gudleviciene 2014 PCR-GP5+/6+, 34 5.9 (1.6-19.1) HPV 6 (2.9%)
(Belarus) PCR-PGMY09/11, PCR HPV 16 (2.9%)
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)
Duray 2011 (Bel- GP5+/GP6+ (L1) and RT-PCR 59 79.7 (67.7-88.0) HPV 16 (62.7%)
gium) E6/E7 for 6. 11. 16. 18. 31. 33. HPV 18 (16.9%)
35. 39. 45. 51. 52. 53. 56. 58. 59. HPV 51 (8.5%)
66. 67-L1. 68 TS real-time and HPV 33 (5.1%)
consensus PCR E6/E7 (6. 11. 16. HPV 66 (5.1%)
18. 31. 33. 35. 39. 45. 51. 52. 53.
56. 58. 59. 66. 67-L1. 68)
Lindeberg 1999 MY09/MY11 (L1). GP5+/GP6+ 30 3.3 (0.6-16.7) -
(Denmark) (L1) and CPII/II (L1)
Hybridization with TS probes (6
. 11 . 16 . 18 . 30 . 31 . 33 . 35)
Koskinen 2003 SPF10 (L1) LiPA 25 28 50.0 (32.6-67.4) HPV 16 (46.4%)
(Finland) HPV 33 (14.3%)
HPV 6 (10.7%)
HPV 11 (3.6%)
HPV 51 (3.6%)
Fouret 1997 TS-PCR E6 for 16/18/31/33/45 103 6.8 (3.3-13.4) HPV 16 (6.8%)
(France) Hybridization with TS probes
(16. 18. 31. 33. 45)


Fischer 2003 (Ger- L1-CP65F. 66F. 69F. 70F 47 34.0 (22.2-48.3) HPV 73 (4.3%)
many) Sequencing HPV 21 (2.1%)
HPV 22 (2.1%)
HPV 38 (2.1%)
HPV 41 (2.1%)
(Germany) for 6/11/16/18/33 SBH (6. 11. 16. HPV 18 (2.0%)
18. 31. 33. 45) HPV 45 (2.0%)
(6. 11. 16. 18. 31. 33. 45)
(6. 11. 16. 18. 31. 33. 45)
Kleist 2000 (Ger- MY09/MY11 (L1) Amplification 35 20.0 (10.0-35.9) HPV 16 (8.6%)
many) with TS primers (16. 18) HPV 18 (8.6%)
Sequencing
Krupar 2014 (Ger- PCR-E6, PCR-E7, PCR- 49 0.0 - -
31, 33, 35, 39, 42, 43, 44, 45, 51,
52, 56, 58, 59, 66, 68)
Gorgoulis 1999 MY09/MY11 (L1) and GP5/GP6 91 20.9 (13.8-30.3) HPV 16 (14.3%)
(Greece) (L1) Amplification with TS HPV 6 (3.3%)
primers (6. 11. 16. 18. 31. 33. HPV 18 (3.3%)
35) and confirmation by DBH HPV 33 (3.3%)
with TS probes (6 . 11 . 16 . 18.
31 . 33 . 35).
Vlachtsis 2005 TS-PCR for 16/18 Amplification 90 40.0 (30.5-50.3) HPV 16 (34.4%)
(Greece) with TS primers (16. 18) HPV 18 (6.7%)
Major 2005 (Hun- MY09/MY11 (L1) and 22 54.5 (34.7-73.1) HPV 11 (18.2%)
gary) GP5+/GP6+ (L1) RFLP (6. 11. HPV 6 (13.6%)
16. 18) HPV 16 (13.6%)
(Italy) HPV 18 (12.0%)
Badaracco 2000 MY09/MY11 (L1) Amplification 22 50.0 (30.7-69.3) HPV 16 (27.3%)
(Italy) with TS primers (6 . 16) and HPV 6 (18.2%)
hybridization with TS probes (11 HPV 45 (4.5%)
. 16 . 18 . 31 . 45 . 56 . 57)
Badaracco 2007 MY09/MY11 (L1) and 30 16.7 (7.3-33.6) HPV 16 (10.0%)
(Italy) GP5+/GP6+ (L1) Sequencing HPV 6 (6.7%)
Boscolo-Rizzo MY09/MY11 (L1) RFLP* and 45 4.4 (1.2-14.8) HPV 16 (4.4%)
2009 (Italy) amplification with TS primers
E6/E2 for 16
Cattani 1998 MY09/MY11 (L1) and TS-PCR 75 29.3 (20.2-40.4) HPV 16 (12.0%)
(Italy) for 33 Hybridization with TS HPV 18 (10.7%)
probes (6 . 11 . 16 . 18 . 31) and HPV 33 (1.3%)
(33)


TS-PCR E1 for 6/11/16/18-31/33
Sequencing
Gudleviciene 2009 Consensus primers from Master 25 32.0 (17.2-51.6) HPV 16 (12.0%)
(Lithuania) Mix Amplification with TS
primers (16. 18)
Gudleviciene 2014 PCR-GP5+/6+, 53 20.8 (12.0-33.5) HPV 6 (1.9%)
(Lithuania) PCR-PGMY09/11, PCR HPV 16 (1.9%)
L1-Consensus primer, PCR-E6, HPV 31 (1.9%)
PCR- MULTIPLEX (HPV 6, 11, HPV 39 (1.9%)
16, 18, 31, 33, 35, 39, 45, 51, 52, HPV 58 (1.9%)
56, 58, 59, 66, 68, 73, 82)
Koskinen 2007a MY09/MY11 (L1). GP5+/GP6+ 69 4.3 (1.5-12.0) HPV 16 (1.4%)
(Northern Eu- (L1) and SPF10 (L1) LiPA 25
rope)
Mork 2001a GP5+/GP6+ (L1) and CPI/CPII 40 2.5 (0.4-12.9) HPV 16 (2.5%)
(Northern Eu- (L1) Amplification with TS
rope) primers (6. 11. 16. 18. 33)
Lie 1996 (Norway) CP (E1). MY09/MY11 (L1) and 39 7.7 (2.7-20.3) HPV 16 (2.6%)
with TS primers (6 . 11 . 16 . 18 .
31 . 33 . 35)
Morshed 2008 SPF10 (L1) LiPA 25 93 35.5 (26.5-45.6) HPV 16 (30.1%)
(Poland) HPV 18 (6.5%)
HPV 33 (5.4%)
Snietura 2011 Real-time High Risk HPV test 65 0.0 - -
consensus primers RT-PCR (16.
18. 31. 33. 35. 39. 45. 51. 52. 56.
58. 59. 66. 68)
Poljak 1997 PGMY09/11 (L1). GP5+/GP6+ 30 3.3 (0.6-16.7) HPV 16 (3.3%)
(Slovenia) (L1) and WD72/76/66/67/154
(E6) Amplification with TS
primers (6 . 11 . 16 . 18 . 31 . 33
. 51)
Alvarez Alvarez TS-PCR E6 and L1 for 6b/16/18 35 25.7 (14.2-42.1) HPV 6 (22.9%)
1997 (Spain) Amplification with TS primers HPV 16 (5.7%)
(6b. 16. 18)
Pérez-Ayala 1990 TS-PCR E6 for 6/11 51 56.9 (43.3-69.5) HPV 16 (56.9%)
(Spain) Hybridization with TS probes
(11 . 16)
Adams 1999 MY09/MY11 (L1) RFLP (6 . 11 . 36 16.7 (7.9-31.9) HPV 16 (16.7%)
(Switzerland) 16 . 18 . 31 . 33 . 35 . 51 . 53 .
56)
Anderson 2007 GP5+/GP6+ (L1) Hybridization 64 0.0 - -
(UK) with Roche LBA (6. 11. 16. 18.
26. 31. 33. 35. 39. 40. 42. 45. 51.
52. 53. 54. 55. 56. 58. 59. 61. 62.
64. 66. 67. 68. 69. 70. 71. 72. 73.
81. 82. 83. 84. 89)


Conway 2012 PCR-GP5+/6+, TS, Sequencing 12 0.0 - -
(UK) (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 (6. 11. 36 22.2 (11.7-38.1) HPV 6 (8.3%)
16. 18. 33) HPV 16 (5.6%)
HPV 11 (2.8%)
Snijders 1996 GP5+/GP6+ (L1) Amplification 31 19.4 (9.2-36.3) HPV 16 (19.4%)
(UK) with TS primers and SBH with
TS probes (6. 11. 16. 18. 31. 33)
Ribeiro 2011b PGMY09/11 (L1) Amplification 239 0.8 (0.2-3.0) HPV 16 (0.8%)
Data updated on 14 Jun 2019 (data as of 31 Dec 2015).
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

5 FACTORS CONTRIBUTING TO CERVICAL CANCER - 142 -
5 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 Europe are presented.
Figure 112: Prevalence of female tobacco smoking in Europe

Adjusted and age-standardized prevalence estimates of tobacco use by country, for the year 2013. 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, 2015. Available at http://www.who.int/tobacco/global_
report/2015/en/index.html

Figure 113: Total fertility rates in Europe

For Austria, Belgium, Bulgaria, Belarus, Germany, United Kingdom, Hungary, Netherlands, Romania, Sweden: 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, Bosnia & Herzegovina, Republic of Moldova: United Nations, Department of Economic and Social Affairs, Population Division (2015). World Fertility Data 2015
(POP/DB/Fert/Rev2015). Available at: http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml. [Accessed on March 22, 2017].
Albania, Austria, Belgium, Bulgaria, Belarus, Switzerland, Cyprus, Czech Republic, Germany, Denmark, Spain, Estonia, Finland, France, United Kingdom, Greece, Croatia, Hungary,
Ireland, Iceland, Italy, Liechtenstein, Lithuania, Luxembourg, Latvia, Macedonia, Malta, Montenegro, Netherlands, Norway, Poland, Portugal, Romania, Russian Federation, Serbia,
Slovakia, Slovenia, Sweden, Ukraine: Eurostat - Statistical office of the European Comission [web site]. Luxembourg: European Commission; 2015. Available at: http://ec.europa.eu/
eurostat/tgm/table.do?tab=table&init=1&language=en&pcode=tsdde220&plugin=1. [Accessed on March 22, 2017].

Figure 114: Prevalence of hormonal contraceptive use in Europe

Proportion (%) of women using hormonal contraception (pill, injectable or implant), among those of reproductive age who are married or in union.
For Belgium: 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 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 Croatia: Data pertain to all women of reproductive age, irrespective of marital status.
For Malta: Data pertain to married women who visited a practitioner belonging to the Malta College of Family Doctors.
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: Data pertain to women exposed to the risk of pregnancy.
For Sweden: Data pertain to women who have ever had sex.
Data sources: United Nations, Department of Economic and Social Affairs, Population Division (2016). World Contraceptive Use 2016 (POP/DB/CP/Rev2016). http://www.un.org/en/
development/desa/population/publications/dataset/contraception/wcu2016.shtml. Available at: [Accessed on March 22, 2017].

Figure 115: Prevalence of HIV in Europe

Estimates include all people with HIV infection, regardless of whether they have developed symptoms of AIDS.
For Greece, Italy: Antiretroviral therapy data was not available at the time of publication
Data sources: UNAIDS database [internet]. Available at: http://aidsinfo.unaids.org/ [Accessed on March 22, 2017]

6 SEXUAL BEHAVIOUR AND REPRODUCTIVE HEALTH INDICATORS - 146 -
6 Sexual behaviour and reproductive health indicators

Sexual intercourse is the primary route of transmission of genital HPV infection. Information about
sexual and reproductive health behaviours is essential to the design of effective preventive strategies
against anogenital cancers. In this section, we describe sexual and reproductive health indicators that
may be used as proxy measures of risk for HPV infection and anogenital cancers. Several studies
have reported that earlier sexual debut is a risk factor for HPV infection, although the reason for this
relationship is still unclear. In this section, information on sexual and reproductive health behaviour in
Europe is presented.
Figure 116: Percentage of 15-year-old girls who report sexual intercourse in Europe

For Albania, Austria, Belgium, Bulgaria, Switzerland, Czech Republic, Germany, Denmark, Spain, Estonia, Finland, France, United Kingdom, Greece, Croatia, Hungary, Ireland, Iceland,
Italy, Lithuania, Luxembourg, Latvia, Republic of Moldova, Macedonia, Malta, Netherlands, Poland, Portugal, Romania, Russian Federation, Slovakia, Slovenia, Sweden, Ukraine: Fifteen-
year-olds teenagers only were asked whether they had ever had sexual intercourse.
For Albania, Bulgaria, Switzerland, Spain, France, Greece, Croatia, Ireland, Lithuania, Latvia, Republic of Moldova, Macedonia, Portugal, Romania, Russian Federation, Slovenia, Ukraine:
Indicates a significant gender difference (at p<0.05).
Italy, Lithuania, Luxembourg, Latvia, Republic of Moldova, Macedonia, Malta, Netherlands, Poland, Portugal, Romania, Russian Federation, Slovakia, Slovenia, Sweden, Ukraine: Year of
estimation: 2013-2014
Data sources:
Italy, Lithuania, Luxembourg, Latvia, Republic of Moldova, Macedonia, Malta, Netherlands, Poland, Portugal, Romania, Russian Federation, Slovakia, Slovenia, Sweden, Ukraine: Growing
up unequal: gender and socioeconomic differences in young people’s health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the
2013/2014 survey. Inchley J, Currie D, Young T, et al. Copenhagen, WHO Regional Office for Europe, 2016 (Health Policy for Children and Adolescents, No. 7). Available at: http:
//www.euro.who.int/__data/assets/pdf_file/0003/303438/HSBC-No.7-Growing-up-unequal-Full-Report.pdf?ua=1

Figure 117: Percentage of 15-year-old boys who report sexual intercourse in Europe

Please refer to original source for methods of estimation
Italy, Lithuania, Luxembourg, Latvia, Republic of Moldova, Macedonia, Malta, Netherlands, Poland, Portugal, Romania, Russian Federation, Slovakia, Slovenia, Sweden, Ukraine: Fifteen-
year-olds teenagers only were asked whether they had ever had sexual intercourse.
For Albania, Bulgaria, Switzerland, Spain, France, Greece, Croatia, Ireland, Lithuania, Latvia, Republic of Moldova, Macedonia, Portugal, Romania, Russian Federation, Slovenia, Ukraine:
Indicates a significant gender difference (at p<0.05).
Italy, Lithuania, Luxembourg, Latvia, Republic of Moldova, Macedonia, Malta, Netherlands, Poland, Portugal, Romania, Russian Federation, Slovakia, Slovenia, Sweden, Ukraine: Year of
estimation: 2013-2014
Data sources:
Italy, Lithuania, Luxembourg, Latvia, Republic of Moldova, Macedonia, Malta, Netherlands, Poland, Portugal, Romania, Russian Federation, Slovakia, Slovenia, Sweden, Ukraine: Growing
up unequal: gender and socioeconomic differences in young people’s health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the
2013/2014 survey. Inchley J, Currie D, Young T, et al. Copenhagen, WHO Regional Office for Europe, 2016 (Health Policy for Children and Adolescents, No. 7). Available at: http:
//www.euro.who.int/__data/assets/pdf_file/0003/303438/HSBC-No.7-Growing-up-unequal-Full-Report.pdf?ua=1

Table 31: Median age at first sex in Europe

MALE FEMALE TOTAL
Median age Median age Median age
Country Study Year/period Birth cohort N at first sex N at first sex N at first sex
Albania Albania BBSS 2005 1956-1987 312 17.0 317 20.0 629 19.0
2005a
Albania DHS 2008-2009 1959-1963 535 23.4 1079 21.1 - -
2008/2009
Albania DHS 2008-2009 1959-1983 - 22.6 - 20.7 - -
2008/2009b
Albania DHS 2008-2009 1959-1983 - 22.0 - 21.3 - -
2008/2009 c
Albania DHS 2008-2009 1959-1983 1904 22.3 4894 20.9 - -
2008/2009
Albania DHS 2008-2009 1964-1968 497 23.2 1216 21.3 - -
2008/2009
Albania DHS 2008-2009 1969-1973 366 21.9 1071 20.8 - -
2008/2009
Albania DHS 2008-2009 1974-1978 262 20.8 817 20.6 - -
2008/2009
Albania DHS 2008-2009 1979-1983 244 20.4 711 20.8 - -
2008/2009
Albania DHS 2008-2009 1984-1988 268 19.9 516 - - -
2008/2009d
Albania DHS 2008-2009 1984-1993 397 - 697 - - -
2008/2009d
Albania DHS 2008-2009 1989-1993 129 - 182 - - -
2008/2009d
Austria Cibula 2008 e, f ,a 2006 1957-1991 - - 507 16.6 - -
Belarus Syrjanen 1998-2001 1913-1983 - - 722 18.4 - -
2003 g,h, f
Syrjanen 2003 i,h, f 1998-2001 1913-1983 - - 761 19.0 - -
Syrjanen 2003h, j, f 1998-2001 1913-1983 - - 1692 19.6 - -
Belgium Fronteira 2005-2006 1986-1989 - - - - 369 15.2
2009k, f ,a
Hubert 1998l 1993 1932-1941 245 20.4 252 20.9 - -
Hubert 1998l 1993 1942-1951 385 19.0 408 20.0 - -
Hubert 1998l 1993 1952-1961 411 18.5 509 18.8 - -
Hubert 1998l 1993 1962-1966 199 18.0 240 18.6 - -
Hubert 1998l 1993 1967-1971 216 18.1 229 18.7 - -
Hubert 1998l 1993 1972-1973 105 17.4 90 18.0 - -
Bosnia & H. Arza 2012 f ,m 2007-2009 - 1871 17.3 1788 18.2 - -
Delva 2007n, f 2004 1989-1993 418 15.5 232 16.3 - -
Croatia Croatia KABP 2010 1985-1992 - - - - 861 17.0
2010 (Landripet
2011)
Hirsl-Hecej 1997 1978-1982 - - - - 686 16.0
2006k,o
Hirsl-Hecej 2001 1982-1986 - - - - 624 16.0
2006k,o
Stulhofer 2009 2005 1981-1987 433 17.0 460 17.0 - -
Czech Rep. Crochard 2009 2006-2007 1982-1988 530 17.0 509 17.0 - -
Czech Republic 1993 1969-1978 - - 1058 17.5 - -
RHS 1993
Fronteira 2005-2006 1986-1989 - - - - 392 16.4
2009k, f ,a
Denmark Hubert 1998l 1989 1932-1941 232 18.4 295 19.0 - -
Hubert 1998l 1989 1942-1951 269 18.2 351 18.3 - -
Hubert 1998l 1989 1952-1961 328 17.8 390 17.7 - -
Hubert 1998l 1989 1962-1966 179 17.1 199 16.8 - -
Hubert 1998l 1989 1967-1971 178 17.5 206 17.0 - -
Hubert 1998l 1989 1972-1973 164 17.4 202 16.7 - -
Jensen 2011 2005 1959-1963 - - - 16.0 - -
Jensen 2011 2005 1964-1968 - - - 16.0 - -
Jensen 2011 2005 1969-1973 - - - 16.5 - -
Jensen 2011 2005 1974-1978 - - - 16.0 - -
Jensen 2011 2005 1979-1982 - - - 16.0 - -
Jensen 2011 2005 1983-1986 - - - 16.0 - -
Estonia Fronteira 2005-2006 1986-1989 - - - - 435 15.3
2009k, f ,a
Haldre 2012 1994 1949-1953 - - - 20.1 - -
Haldre 2012 2004/2005 1949-1953 - 18.6 - 20.2 - -
Haldre 2012 1996 1951-1955 - 18.0 - 20.0 - -
Haldre 2012 1994 1964-1968 - - - 19.3 - -
Haldre 2012 2004/2005 1964-1968 - 18.2 - 19.1 - -
Haldre 2012 1996 1966-1970 - 18.0 - 18.0 - -
Haldre 2012 2005 1976-1980 - 17.5 - 17.4 - -
Haldre 2012 2007 1978-1982 - 17.4 - 17.5 - -
Part 2007 2004-2005 1960-1969 - - 680 18.0 - -


MALE FEMALE TOTAL
Part 2007 2004-2005 1970-1979 - - 707 18.0 - -

Part 2007 2004-2005 1980-1986 - - 908 17.0 - -
Part 2007 2004-2005 1987-1988 - - 90 15.0 - -
Uusk|la 2008 f 2005-2006 1970-1987 - - - - 526 17.6
Finland Hubert 1998l 1992 1922-1931 148 18.8 187 20.7 - -
Hubert 1998l 1992 1932-1941 134 18.7 149 20.0 - -
Hubert 1998l 1992 1942-1951 227 18.2 209 19.0 - -
Hubert 1998l 1992 1952-1961 256 18.0 246 17.7 - -
Hubert 1998l 1992 1962-1966 123 17.3 109 17.8 - -
Hubert 1998l 1992 1967-1971 113 18.0 121 18.0 - -
Hubert 1998l 1992 1972-1973 46 18.0 40 16.6 - -
France Bajos 2010 2006 1937-1988 - 17.2 - 17.6 - -
Bajos 2010 1970 1939 - 18.1 - 22.0 - -
Crochard 2009 2006-2007 1982-1988 446 16.0 482 17.0 - -
France KABP 1994 1940-1976 516 16.6 653 17.6 - -
2005
France KABP 1998 1944-1980 838 16.7 874 17.4 - -
2005
France KABP 2001 1947-1983 1149 16.8 1452 17.3 - -
2005
France KABP 2004 1950-1986 1281 16.6 1609 17.2 - -
2005
France KABP 2010 1956-1992 - 16.5 - 17.2 - -
2010 p
Hubert 1998 q,l 1992 1922-1931 140 18.0 100 21.1 - -
Hubert 1998 q,l 1992 1932-1941 200 18.4 161 20.6 - -
Hubert 1998 q,l 1992 1942-1951 432 18.1 341 19.3 - -
Hubert 1998 q,l 1992 1952-1961 679 17.6 560 18.3 - -
Hubert 1998 q,l 1992 1962-1966 502 17.4 386 18.2 - -
Hubert 1998 q,l 1992 1967-1971 539 17.7 471 18.3 - -
Hubert 1998 q,l 1992 1972-1973 150 17.0 159 18.1 - -
Germany Griesinger 2007r, f 2004 1984-1990 - - 521 15.2 - -
Hubert 1998s,l 1990 1922-1931 125 20.2 161 20.9 - -
Hubert 1998s,l 1990 1932-1941 203 19.0 237 19.7 - -
Hubert 1998s,l 1990 1942-1951 263 18.4 325 18.6 - -
Hubert 1998s,l 1990 1952-1961 362 18.0 454 17.5 - -
Hubert 1998s,l 1990 1962-1966 263 17.7 241 17.6 - -
Hubert 1998s,l 1990 1967-1971 182 17.7 198 17.7 - -
Greece Hubert 1998l 1990 1932-1941 54 17.3 57 22.8 - -
Hubert 1998l 1990 1942-1951 213 17.3 258 20.6 - -
Hubert 1998l 1990 1952-1961 259 17.5 322 19.5 - -
Hubert 1998l 1990 1962-1966 136 17.6 163 19.2 - -
Hubert 1998l 1990 1967-1971 152 17.5 155 19.0 - -
Tsitsika 2010 t, f 2007-2008 1991-1997 185 13.0 61 14.5 246 14.0
Iceland Bender 1999 f ,o 1996 1976-1979 273 15.4 1423 15.4 1696 15.4
Hubert 1998l 1992 1932-1941 33 17.8 39 18.7 - -
Hubert 1998l 1992 1942-1951 85 17.5 100 18.0 - -
Hubert 1998l 1992 1952-1961 143 16.9 143 17.2 - -
Hubert 1998l 1992 1962-1966 67 16.8 87 17.1 - -
Hubert 1998l 1992 1967-1971 56 16.8 76 16.9 - -
Hubert 1998l 1992 1972-1973 49 16.4 63 16.3 - -
Jensen 2011 2005 1959-1963 - - - 16.0 - -
Jensen 2011 2005 1964-1968 - - - 16.0 - -
Jensen 2011 2005 1969-1973 - - - 16.0 - -
Jensen 2011 2005 1974-1978 - - - 16.0 - -
Jensen 2011 2005 1979-1982 - - - 16.0 - -
Jensen 2011 2005 1983-1986 - - - 16.0 - -
Ireland Crochard 2009 2006-2007 1982-1988 398 16.0 403 17.0 - -
ISSHR 2006a 2006 1942-1946 205 22.0 242 23.0 - -
ISSHR 2006a 2006 1947-1951 302 20.0 368 22.0 - -
ISSHR 2006a 2006 1952-1956 265 19.0 366 21.0 - -
ISSHR 2006a 2006 1957-1961 309 19.0 389 20.0 - -
ISSHR 2006a 2006 1962-1966 347 19.0 441 20.0 - -
ISSHR 2006a 2006 1967-1971 300 18.0 573 19.0 - -
ISSHR 2006a 2006 1972-1976 247 18.0 357 18.0 - -
ISSHR 2006a 2006 1977-1981 454 17.0 587 18.0 - -
ISSHR 2006a 2006 1982-1988 759 17.0 908 17.0 - -


MALE FEMALE TOTAL
O’Connell 2009u 2004-2005 1970-1988 - - 215 17.0 - -

Israel Ben-Zur 2000v 1995-1996 1976-1982 - - - - 231 15.0
Italy Crochard 2009w 2006-2007 1982-1988 453 16.0 371 16.0 - -
Panatto 2009w 2006-2007 1982-1987 282 16.0 493 16.0 775 16.0
Panatto 2009 x 2006-2007 1982-1999 377 15.0 914 15.0 1291 15.0
Pannato 2012 y 2008-2011 1984-1994 1166 16.0 2739 16.0 3905 16.0
Signorelli 2006 2002 1953-1957 - - - - 266 18.0
Signorelli 2006 2002 1958-1962 - - - - 340 18.0
Signorelli 2006 2002 1963-1967 - - - - 226 18.0
Signorelli 2006 2002 1968-1972 - - - - 261 18.0
Signorelli 2006 2002 1973-1977 - - - - 297 18.0
Signorelli 2006 2002 1978-1984 - - - - 306 17.0
Tafuri 2010 z, f 2008 1978-1992 - 16.7 - 16.8 960 16.8
Latvia Syrjanen 2003h, j, f 1998-2001 1913-1983 - - 1692 19.6 - -
Syrjanen 2003 i,h, f 1998-2001 1913-1983 - - 761 19.0 - -
Syrjanen 1998-2001 1913-1983 - - 722 18.4 - -
2003 g,h, f
Macedonia Delva 2007n, f 2004 1989-1993 418 15.5 232 16.3 - -
Malta Malta HIS 2002 2002 <=1986 - - - - 4854 20.0
Montenegro Delva 2007n, f 2004 1989-1993 418 15.5 232 16.3 - -
Labovic 2011 f 2009 1985-1994 411 16.6 194 18.4 605 17.2
Netherlands Crochard 2009 2006-2007 1982-1988 526 16.0 481 16.0 - -
deGraaf 2010 f 2005 1980-1993 1273 16.8 1360 16.7 - -
deGraaf 2010 f 2005 1981-1984 - - - - 1214 17.5
deGraaf 2010 f 2005 1985-1988 - - - - 1124 16.5
deGraaf 2010 f 2005 1989-1993 - - - - 295 14.4
Hubert 1998l 1989 1932-1941 28 21.2 39 21.6 - -
Hubert 1998l 1989 1942-1951 94 19.1 162 19.7 - -
Hubert 1998l 1989 1952-1961 154 18.2 195 18.4 - -
Hubert 1998l 1989 1962-1966 73 17.8 93 17.8 - -
Hubert 1998l 1989 1967-1971 52 18.3 74 18.3 - -
Lenselink 2008 A, f 2007 1978-1989 - - 1944 16.7 - -
Norway Bakken 2007B, f 2005 1975-1987 1032 17.5 - - - -
Hubert 1998l 1992 1932-1941 256 19.3 271 19.5 - -
Hubert 1998l 1992 1942-1951 442 18.8 536 18.8 - -
Hubert 1998l 1992 1952-1961 548 18.3 714 17.7 - -
Hubert 1998l 1992 1962-1966 308 18.4 392 17.5 - -
Hubert 1998l 1992 1967-1971 311 18.3 396 17.6 - -
Hubert 1998l 1992 1972-1973 125 18.1 143 17.5 - -
Jensen 2011a 2005 1959-1963 - - - 17.0 - -
Jensen 2011a 2005 1964-1968 - - - 17.0 - -
Jensen 2011a 2005 1969-1973 - - - 17.0 - -
Jensen 2011a 2005 1974-1978 - - - 17.0 - -
Jensen 2011a 2005 1979-1982 - - - 17.0 - -
Jensen 2011a 2005 1983-1986 - - - 16.0 - -
Pedersen 2003C, f 1992 1976-1980 646 17.9 753 17.3 - -
Trfen 2003 1987 1965-1969 - 18.2 - 17.2 - -
Trfen 2003 1997 1975-1979 - 18.2 - 17.4 - -
Trfen 2003 2002 1980-1984 - 17.5 - 17.1 - -
Poland Crochard 2009 2006-2007 1982-1988 489 17.0 409 18.0 - -
Olszewski 2008 1981-1990 - - 993 18.7 - -
2010D, f
Portugal Aboim 2012 f 2007 1942-1989 - 17.2 - 19.5 3055 -
Ferreira 2011 x, f 2005 1986-1990 - - - - 240 15.5
Fronteira 2005-2006 1986-1989 - - - - 361 15.6
2009k, f ,a
Hubert 1998l 1991 1932-1941 29 16.4 39 24.3 - -
Hubert 1998l 1991 1942-1951 383 16.8 334 21.9 - -
Hubert 1998l 1991 1952-1961 379 16.5 394 20.3 - -
Hubert 1998l 1991 1962-1966 142 16.8 147 19.8 - -
Hubert 1998l 1991 1967-1971 256 17.1 234 19.9 - -
Hubert 1998l 1991 1972-1973 66 16.2 68 > 19.0 - -
Romania Romania RHS 1993 1949-1953 - - 697 20.2 - -
1993a
Romania RHS 1993 1949-1978 - - 4832 20.2 - -
1993a
Romania RHS 1993 1954-1958 - - 877 20.1 - -
1993a


MALE FEMALE TOTAL
Romania RHS 1993 1959-1963 - - 792 19.9 - -

1993a
Romania RHS 1993 1964-1968 - - 828 20.1 - -
1993a
Romania RHS 1993 1969-1973 - - 888 20.5 - -
1993a
Romania RHS 1999 1955-1959 - - 1086 20.1 - -
1999
Romania RHS 1999 1955-1984 - - 5627 19.8 - -
1999
Romania RHS 1999 1960-1964 - - 946 19.9 - -
1999
Romania RHS 1999 1965-1969 - - 1343 19.9 - -
1999
Romania RHS 1999 1970-1974 - - 1242 19.9 - -
1999
Romania RHS 1999 1975-1979 - - 963 19.5 - -
1999
Romania RHS 1999 1980-1984 - - 237 - - -
1999d
Russia Bobrova 2005 f 2002 1973-1987 - - - - 929 17.7
Crochard 2009 2006-2007 1982-1988 637 16.0 574 17.0 - -
Syrjanen 2003h, j, f 1998-2001 1913-1983 - - 1692 19.6 - -
Syrjanen 2003 i,h, f 1998-2001 1913-1983 - - 761 19.0 - -
Syrjanen 1998-2001 1913-1983 - - 722 18.4 - -
2003 g,h, f
Serbia Delva 2007n, f 2004 1989-1993 418 15.5 232 16.3 - -
Slovenia Klavs 2006a 1999-2001 1957-1988 849 17.0 903 18.0 - -
Spain Castellsague 2007-2008 1942-1952 - - 479 22.7 - -
2012E, f
Castellsague 2007-2008 1982-1990 - - 1617 16.7 - -
2012E, f
de Sanjose 2008 f 2005 1935-1987 - - 6249 20.9 - -
Gomez 2007F, f 2001-2003 1981-1990 - - 384 16.5 - -
Spain ESHS 2003 2003 1954-1963 - 18.0 - 19.0 - 19.0
Spain ESHS 2003 2003 1964-1973 - 18.0 - 18.0 - 18.0
Spain ESHS 2003 2003 1974-1985 - 17.0 - 18.0 - 18.0
Vaccarella 1998-2000 1925-1984 - - 908 21.0 - -
2006F, f
Sweden Hdggstrvm- 2009 1989-1994 - - - - 209 15.0
Nordin
2010k
Jensen 2011 2005 1959-1963 - - - 16.0 - -
Jensen 2011 2005 1964-1968 - - - 17.0 - -
Jensen 2011 2005 1969-1973 - - - 17.0 - -
Jensen 2011 2005 1974-1978 - - - 17.0 - -
Jensen 2011 2005 1979-1982 - - - 16.0 - -
Jensen 2011 2005 1983-1986 - - - 16.0 - -
Priebe 2009k, f 2003-2004 1983-1987 1558 15.7 819 15.9 - -
Stenhammar 2014 1979-1997 - - 359 16.7 - -
2015 f ,G
Switzerland Hubert 1998l 1992 1942-1951 239 19.2 229 19.5 - -
Hubert 1998l 1992 1952-1961 495 18.5 478 18.7 - -
Hubert 1998l 1992 1962-1966 237 18.7 224 18.5 - -
Hubert 1998l 1992 1967-1971 227 18.1 233 18.4 - -
Hubert 1998l 1992 1972-1973 128 18.2 123 18.4 - -
Turkey Turkey DHS 1998 1934-1948 226 20.9 - - - -
1998H
Turkey DHS 1998 1934-1973 - 19.0 - - - -
1998H,c
Turkey DHS 1998 1934-1973 - 19.8 - - - -
1998H,b
Turkey DHS 1998 1934-1973 1859 19.2 - - - -
1998H
Turkey DHS 1998 1949-1953 240 19.3 - - - -
1998H
Turkey DHS 1998 1954-1958 335 19.0 - - - -
1998H
Turkey DHS 1998 1959-1963 352 18.8 - - - -
1998H
Turkey DHS 1998 1964-1968 364 18.9 - - - -
1998H
Turkey DHS 1998 1969-1973 342 19.2 - - - -
1998H
UK Hubert 1998l 1991 1932-1941 1318 19.1 1980 20.9 - -
Hubert 1998l 1991 1942-1951 1924 18.3 2306 19.5 - -
Hubert 1998l 1991 1952-1961 2268 17.5 3031 18.2 - -


MALE FEMALE TOTAL
Hubert 1998l 1991 1962-1966 1202 17.2 1629 17.9 - -

Hubert 1998l 1991 1967-1971 864 17.1 1125 17.4 - -
Hubert 1998l 1991 1972-1973 288 17.0 350 17.3 - -
Wellings 2001a 2001 1957-1961 578 17.0 613 17.0 - -
Wellings 2001a 2001 1957-1985 4743 17.0 6364 17.0 - -
Wellings 2001a 2001 1962-1966 646 17.0 824 17.0 - -
Wellings 2001a 2001 1967-1971 808 17.0 1160 17.0 - -
Wellings 2001a 2001 1972-1976 981 17.0 1357 17.0 - -
Wellings 2001a 2001 1977-1981 903 17.0 1279 16.0 - -
Wellings 2001a 2001 1982-1985 827 16.0 1131 16.0 - -
Wellings 2013a 2010-2012 1936-1945 657 18.0 850 19.0 - -
Wellings 2013a 2010-2012 1936-1994 6207 17.0 8746 17.0 - -
Wellings 2013a 2010-2012 1946-1955 758 18.0 1015 18.0 - -
Wellings 2013a 2010-2012 1956-1965 780 17.0 1106 17.0 - -
Wellings 2013a 2010-2012 1966-1975 792 17.0 1196 17.0 - -
Wellings 2013a 2010-2012 1976-1985 1508 17.0 2469 16.0 - -
Wellings 2013a 2010-2012 1986-1994 1712 16.0 2110 16.0 - -
Ukraine Ukraine DHS 2007 1958-1962 509 18.8 1080 20.3 - -
2007a
Ukraine DHS 2007 1958-1982 - 18.5 - 19.7 - -
2007 c
Ukraine DHS 2007 1958-1982 - 19.1 - 19.5 - -
2007b
Ukraine DHS 2007 1958-1982 2259 18.7 4972 19.6 - -
2007
Ukraine DHS 2007 1958-1987 2679 18.6 5762 19.6 - -
2007a
Ukraine DHS 2007 1958-1987 - 18.5 - 19.6 - -
2007 c
Ukraine DHS 2007 1958-1987 - 19.0 - 19.5 - -
2007b
Ukraine DHS 2007 1963-1967 398 18.9 929 19.8 - -
2007a
Ukraine DHS 2007 1968-1972 446 18.6 1043 19.4 - -
2007a
Ukraine DHS 2007 1973-1977 474 18.6 967 19.1 - -
2007a
Ukraine DHS 2007 1978-1982 430 18.4 954 19.3 - -
2007a
Ukraine DHS 2007 1983-1987 421 18.3 790 19.4 - -
2007a
Ukraine DHS 2007 1983-1992 568 19.3 930 22.4 - -
2007
Ukraine DHS 2007 1988-1992 147 - 140 - - -
2007d
a Number of subjects refers to the number of surveyed men/women (not all sexually active).
b Rural.
c Urban.
d Data omitted because less than 50 percent of respondents had intercourse for the first time before reaching the beginning of the age group.
e Data pertain to women randomly selected from a panel of more than three million women who had stated in a previous internet interview.
f Mean age at first sex.
g Data pertain to women attending a sexually transmitted disease clinic.
h Data pertain to women attending six clinics in Belarus, Latvia and Russian Federation.
i Data pertain to gynecological patients.
j Data pertain to women participating in cervical cancer screening.
k Data pertain to high school students.
l Not especified if estimations are among sexually active or surveyed.
m Sarajevo, Tuzla, Mostar, Banja Luka.
n Data pertain to high school students in Bosnia (Sarajevo), the FYR of Macedonia (Skopje), and Serbia and Montenegro (Belgrade and Podgorica).
o Not especified if estimations are among sexually active or surveyed (provided N among surveyed).
p Ile-de-France.
q Data from the Analysis on Sexual Behaviour in France (ACSF).
r Data pertain to women attending a sample of gyneacologists in Berlin.
s Data from the Survey performed in the Federal Republic of Germany (before reunification).
t Data pertain to students attending 20 public junior high and high schools.
u Data pertain to students attending student health units in three high education institutions (two universities and one institute of education).
v Data pertain to Jewish adolescents.
w Data pertain to workers.
x Data pertain to secondary schools students.
y Data pertain to secondary school students from Genova, Florence, Turin, Sassari and Cagliari.
z Data pertain to school-leavers attending a pre-university study course.
A Data pertain to unscreened women.
B Data pertain to men recruited at student health services.
C Data pertain to schools students.
D Data pertain to high school and secondary schools students.
E Data pertain to women attending routine cervical cancer screening.
F Data pertain to population attending family planning centers or screening centers.
G Swedish female university students from Uppsala undergoing contraceptive counseling at the students health center.
H Data pertain to husbands.

Table 32: Average number of sexual partners in Europe

Period MALE FEMALE TOTAL
Country Study of estimate Year/Period Birth cohort Mean(N) Mean(N) Mean(N)
Albania Albania DHS 2008-9 Lifetime 2008-2009 (1959-1969) 2.1 (1023) 1.0 (2294) - (-)
Albania DHS 2008-9 Lifetime 2008-2009 (1969-1979) 3.1 (621) 1.1 (1887) - (-)
Belarus Syrjanen 2003a,b Last 2 years 1998 - - (-) 2.2 (722) - (-)
Syrjanen 2003 c,b Last 2 years 1998 - - (-) 1.7 (761) - (-)
Syrjanen 2003d,b Last 2 years 1998 - - (-) 1.6 (1692) - (-)
Belgium Hubert 1998 e Last year 1993 (1944-1975) 1.4 (1233) 1.0 (1380) - (-)
Czech Rep. Crochard 2009 f Lifetime 2006-2007 (1982-1989) 4.0 (518) 3.0 (505) - (-)
Denmark Buttmann 2011 g Lifetime 2006-2007 (1961-1989) 8.0 (22410) - (-) - (-)
Kjaer 2007 g Lifetime 2004-2005 (1959-1987) - (-) 8.4 (22173) - (-)
Estonia Lõhmus 2003 Last year 2002-2003 (1973-1978) 2.1 (395) 1.4 (575) 1.7 (970)
Lõhmus 2003 Last year 2002-2003 (1978-1984) 3.0 (524) 1.9 (773) 2.3 (1272)
Lõhmus 2003 Last year 2002-2003 (1984-1987) 3.8 (251) 1.9 (392) 2.7 (643)
Lõhmus 2003 Last year 2002-2003 (1987-1989) 2.7 (94) 1.9 (112) 2.3 (205)
Part 2007 Lifetime 2004-2005 (1960-1970) - (-) 5.9 (680) - (-)
Part 2007 Last year 2004-2005 (1960-1970) - (-) 1.1 (680) - (-)
Part 2007 Lifetime 2004-2005 (1970-1980) - (-) 7.5 (707) - (-)
Part 2007 Last year 2004-2005 (1970-1980) - (-) 1.5 (707) - (-)
Part 2007 Lifetime 2004-2005 (1980-1987) - (-) 4.5 (908) - (-)
Part 2007 Last year 2004-2005 (1980-1987) - (-) 1.5 (908) - (-)
Part 2007 Lifetime 2004-2005 (1987-1989) - (-) 2.7 (90) - (-)
Part 2007 Last year 2004-2005 (1987-1989) - (-) 1.7 (90) - (-)
France Bajos 2010 g Lifetime 1970 <=1950 11.8 (1250) 1.8 (1375) - (-)
Bajos 2010 g Lifetime 1970 <=1920 12.2 (1250) 1.6 (1375) - (-)
Bajos 2010 g Lifetime 1970 (1921-1940) 12.8 (1250) 1.9 (1375) - (-)
Bajos 2010 g Lifetime 1970 (1941-1950) 9.4 (1250) 2.0 (1375) - (-)
Bajos 2010 g Lifetime 1992 (1923-1942) 10.3 (8948) 2.0 (11098) - (-)
Bajos 2010 g Lifetime 1992 (1923-1974) 11.0 (8948) 3.3 (11098) - (-)
Bajos 2010 g Lifetime 1992 (1943-1962) 12.6 (8948) 4.0 (11098) - (-)
Bajos 2010 g Lifetime 1992 (1963-1972) 10.4 (8948) 3.9 (11098) - (-)
Bajos 2010 g Lifetime 2006 (1937-1956) 12.9 (5540) 3.9 (6824) - (-)
Bajos 2010 g Lifetime 2006 (1937-1988) 11.6 (5540) 4.4 (6824) - (-)
Bajos 2010 g Lifetime 2006 (1957-1976) 12.9 (5540) 5.1 (6824) - (-)
Bajos 2010 g Lifetime 2006 (1977-1986) 7.7 (5540) 3.8 (6824) - (-)
Crochard 2009 f Lifetime 2006-2007 (1982-1989) 4.0 (419) 3.0 (460) - (-)
Hubert 1998 g,h Lifetime 1991-1992 (1942-1974) 11.5 (6551) 3.8 (7777) - (-)
Hubert 1998 e,h Last year 1991-1992 (1942-1974) 1.4 (6252) 1.1 (7403) - (-)
Germany Griesinger 2007 i Lifetime 2004 (1984-1990) - (-) 3.5 (521) - (-)
Hubert 1998 j,k Last year 1990 (1941-1972) 1.4 (927) 1.1 (1056) - (-)
Greece Hubert 1998k Last year 1990 (1941-1972) 1.2 (743) 1.0 (839) - (-)
Kordoutis 2000 f Lifetime - - 4.0 (179) 2.0 (279) - (-)
Hungary Takacs 2006l Lifetime 2003-2004 (1976-1988) 19.1 (24) 10.8 (12) 16.5 (36)
Takacs 2006l Last year 2003-2004 (1976-1988) 4.6 (24) 4.2 (12) 4.5 (36)
Iceland Kjaer 2007 g Lifetime 2004-2005 (1959-1987) - (-) 8.8 (15025) - (-)
Ireland Crochard 2009 f ,m Lifetime 2006-2007 (1982-1989) 6.0 (371) 4.0 (377) - (-)
ISSHR 2006n Lifetime 2004-2005 (1940-1987) 9.1 (3188) 3.1 (4253) - (-)
ISSHR 2006n Last 5 years 2004-2005 (1940-1987) 9.1 (3188) 3.1 (4253) - (-)
ISSHR 2006n Last year 2004-2005 (1940-1987) 9.1 (3188) 3.1 (4253) - (-)
O’Connell 2009 o Lifetime 2004-2005 (1970-1988) - (-) 4.7 (215) - (-)
Israel Ben-Zur 2000 p Lifetime 1995-1996 (1977-1982) - (-) - (-) 3.6 (231)
Chemtob 2006 g Last 3 months 2000 (1955-1965) - (-) - (-) 1.1 (276)
Chemtob 2006 g Last 3 months 2000 (1955-1982) 1.9 (398) 1.5 (402) 1.3 (800)
Italy Crochard 2009 f Lifetime 2006-2007 (1982-1989) 5.0 (410) 3.0 (314) - (-)
Panatto 2012 q,r Lifetime 2008-2011 (1984-1991) 3.0 (277) 2.0 (733) - (-)
Latvia Syrjanen 2003a,b Last 2 years 1998 - - (-) 2.2 (722) - (-)
Moldova Moldova DHS 2005 Lifetime 2005 (1956-1965) 6.3 (529) 1.5 (2142) - (-)
Moldova DHS 2005 Lifetime 2005 (1966-1975) 7.1 (425) 1.7 (1746) - (-)


Country Study of estimate Year/Period Birth cohort Mean N Mean
Montenegro Labovic 2011 Last year 2009 (1985-1994) 2.6 (398) 1.3 (194) - (-)
Netherlands Crochard 2009 f ,m Lifetime 2006-2007 (1982-1989) 4.0 (476) 3.0 (463) - (-)
deGraaf 2010 Lifetime 2005 (1980-1993) 4.9 (1273) 3.3 (1360) - (-)
deGraaf 2010 Lifetime 2005 (1981-1984) - (-) - (-) 4.7 (1214)
Hubert 1998 e Last year 1989 (1940-1971) 1.2 (392) 1.1 (551) - (-)
Kuyper 2010k Lifetime 2005-2006 (1935-1987) - (-) 4.1 (1965) - (-)
Norway Bakken 2007 f Last year 2005 (1975-1987) 2.0 (1032) - (-) - (-)
Bakken 2007 f Last 6 months 2005 (1975-1987) 1.0 (973) - (-) - (-)
Hubert 1998 g Lifetime 1992 (1943-1974) 11.7 (1684) 5.5 (2116) - (-)
Hubert 1998 e Last year 1992 (1943-1974) 1.5 (1454) 1.2 (1944) - (-)
Kjaer 2007 g Lifetime 2004-2005 (1959-1987) - (-) 7.4 (16575) - (-)
Træen 2003s Lifetime 1997 (1975-1979) 7.0 (-) 6.0 (-) - (-)
Træen 2003 t Lifetime 1997 (1975-1979) 6.0 (-) 6.0 (-) - (-)
Træen 2003s Lifetime 2002 (1980-1984) 7.0 (-) 6.0 (-) - (-)
Træen 2003 t Lifetime 2002 (1980-1984) 6.0 (-) 7.0 (-) - (-)
Poland Crochard 2009 f Lifetime 2006-2007 (1982-1989) 3.0 (481) 2.0 (404) - (-)
Portugal Hubert 1998 e Last year 1990-1991 (1941-1973) 1.8 (1102) 1.0 (1031) - (-)
Russia Crochard 2009 f ,m Lifetime 2006-2007 (1982-1989) 5.0 (630) 3.0 (573) - (-)
Syrjanen 2003a,b Last 2 years 1998 - - (-) 2.2 (722) - (-)
Takacs 2006l Lifetime 2003-2004 (1976-1988) 14.1 (14) 4.1 (16) 8.8 (30)
Takacs 2006l Last year 2003-2004 (1976-1988) 3.6 (14) 1.8 (16) 2.7 (30)
Slovenia Klavs 2009 g Lifetime 1999-2001 (1950-1966) 9.5 (303) 3.1 (352) - (-)
Klavs 2009 g Last 5 years 1999-2001 (1950-1966) 2.1 (307) 1.1 (357) - (-)
Klavs 2009 g Last year 1999-2001 (1950-1966) 1.2 (306) 1.0 (357) - (-)
Klavs 2009 g Lifetime 1999-2001 (1950-1983) 8.3 (812) 3.2 (879) - (-)
Klavs 2009 g Last year 1999-2001 (1950-1983) 1.4 (812) 1.0 (889) - (-)
Klavs 2009 g Lifetime 1999-2001 (1965-1976) 7.9 (186) 3.4 (214) - (-)
Klavs 2009 g Last year 1999-2001 (1965-1976) 1.3 (185) 1.0 (217) - (-)
Klavs 2009 g Lifetime 1999-2001 (1975-1983) 6.5 (323) 2.9 (313) - (-)
Klavs 2009 g Last year 1999-2001 (1975-1983) 1.8 (321) 1.1 (315) - (-)
Spain Castellsague 2012u Lifetime 2007-2008 (1942-1952) - (-) 1.4 (479) - (-)
Castellsague 2012u Lifetime 2007-2008 (1982-1990) - (-) 2.8 (1617) - (-)
Gomez 2007v Lifetime 2001-2003 (1981-1990) - (-) 1.9 (384) - (-)
HSBS 2003 Last year 2003 (1954-1963) 2.2 (-) 1.0 (-) 1.6 (-)
HSBS 2003 Last year 2003 (1954-1985) 2.6 (-) 1.2 (-) 1.9 (-)
HSBS 2003 Last year 2003 (1964-1973) 2.8 (-) 1.1 (-) 2.0 (-)
HSBS 2003 Last year 2003 (1974-1985) 2.8 (-) 1.4 (-) 2.1 (-)
Vaccarella 2006v Lifetime 1998-2000 (1923-1986) - (-) 1.5 (908) - (-)
Sweden Häggström-Nordin 2010w, f Lifetime 2009 (1989-1994) 3.0 (91) 2.0 (118) 2.0 (209)
Kjaer 2007 g Lifetime 2004-2005 (1959-1987) - (-) 8.6 (15713) - (-)
Langstrom 2006 g Lifetime 1996 (1936-1978) 1.4 (1244) 1.2 (1142) - (-)
Tyden 2012 g,x Lifetime 2009 - - (-) 11.0 (350) - (-)
Tyden 2012 g,x Last year 2009 - - (-) 2.6 (350) - (-)
Switzerland Jeannin 2009 y,g, f Lifetime 2007 (1962-1976) 6.0 (-) 4.0 (-) - (-)
Jeannin 2009 y,g, f Last year 2007 (1962-1976) 1.0 (-) 1.0 (-) - (-)
Jeannin 2009 y,g, f Lifetime 2007 (1977-1986) 5.0 (-) 3.0 (-) - (-)
Jeannin 2009 y,g, f Lifetime 2007 (1987-1990) 2.0 (-) 1.0 (-) - (-)
Jeannin 2009 z Last year 2007 (1933-1946) 1.0 (-) 0.6 (-) 0.8 (3291)
UK Almonte 2011 g,A Lifetime 2003-2007 (1959-1972) - (-) 5.6 (195) - (-)
Almonte 2011 g,A Lifetime 2003-2007 (1959-1990) - (-) 7.5 (436) - (-)
Hubert 1998 g Lifetime 1990-1991 (1941-1973) 10.4 (6414) 3.7 (8049) - (-)


Country Study of estimate Year/Period Birth cohort Mean N Mean
Hubert 1998 e Last year 1990-1991 (1941-1973) 1.3 (6134) 1.1 (7790) - (-)
Johnson 2001n Lifetime 1999-2001 (1955-1966) 16.0 (1691) 6.8 (2356) - (-)
Johnson 2001n Last 5 years 1999-2001 (1955-1966) 2.2 (1669) 1.5 (2332) - (-)
Mercer 2009n Last year 1999-2001 (1955-1985) 1.8 (4762) 1.3 (6399) - (-)
Ukraine Ukraine DHS 2007 Lifetime 2007 (1958-1967) 6.8 (747) 2.1 (1916) - (-)
Ukraine DHS 2007 Lifetime 2007 (1968-1977) 6.0 (743) 2.2 (1917) - (-)
Data accessed on 08 Aug 2013.
N: number of subjects sexually active;
a Data pertain to women attending a sexually transmitted disease clinic.
b Data pertain to women attending six clinics in Belarus, Latvia and Russian Federation.
c Data pertain to gynecological patients.
d Data pertain to women participating in cervical cancer screening.
e Data among responders who ever had a heterosexual partner.
f Median number of sexual partners.
g Number of surveyed people (not all sexually active).
h Data from the Analysis on Sexual Behaviour in France (ACSF).
i Data pertain to women attending a sample of gyneacologists in Berlin.
j Data from the Survey performed in the Federal Republic of Germany (before reunification).
k Data from "every man/woman who presents herself as heterosexual"; all partners are included.
l Data pertain to heterosexual members from 12 social networks.
m Weighted data based on national age distributions for Ireland, the Netherlands and Russia.
n Number of heterosexual partners among surveyed (not all sexually active).
o Data pertain to students attending student health units in three high education institutions (two universities and one institute of education)
p Data pertain to Jewish adolescents.
q Data pertain to secondary schools students.
r Data pertain to students who reported regular sexual activity after their sexual debut.
s Data pertain to heterosexuals not living with a partner.
t Data pertain to heterosexuals married or living with a partner.
u Data pertain to women attending routine cervical cancer screening.
v Data pertain to population attending family planning centers or screening centers.
w Data pertain to high school students.
x Data pertain to university students.
y Data from the EPSS (Enquête téléphonique périodique sur la Prévention du VIH/sida en Suisse).
z Data from the ESS 2007 (Enquête Suisse sur la Santé). Some of the questions that were only included in the EPSS survey were also integrated into the Swiss Health Survey (ESS) in
2007. This allowes the documentation of these aspects also for people aged 46 to 74 years.
A The authors used the following formula to estimate the Number of lifetime partners in year 2000 in women aged 17-45 years= Number of lifetime partners - Number of new partners in
the last 5 years.
Table 33: Lifetime prevalence of anal intercourse among women in Europe

FEMALE
% among
Country Study Year/Period Birth cohort N surveyed N sexual active sexually active
Belgium Hubbert 1998a,b 1993 (1934-1978) - 631 20.0

Croatia Stulhofer 2009 2005 (1981-1987) 574 475 21.5
Stulhofer 2011 2010 (1985-1992) 495 - 29.8
Czech Rep. Brody 2011 c 1993 <=1978 - 542 16.6
Brody 2011 c 1998 <=1983 - 696 18.0
Brody 2011 c 2003 <=1988 - 799 17.4
Brody 2011 c 2008 <=1993 - 843 19.7
Estonia Part 2007d 2004-2005 (1987-1989) 194 90 7.2
Part 2007d 2004-2005 (1980-1987) 1068 908 25.1
Part 2007d 2004-2005 (1970-1980) 721 707 32.9
Part 2007d 2004-2005 (1960-1970) 689 680 24.7
Finland Hubbert 1998a 1991-1992 (1917-1974) - 570 23.0
France Bajos 2010 1970 <=1950 1375 - 15.0
Bajos 2010 1970 (1941-1950) 1375 - 16.0


FEMALE
% among
Country Study Year/Period Birth cohort N surveyed N sexual active sexually active
Bajos 2010 1970 (1921-1940) 1375 - 14.0

Bajos 2010 1992 (1923-1974) 11098 - 28.1
Bajos 2010 1992 (1963-1972) 11098 - 23.8
Bajos 2010 1992 (1943-1962) 11098 - 30.3
Bajos 2010 2006 (1937-1988) 6824 - 40.8
Bajos 2010 2006 (1977-1986) 6824 - 36.8
Bajos 2010 2006 (1957-1976) 6824 - 42.5
Germany Hubbert 1998 e,a 1990 (1921-1972) - 856 15.5
Greece Hubbert 1998a 1990 (1941-1975) - 721 10.1
Ireland ISSHR 2006 c, f ,g 2004-2005 (1940-1987) 4253 - 8.0
ISSHR 2006 c, f ,g 2004-2005 (1980-1987) 1497 - 4.0
ISSHR 2006 c, f ,g 2004-2005 (1970-1980) 953 - 6.0
ISSHR 2006 c, f ,g 2004-2005 (1960-1970) 829 - 7.0
ISSHR 2006 c, f ,g 2004-2005 (1950-1960) 736 - 13.0
ISSHR 2006 c, f ,g 2004-2005 (1940-1950) 264 - 9.0
Montenegro Labovic 2011d 2009 (1985-1994) 544 194 16.4
Netherlands Bakker 2006h, f ,g 2005-2006 (1936-1987) 2046 1689 22.7
Hubbert 1998a,i 1989 (1939-1971) - 461 11.6
Slovenia Klavs 2009 1999-2001 (1975-1983) 312 - 19.6
Klavs 2009 1999-2001 (1950-1983) 864 - 22.3
Klavs 2009 1999-2001 (1965-1976) 213 - 30.6
Klavs 2009 1999-2001 (1950-1966) 339 - 18.3
Spain Faílde Garrido - - 1086 719 6.0
2008 j,g
Sweden Häggström- 2009 (1989-1994) 213 118 15.4
Nordin 2010k,d
Tyden 2012l,d 1999 - 333 - 27.0
Tyden 2012l,d 2004 - 315 - 32.0
Tyden 2012l,d 2009 - 350 - 39.0
UK Johnson 2001 c, f 1990-1991 (1946-1975) 7765 - 6.5
Johnson 2001 c, f 1999-2001 (1955-1985) 6399 - 11.3
Stone 2006 c,m 2003-2005 (1984-1990) 765 - 9.3
N: number of subjects;
a Data pertain to women in current steady heterosexual relationship.
b Proportion among women who ever practice receptive anal intercourse with current partner.
c Instead of number of women sexually active, this time was number of women who answered the question on anal intercourse.
d Proportion among surveyed women (not all sexually active).
e Data from the Survey performed in the Federal Republic of Germany (before reunification).
f Data pertain to heterosexual women.
g Proportion among women who ever practice receptive anal intercourse in the last 6 months.
h Data on anal intercourse was not provided by the authors but calculated from percentage of those that have never practice anal intercourse.
i Proportion among women who recently practice receptive anal intercourse with current partner.
j Data pertain to adolescents and young adults.
k Data pertain to high school students.
l Data pertain to university students.
m Data pertain to full and part time students.

7 HPV PREVENTIVE STRATEGIES - 157 -
7 HPV preventive strategies

It is established that well-organised cervical screening programmes or widespread good quality cytology can reduce cervical
cancer incidence and mortality. The introduction of HPV vaccination could also effectively reduce the burden of cervical cancer
in the coming decades. This section presents indicators on basic characteristics and performance of cervical cancer screening,
status of HPV vaccine licensure, and introduction in Europe.
7.1 Cervical cancer screening practices

Screening strategies differ between countries. Some countries have population-based programmes, where in each round of
screening women in the target population are individually identified and invited to attend screening. This type of programme
can be implemented nationwide or only in specific regions of the country. In opportunistic screening, invitations depend on
the individual’s decision or on encounters with health-care providers. The most frequent method for cervical cancer screening
is cytology, and there are alternative methods such as HPV DNA tests and visual inspection with acetic acid (VIA). VIA is
an alternative to cytology-based screening in low-resource settings (the ’see and treat’ approach). HPV DNA testing is being
introduced into some countries as an adjunct to cytology screening (’co-testing’) or as the primary screening test to be followed
by a secondary, more specific test, such as cytology.
Table 34: Cervical cancer screening policies in Europe
Country Availability Quality Active Main Demonstration Screening Screening

of cervical assurance invitation screening projects ages interval or
cancer structure to test used (years) frequency
screening and screeningγ for of
programmeα mandate primary screenings
to screening
supervise
and to
monitor
the
screening
processβ
Albania Yes No No Cytology Above 20 2-3 Years
Andorra Yes No No Cytology - -
Austria Yes No No Cytology Above 18 1 year
Belarus Yes No No Cytology Above 18 1 year
Belgium Yes No. Varies No Cytology 25-64 3 years
by region A
Bosnia & H. Yes YesB No Cytology 21-70 1 year
Bulgaria Yes No No Cytology 30-59 3 years
Croatia Yes Yes A,B No Cytology 25-64 3 years
Cyprus Yes No No Cytology 24-65 -
Czech Rep. Yes Yes No Cytology 25-60 1 year
Denmark Yes Yes A Yes Cytology 23-65 3 years
(ages
23-49), 5
years (ages
50-65)
Estonia Yes Yes A Yes Cytology 30-59 5 years
Finland Yes Yes A Yes Cytology 30-60 5 years
France Yes Yes A,B Yes Cytology 25-65 3 years
Germany Yes No No Cytology HPV test Above 20 1 year
Greece Yes No No Cytology Above 20 1 year
Hungary Yes Yes A Yes Cytology 25-65 3 years
Iceland Yes Yes Yes Cytology 20-69 2 years
(ages
20-39), 4
years (ages
40-69)
Ireland Yes Yes Yes Cytology 25-60 3 years
(ages
25-44), 5
years (ages
45-60)


to screening
supervise
and to
monitor
the
screening
processβ
Italy Yes Yes A,B Yes Cytology/HPV 25-64 3 years
test (Cytology),
5 years
(HPV test)
Latvia Yes Yes A,B Yes Cytology 25-70 3 years
Lithuania Yes Yes A,B Yes Cytology 25-60 3 years
Luxembourg Yes No No Cytology Above 15 1 year
Macedonia Yes No No Cytology 30-55 3 years
Malta Yes Yes Yes Cytology/HPV Above 25 Cytology
test (cytology), every 3
Above 30 years (ages
(HPV test) 25-50), VIA
every 5
years (above
50 years
old). HPV
test every 5
years
Moldova Yes No No Cytology Above 20 2 years
Monaco Yes - No Cytology 21-65 3 years
after 2
consecutive
annual
negative
tests
Montenegro Yes YesB No Cytology 25-64 3 years
Netherlands Yes Yes A Yes Cytology/HPV 30-60 5 years
test
Norway Yes Yes Yes Cytology 25-69 3 years
Poland Yes Yes A Yes Cytology 25-59 3 years
Portugal Yes Yes A Yes Cytology 25-64 3 years
Romania Yes Yes A,B Yes Cytology 25-64 5 years
Russia Yes No No Cytology Above 18 1 year
San Marino Yes - Yes Cytology/HPV 25-30 3 years
test (cytology), (cytology), 5
30-65 (HPV years (HPV
test) test)
Serbia Yes YesB Yes Cytology 25-65 3 years
Slovakia Yes No No Cytology 23-64 3 years
Slovenia Yes Yes Yes Cytology 20-64 3 years
Spain Yes No. Varies No. Varies Cytology/HPV 25-65 3 years
by region by region test (cytology), (cytology), 5
30-65 (HPV years (HPV
test) test)
Sweden Yes Yes A Yes Cytology 23-60 3 years
(ages
23-50), 5
years (ages
50-60)
Switzerland Yes No No Cytology Above 20 3 years


to screening
supervise
and to
monitor
the
screening
processβ
UK Yes Yes A Yes Cytology/HPV 25-64 3 years
test (ages
25-49), 5
years (ages
50-64)
Ukraine Yes No No Cytology 18-65 1 year
Data accessed on 31 Dec 2016.
A Information about performance indicators in organized and population-based cervical cancer screening programmes in European countries is found in the following document "Cancer
Screening in the European Union (2017). Report on the implementation of the Council: Recommendation on cancer screening. International Agency for Research on Cancer. European Com-
mission. January 2017. Available at: https://ec.europa.eu/health/sites/health/files/major_chronic_diseases/docs/2017_cancerscreening_2ndreportimplementation_
en.pdf."
B Implementation is in progress.
C To replace Pap-test by hrHPV DNA test as the primary screening instrument (starting in 2016).
D Screening program since 1968.
α Public national cervical cancer screening program in place (Cytology/VIA/HPV testing). Countries may have clinical guidelines or protocols, and cervical cancer screening services in a
private sector but without a public national program. Publicly mandat
β Self-reported quality assurance: Organised programmes provide for a national or regional team responsible for implementation and require providers to follow guidelines, rules, or standard
operating procedures. They also define a quality assurance structur
γ Self-reported active invitation or recruitment, as organised population-based programmes, identify and personally invite each eligible person in the target population to attend a given
round of screening.
Data sources:
Data sources are detailed at the country-specific report

7.2 HPV vaccination

7.2.1 HPV vaccine licensure and introduction
Figure 118: Status of HPV vaccination programmes in Europe

Data sources: Adapted from Bruni L, Diaz M, Barrionuevo-Rosas L, Herrero R, Bray F, Bosch FX, de Sanjosé S, Castellsagué X. Global estimates of human papillomavirus vaccination
coverage by region and income level: a pooled analysis. Lancet Glob Health. 2016 Jul;4(7):e453-63

Table 35: HPV vaccination policies for the female population in Europe
Routine Immunization
Country HPV vaccination programme Date of start
Albania No program -
Andorra National program 2014
Austria National program 2014
Belarus No program -
Belgium National program 2007
Bosnia and Herzegovina No program -
Bulgaria National program 2012
Croatia National program 2016
Cyprus National program 2016
Czech Republic National program 2012
Denmark National program 2009
Estonia No program -
Finland National program 2013
France National program 2007
Germany National program 2007
Greece National program 2008
Hungary National program 2014
Iceland National program 2011
Ireland National program 2010
Italy National program 2007
Latvia National program 2010
Liechtenstein National program 2008
Lithuania National program 2016
Luxembourg National program 2008
Malta National program 2012
Monaco National program 2011
Montenegro No program -
Netherlands National program 2010
Norway National program 2009
Poland No program -
Portugal National program 2008
Republic of Moldova Pilot -
Romania No program -
Russian Federation Partial program 2009
San Marino National program 2008
Serbia No program -
Slovakia National program 2014
Slovenia National program 2009
Spain National program 2007
Sweden National program 2010
Switzerland National program 2008
The former Yugoslav Republic of Macedonia National program 2009
Ukraine No program -
United Kingdom of Great Britain and Northern Ireland National program 2008
Data sources:
Adapted from Bruni L, Diaz M, Barrionuevo-Rosas L, Herrero R, Bray F, Bosch FX, de Sanjosé S, Castellsagué X. Global estimates of human papillomavirus vaccination coverage by region
and income level: a pooled analysis. Lancet Glob Health. 2016 Jul;4(7):e453-63

8 PROTECTIVE FACTORS FOR CERVICAL CANCER - 162 -
8 Protective factors for cervical cancer

Male circumcision and the use of condoms have shown a significant protective effect against HPV transmission.
Figure 119: Prevalence of male circumcision in Europe

Data from Demographic and Health Surveys (DHS) and other publications to categorise the country-wide prevalence of male circumcision as <20%, 20-80%, or >80%.
Please refer to country-specific reference(s) for full methodologies.
Data sources: Based on systematic reviews and meta-analysis performed by ICO. The ICO HPV Information Centre has updated data until August 2015. Reference publication: Albero G,
Sex Transm Dis. 2012 Feb;39(2):104-13.
For Albania: 2008 Demographic and Health Surveys (DHS) | Drain PK, BMC Infect Dis 2006; 6: 172 | WHO 2007: Male circumcision: Global trends and determinants of prevalence, safety
and acceptability
Austria, Belarus, Switzerland, Cyprus, Czech Republic, Estonia, Finland, France, Greece, Hungary, Iceland, Italy, Lithuania, Latvia, Netherlands, Norway, Poland, Portugal, Slovakia,
Sweden: WHO 2007: Male circumcision: Global trends and determinants of prevalence, safety and acceptability
Belgium: Bronselaer GA, BJU Int 2013; 111: 820 | WHO 2007: Male circumcision: Global trends and determinants of prevalence, safety and acceptability
Bulgaria, Bosnia & Herzegovina, Macedonia, Montenegro, Romania, Russian Federation, Serbia: Drain PK, BMC Infect Dis 2006; 6: 172 | WHO 2007: Male circumcision: Global trends
and determinants of prevalence, safety and acceptability
Germany: Hoschke B, Urologe A 2013; 52: 562 | WHO 2007: Male circumcision: Global trends and determinants of prevalence, safety and acceptability
Denmark: Frisch M, BMJ 1995; 311: 1471 | Frisch M, J R Soc Med 2015; 108: 297 | Svare EI, Sex Transm Infect 2002; 78: 215 | WHO 2007: Male circumcision: Global trends and
determinants of prevalence, safety and acceptability
Spain: Canadas MP, Clin Microbiol Infect 2013; 19: 611 | Castellsagué X, Am J Epidemiol 2005; 162: 907 | WHO 2007: Male circumcision: Global trends and determinants of prevalence,
safety and acceptability
United Kingdom: Cathcart P, Br J Surg 2006; 93: 885 | Dave SS, Sex Transm Infect 2003; 79: 499 | Doerner R, Arch Sex Behav 2013; 42: 1319 | Oriel JD, Br J Vener Dis 1971; 47: 1 |
Rickwood AM, BMJ 2000; 321: 792 | Thornton AC, Sex Transm Dis 2011; 38: 928 | WHO 2007: Male circumcision: Global trends and determinants of prevalence, safety and acceptability
Ireland: Groves H, Ulster Med J 2010; 79: 80 | Ryan C, J Am Acad Dermatol 2015; 72: 978 | WHO 2007: Male circumcision: Global trends and determinants of prevalence, safety and
acceptability
Republic of Moldova: 2005 Demographic and Health Surveys (DHS) | Drain PK, BMC Infect Dis 2006; 6: 172 | WHO 2007: Male circumcision: Global trends and determinants of prevalence,
safety and acceptability
Slovenia: Klavs I, Sex Transm Infect 2008; 84: 49 | WHO 2007: Male circumcision: Global trends and determinants of prevalence, safety and acceptability
Ukraine: 2007 Demographic and Health Surveys (DHS) | Drain PK, BMC Infect Dis 2006; 6: 172 | WHO 2007: Male circumcision: Global trends and determinants of prevalence, safety
and acceptability

8 PROTECTIVE FACTORS FOR CERVICAL CANCER - 163 -
Figure 120: Prevalence of condom use in Europe

Condom use: Proportion of male partners who are using condoms with their female partners of reproductive age (15-49 years) to whom they are married or in union by country.
For United Kingdom: Excluding Northern Ireland.
Data sources: United Nations, Department of Economic and Social Affairs, Population Division (2016). World Contraceptive Use 2016 (POP/DB/CP/Rev2016). http://www.un.org/en/
development/desa/population/publications/dataset/contraception/wcu2016.shtml. Available at: [Accessed on March 22, 2017].
For Albania: Albania 2008-2009 Demographic and Health Survey
Austria: Austria 2012-2013 Generations and Gender Survey
Belgium: Belgium 2008-2010 Generations and Gender Survey
Bulgaria: Bulgaria 2007 Generations and Gender Survey Wave 2
Bosnia & Herzegovina: Bosnia and Herzegovina 2011-2012 Multiple Indicator Cluster Survey
Belarus: Belarus 2012 Multiple Indicator Cluster Survey
Switzerland: Switzerland 2012 Health Survey
Czech Republic: Czech Republic 2008 Generations and Gender Survey
Germany: Germany 2005 Generations and Gender Survey
Denmark: Denmark 1991-1993 Infertility Survey
Spain: Spain 2006 Fertility and Values Survey
Estonia: Estonia 2005 Gender and Generation Survey
Finland: Finland 1989-1990 Fertility and Family Survey
France: France 2010 Enquête Fecond
United Kingdom: United Kingdom 2008-2009 National Statistics Opinions Survey
Greece: Greece 2001 Family planning survey
Croatia: Croatia 1970 Yugoslavia Fertility Survey
Hungary: Hungary 1992-1993 Fertility and Family Survey
Ireland: Ireland 2004-2005 SSHR
Italy: Italy 1995-1996 Fertility and Family Survey
Lithuania: Lithuania 2006 Generations and Gender Survey
Latvia: Latvia 1995 Fertility and Family Survey
Republic of Moldova: Moldova 2012 Multiple Indicator Cluster Survey
Macedonia: The former Yugoslav Republic of Macedonia 2011 Multiple Indicator Cluster Survey
Malta: Malta 1993 Survey of Family Planning
Montenegro: Montenegro 2013 Multiple Indicator Cluster Survey
Netherlands: Netherlands 2013 Family Formation Survey
Norway: Norway 2005 Survey on Contraceptive Use
Poland: Poland 1991 Fertility and Family Survey
Portugal: Portugal 2014 Health Survey
Romania: Romania 2005 Generations and Gender Survey
Russian Federation: Russian Federation 2011 Reproductive Health Survey
Serbia: Serbia 2014 Multiple Indicator Cluster Survey
Slovakia: Slovakia 1997 Reproductive Practices of Slovak Women
Slovenia: Slovenia 1994-1995 Fertility and Family Survey
Sweden: Sweden 1996 National Survey on Sexual Behavior
Ukraine: Ukraine 2012 Multiple Indicator Cluster Survey

9 REFERENCES - 164 -
9 References
HPV-related statistics were gathered from specific databases created at the Institut Català d’Oncologia and the International Agency for
Research on Cancer.
Systematic collection of published literature from peer-reviewed journals is stored in these databases. Data correspond to results from
the following reference papers as well as updated results from continuous monitoring of the literature by the HPV Information Centre:
Table 36: References of studies included

Country Study
HPV prevalence and HPV type distribution for cytologically normal women
General sources Based on systematic reviews and meta-analysis performed by ICO. The ICO
HPV Information Centre has updated data until June 2014. Reference
publications: 1) Bruni L, J Infect Dis 2010; 202: 1789. 2) De Sanjosé S, Lancet
Infect Dis 2007; 7: 453
Europe
Belgium Arbyn M, Cancer Epidemiol Biomarkers Prev 2009; 18: 321 | Baay MF, Eur J
Cancer 2005; 41: 2704 | Baay MF, Eur J Gynaecol Oncol 2001; 22: 204 |
Depuydt CE, Br J Cancer 2003; 88: 560 | Depuydt CE, Gynecol Obstet Invest
2010; 70: 273 | Depuydt CE, J Clin Microbiol 2012; 50: 4073 | Merckx M, Eur J
Cancer Prev 2014; 23: 288 | Schmitt M, Int J Cancer 2013; 132: 2395 | Weyn C,
Cancer Epidemiol 2013; 37: 457
Belarus Rogovskaya SI, Vaccine 2013; 31 Suppl 7: H46
Switzerland Bigras G, Br J Cancer 2005; 93: 575
Czech Republic Tachezy R, PLoS ONE 2013; 8: e79156
Germany de Jonge M, Acta Cytol 2013; 57: 591 | Iftner T, J Med Virol 2010; 82: 1928 |
Luyten A, J Clin Virol 2009; 46 Suppl 3: S5 | Petry KU, Br J Cancer 2003; 88:
1570 | Schneider A, Int J Cancer 2000; 89: 529
Denmark Bonde J, BMC Infect Dis 2014; 14: 413 | Kjær SK, Cancer Causes Control 2014;
25: 179 | Nielsen A, Sex Transm Dis 2008; 35: 276 | Nielsen A, Sex Transm
Infect 2012; 88: 627 | Svare EI, Eur J Cancer 1998; 34: 1230
Spain Bernal M, Infect Agents Cancer 2008; 3: 8 | Castellsagué X, J Med Virol 2012;
84: 947 | de Sanjose S, Sex Transm Dis 2003; 30: 788 | Dillner J, BMJ 2008;
337: a1754 | González C, Sex Transm Infect 2006; 82: 260 | Martorell M, Scand
J Infect Dis 2010; 42: 549 | Muñoz N, Sex Transm Dis 1996; 23: 504 | Ortiz M, J
Clin Microbiol 2006; 44: 1428
Estonia Uusküla A, BMC Infect Dis 2010; 10: 63
Finland Auvinen E, Scand J Infect Dis 2005; 37: 873 | Leinonen M, Int J Cancer 2008;
123: 1344
France Baudu A, J Epidemiol Glob Health 2014; 4: 35 | Beby-Defaux A, J Med Virol
2004; 73: 262 | Boulanger JC, Gynecol Obstet Fertil 2004; 32: 218 | Casalegno
JS, Int J Gynaecol Obstet 2011; 114: 116 | Clavel C, Br J Cancer 2001; 84: 1616
| Dalstein V, Int J Cancer 2003; 106: 396 | Heard I, PLoS ONE 2013; 8: e79372
| Monsonego J, Gynecol Oncol 2005; 99: 160 | Monsonego J, Int J Cancer 2011;
129: 691 | Pannier-Stockman C, J Clin Virol 2008; 42: 353 | Riethmuller D,
Diagn Mol Pathol 1999; 8: 157 | Vaucel E, Arch Gynecol Obstet 2011; 284: 989
United Kingdom Cuschieri KS, J Clin Pathol 2004; 57: 68 | Cuzick J, Br J Cancer 1999; 81: 554 |
Cuzick J, Lancet 1995; 345: 1533 | Cuzick J, Lancet 2003; 362: 1871 | Grainge
MJ, Emerging Infect Dis 2005; 11: 1680 | Herbert A, J Fam Plann Reprod
Health Care 2007; 33: 171 | Hibbitts S, Br J Cancer 2008; 99: 1929 | Hibbitts S,
J Clin Virol 2014; 59: 109 | Howell-Jones R, Br J Cancer 2010; 103: 209 |
Kitchener HC, Br J Cancer 2006; 95: 56 | Peto J, Br J Cancer 2004; 91: 942
Greece Agorastos T, Eur J Cancer Prev 2004; 13: 145 | Agorastos T, Eur J Cancer Prev
2009; 18: 504 | Argyri E, BMC Infect Dis 2013; 13: 53 | Panotopoulou E, J Med
Virol 2007; 79: 1898 | Paraskevaidis E, Gynecol Oncol 2001; 82: 355 | Tsiodras
S, BMC Cancer 2010; 10: 53 | Tsiodras S, Clin Microbiol Infect 2011; 17: 1185
(Continued)

Table 36 – Continued
Country Study
Croatia Grahovac M, Coll Antropol 2007; 31 Suppl 2: 73 | Kaliterna V, Coll Antropol
2007; 31 Suppl 2: 79
Hungary Nyári T, Eur J Obstet Gynecol Reprod Biol 2006; 126: 246
Ireland Anderson L, J Med Virol 2013; 85: 295 | Keegan H, Br J Biomed Sci 2007; 64: 18
Italy Agarossi A, J Med Virol 2009; 81: 529 | Ammatuna P, Cancer Epidemiol
Biomarkers Prev 2008; 17: 2002 | Astori G, Virus Res 1997; 50: 57 | Carozzi F,
Br J Cancer 2000; 83: 1462 | Centurioni MG, BMC Infect Dis 2005; 5: 77 | Del
Prete R, J Clin Virol 2008; 42: 211 | Giambi C, BMC Infect Dis 2013; 13: 74 |
Giorgi Rossi P, Infect Agents Cancer 2011; 6: 2 | Masia G, Vaccine 2009; 27
Suppl 1: A11 | Panatto D, BMC Infect Dis 2013; 13: 575 | Piana A, BMC Public
Health 2011; 11: 785 | Ronco G, Eur J Cancer 2005; 41: 297 | Ronco G, J Natl
Cancer Inst 2006; 98: 765 | Ronco G, Lancet Oncol 2006; 7: 547 | Sammarco
ML, Eur J Obstet Gynecol Reprod Biol 2013; 168: 222 | Tenti P, J Infect Dis
1997; 176: 277 | Tornesello ML, J Gen Virol 2008; 89: 1380 | Tornesello ML, J
Med Virol 2006; 78: 1663 | Verteramo R, BMC Infect Dis 2009; 9: 16 |
Zappacosta B, New Microbiol 2009; 32: 351
Lithuania Gudleviciene Z, Medicina (Kaunas) 2005; 41: 910 | Kliucinskas M, Gynecol
Obstet Invest 2006; 62: 173 | Simanaviciene V, J Med Virol 2014
Latvia Silins I, Gynecol Oncol 2004; 93: 484
Netherlands Boers A, PLoS ONE 2014; 9: e101930 | Bulkmans NW, Int J Cancer 2004; 110:
94 | Hesselink AT, J Clin Microbiol 2013; 51: 2409 | Jacobs MV, Int J Cancer
2000; 87: 221 | Lenselink CH, PLoS ONE 2008; 3: e3743 | Rijkaart DC, Br J
Cancer 2012; 106: 975 | Rijkaart DC, Lancet Oncol 2012; 13: 78 | Rozendaal L,
J Clin Pathol 2000; 53: 606 | Zielinski GD, Br J Cancer 2001; 85: 398
Norway Gjøoen K, APMIS 1996; 104: 68 | Molden T, Cancer Epidemiol Biomarkers Prev
2005; 14: 367 | Molden T, Gynecol Oncol 2006; 100: 95 | Skjeldestad FE, Acta
Obstet Gynecol Scand 2008; 87: 81
Poland Bardin A, Eur J Cancer 2008; 44: 557
Portugal Dutra I, Infect Agents Cancer 2008; 3: 6 | Pista A, Clin Microbiol Infect 2011;
17: 941 | Pista A, Int J Gynecol Cancer 2011; 21: 1150 | Vieira L, Eur J
Microbiol Immunol (Bp) 2013; 3: 61
Romania Moga MA, Asian Pac J Cancer Prev 2014; 15: 6887 | Ursu RG, Virol J 2011; 8:
558
Russian Federation Alexandrova YN, Cancer Lett 1999; 145: 43 | Bdaizieva 2010: reported in De
Vuyst H, Vaccine 2013; 31 Suppl 5: F32 | Goncharevskaya 2011: reported in De
Vuyst H, Vaccine 2013; 31 Suppl 5: F32 | Komarova 2010: reported in De Vuyst
H, Vaccine 2013; 31 Suppl 5: F32 | Kubanov 2005: reported in De Vuyst H,
Vaccine 2013; 31 Suppl 5: F32 | Rogovskaya SI, Vaccine 2013; 31 Suppl 7: H46 |
Shargorodskaya 2011: reported in De Vuyst H, Vaccine 2013; 31 Suppl 5: F32 |
Shipitsyna E, Cancer Epidemiol 2011; 35: 160 | Shipulina 2011: reported in De
Vuyst H, Vaccine 2013; 31 Suppl 5: F32
Slovenia Ucakar V, J Med Virol 2014; 86: 1772 | Ucakar V, Vaccine 2012; 30: 116
Sweden Elfström KM, BMJ 2014; 348: g130 | Kjellberg L, Am J Obstet Gynecol 1998;
179: 1497 | Naucler P, N Engl J Med 2007; 357: 1589 | Stenvall H, Acta Derm
Venereol 2007; 87: 243 | Ylitalo N, Cancer Res 2000; 60: 6027
HPV type distribution for invasive cervical cancer (ICC)
General sources Based on meta-analysis performed by IARC’s Infections and Cancer
Epidemiology Group up to November 2011, the ICO HPV Information Centre
has updated data until June 2014. Reference publications: 1) Guan P, Int J
Cancer 2012;131:2349 2) Li N, Int J Cancer 2011;128:927 3) Smith JS, Int J
Cancer 2007;121:621 4) Clifford GM, Br J Cancer 2003;88:63 5) Clifford GM, Br
J Cancer 2003;89:101.
Europe
Austria Contributing studies: Bachtiary B, Int J Cancer 2002; 102: 237 | Widschwendter
A, Cancer Lett 2003; 202: 231
(Continued)

Country Study
Belgium Contributing studies: Baay MF, Eur J Gynaecol Oncol 2001; 22: 204
Bulgaria Contributing studies: Todorova I, J Clin Pathol 2010; 63: 1121
Bosnia & Herzegovina Contributing studies: Iljazovi? E, Cancer Epidemiol 2014; 38: 504
Belarus Contributing studies: Kulmala SM, J Med Virol 2007; 79: 771
Czech Republic Contributing studies: Slama J, Int J Gynecol Cancer 2009; 19: 703 | Tachezy R,
J Med Virol 1999; 58: 378 | Tachezy R, PLoS ONE 2011; 6: e21913
Germany Contributing studies: Bosch FX, J Natl Cancer Inst 1995; 87: 796 |
Milde-Langosch K, Int J Cancer 1995; 63: 639
Denmark Contributing studies: Hording U, APMIS 1997; 105: 313 | Kirschner B, Acta
Obstet Gynecol Scand 2013; 92: 1023 | Kjær SK, Cancer Causes Control 2014;
25: 179 | Sebbelov AM, Microbes Infect 2000; 2: 121
Spain Contributing studies: Alemany L, Gynecol Oncol 2012; 124: 512 | Bosch FX, J
Natl Cancer Inst 1995; 87: 796 | Darwich L, Int J Gynecol Cancer 2011; 21:
1486 | González-Bosquet E, Gynecol Oncol 2008; 111: 9 | Herraez-Hernandez E,
J Virol Methods 2013; 193: 9 | Martró E, Enferm Infecc Microbiol Clin 2012; 30:
225 | Mazarico E, Gynecol Oncol 2012; 125: 181 | Muñoz N, Int J Cancer 1992;
52: 743 | Rodriguez JA, Diagn Mol Pathol 1998; 7: 276
Finland Contributing studies: Iwasawa A, Cancer 1996; 77: 2275
France Contributing studies: de Cremoux P, Int J Cancer 2009; 124: 778 | Lombard I, J
Clin Oncol 1998; 16: 2613 | Prétet JL, Int J Cancer 2008; 122: 424 | Riou G,
Lancet 1990; 335: 1171
United Kingdom Contributing studies: Arends MJ, Hum Pathol 1993; 24: 432 | Crook T, Lancet
1992; 339: 1070 | Cuschieri K, Br J Cancer 2010; 102: 930 | Cuschieri K, Int J
Cancer 2014; 135: 2721 | Cuzick J, Br J Cancer 2000; 82: 1348 | Giannoudis A,
Int J Cancer 1999; 83: 66 | Howell-Jones R, Br J Cancer 2010; 103: 209 |
Mesher D, J Clin Pathol 2015; 68: 135 | Powell N, Int J Cancer 2009; 125: 2425
| Tawfik El-Mansi M, Int J Gynecol Cancer 2006; 16: 1025
Greece Contributing studies: Adamopoulou M, Anticancer Res 2009; 29: 3401 |
Dokianakis DN, Oncol Rep 1999; 6: 1327 | Koffa M, Int J Oncol 1994; 5: 189 |
Labropoulou V, Sex Transm Dis 1997; 24: 469 | Panotopoulou E, J Med Virol
2007; 79: 1898
Croatia Contributing studies: Dabic MM, Acta Obstet Gynecol Scand 2008; 87: 366 |
Hadzisejdic I, Coll Antropol 2006; 30: 879
Hungary Contributing studies: Kónya J, J Med Virol 1995; 46: 1
Ireland Contributing studies: Butler D, J Pathol 2000; 192: 502 | Fay J, J Med Virol
2009; 81: 897 | O’Leary JJ, J Clin Pathol 1998; 51: 576 | Skyldberg BM, Mod
Pathol 1999; 12: 675
Iceland Contributing studies: Sigurdsson K, Int J Cancer 2007; 121: 2682
Italy Contributing studies: Carozzi FM, Cancer Epidemiol Biomarkers Prev 2010; 19:
2389 | Ciotti M, Oncol Rep 2006; 15: 143 | Del Mistro A, Infect Agents Cancer
2006; 1: 9 | Gargiulo F, Virus Res 2007; 125: 176 | Garzetti GG, Cancer 1998;
82: 886 | Mariani L, BMC Cancer 2010; 10: 259 | Rolla M, Eur J Gynaecol Oncol
2009; 30: 557 | Sideri M, Vaccine 2009; 27 Suppl 1: A30 | Spinillo A, J Med
Virol 2014; 86: 1145 | Tornesello ML, Gynecol Oncol 2011; 121: 32 | Tornesello
ML, J Med Virol 2006; 78: 1663 | Voglino G, Pathologica 2000; 92: 516
Lithuania Contributing studies: Gudleviciene Z, Medicina (Kaunas) 2005; 41: 910 |
Simanaviciene V, J Med Virol 2014
Luxembourg Contributing studies: Ressler S, Clin Cancer Res 2007; 13: 7067
Latvia Contributing studies: Kulmala SM, J Med Virol 2007; 79: 771 | Silins I, Gynecol
Oncol 2004; 93: 484
(Continued)

Country Study
Netherlands Contributing studies: Baalbergen A, Gynecol Oncol 2013; 128: 530 | Baay MF, J
Clin Microbiol 1996; 34: 745 | Bulk S, Br J Cancer 2006; 94: 171 | De Boer MA,
Int J Cancer 2005; 114: 422 | Krul EJ, Int J Gynecol Cancer 1999; 9: 206 |
Resnick RM, J Natl Cancer Inst 1990; 82: 1477 | Tang N, J Clin Virol 2009; 45
Suppl 1: S25 | Van Den Brule AJ, Int J Cancer 1991; 48: 404 | Zielinski GD, J
Pathol 2003; 201: 535
Norway Contributing studies: Bertelsen BI, Virchows Arch 2006; 449: 141 | Karlsen F, J
Clin Microbiol 1996; 34: 2095
Poland Contributing studies: Baay MF, Eur J Gynaecol Oncol 2009; 30: 162 | Bardin A,
Eur J Cancer 2008; 44: 557 | Biesaga B, Folia Histochem Cytobiol 2012; 50: 239
| Bosch FX, J Natl Cancer Inst 1995; 87: 796 | Dybikowska A, Oncol Rep 2002;
9: 871 | Kwasniewska A, Eur J Gynaecol Oncol 2009; 30: 65 | Pirog EC, Am J
Pathol 2000; 157: 1055
Portugal Contributing studies: Medeiros R, Eur J Cancer Prev 2005; 14: 467 | Nobre RJ,
J Med Virol 2010; 82: 1024 | Pista A, Int J Gynecol Cancer 2013; 23: 500
Russian Federation Contributing studies: Kleter B, J Clin Microbiol 1999; 37: 2508 | Kulmala SM, J
Med Virol 2007; 79: 771
Slovenia Contributing studies: Jancar N, Eur J Obstet Gynecol Reprod Biol 2009; 145:
184
Sweden Contributing studies: Andersson S, Acta Obstet Gynecol Scand 2003; 82: 960 |
Andersson S, Cancer Detect Prev 2005; 29: 37 | Andersson S, Eur J Cancer
2001; 37: 246 | Du J, Acta Oncol 2011; 50: 1215 | Graflund M, Int J Gynecol
Cancer 2004; 14: 896 | Hagmar B, Med Oncol Tumor Pharmacother 1992; 9: 113
| Skyldberg BM, Mod Pathol 1999; 12: 675 | Wallin KL, N Engl J Med 1999;
341: 1633 | Zehbe I, J Pathol 1997; 181: 270
HPV type distribution for cervical high grade squamous intraepithelial lesions
Epidemiology Group up to November 2011, the ICO HPV Information Centre
has updated data until June 2015. Reference publications: 1) Guan P, Int J
Cancer 2012;131:2349 2) Smith JS, Int J Cancer 2007;121:621 3) Clifford GM, Br
J Cancer 2003;89:101.
Europe
Austria Contributing studies: Rössler L, Wien Klin Wochenschr 2013; 125: 591
Belgium Contributing studies: Arbyn M, Cancer Epidemiol Biomarkers Prev 2009; 18:
321 | Baay MF, Eur J Gynaecol Oncol 2001; 22: 204 | Beerens E, Cytopathology
2005; 16: 199 | Depuydt CE, Br J Cancer 2003; 88: 560
Switzerland Contributing studies: Dobec M, J Med Virol 2011; 83: 1370
Czech Republic Contributing studies: Tachezy R, PLoS ONE 2011; 6: e21913
Germany Contributing studies: de Jonge M, Acta Cytol 2013; 57: 591 | Klug SJ, J Med
Virol 2007; 79: 616 | Merkelbach-Bruse S, Diagn Mol Pathol 1999; 8: 32 | Meyer
T, Int J Gynecol Cancer 2001; 11: 198 | Nindl I, Int J Gynecol Pathol 1997; 16:
197 | Nindl I, J Clin Pathol 1999; 52: 17
Denmark Contributing studies: Bonde J, BMC Infect Dis 2014; 14: 413 | Hording U, Eur J
Obstet Gynecol Reprod Biol 1995; 62: 49 | Kirschner B, Acta Obstet Gynecol
Scand 2013; 92: 1032 | Kjaer SK, Int J Cancer 2008; 123: 1864 | Kjær SK,
Cancer Causes Control 2014; 25: 179 | Sebbelov AM, Res Virol 1994; 145: 83 |
Thomsen LT, Int J Cancer 2015; 137: 193
Spain Contributing studies: Bosch FX, Cancer Epidemiol Biomarkers Prev 1993; 2:
415 | Conesa-Zamora P, BMC Infect Dis 2009; 9: 124 | Darwich L, Int J Gynecol
Cancer 2011; 21: 1486 | de Méndez MT, Acta Cytol 2009; 53: 540 | de Oña M, J
Med Virol 2010; 82: 597 | García-Sierra N, J Clin Microbiol 2009; 47: 2165 |
Herraez-Hernandez E, J Virol Methods 2013; 193: 9 | Martín P, BMC Infect Dis
2011; 11: 316 | Muñoz N, Int J Cancer 1992; 52: 743
France Contributing studies: Monsonego J, Int J STD AIDS 2008; 19: 385 | Prétet JL,
Int J Cancer 2008; 122: 424 | Vaucel E, Arch Gynecol Obstet 2011; 284: 989
(Continued)

Country Study
United Kingdom Contributing studies: Anderson L, J Med Virol 2013; 85: 295 | Arends MJ, Hum
Pathol 1993; 24: 432 | Cuschieri KS, J Clin Pathol 2004; 57: 68 | Cuzick J, Br J
Cancer 1994; 69: 167 | Cuzick J, J Clin Virol 2014; 60: 44 | Geraets DT, J Clin
Microbiol 2014; 52: 3996 | Herrington CS, Br J Cancer 1995; 71: 206 | Hibbitts
S, Br J Cancer 2008; 99: 1929 | Howell-Jones R, Br J Cancer 2010; 103: 209 |
Jamison J, Cytopathology 2009; 20: 242 | Sargent A, Br J Cancer 2008; 98: 1704
| Southern SA, Diagn Mol Pathol 1998; 7: 114
Greece Contributing studies: Agorastos T, Eur J Obstet Gynecol Reprod Biol 2005; 121:
99 | Argyri E, BMC Infect Dis 2013; 13: 53 | Daponte A, J Clin Virol 2006; 36:
189 | Kroupis C, Epidemiol Infect 2007; 135: 943 | Labropoulou V, Sex Transm
Dis 1997; 24: 469 | Panotopoulou E, J Med Virol 2007; 79: 1898 | Paraskevaidis
E, Gynecol Oncol 2001; 82: 355 | Tsiodras S, Clin Microbiol Infect 2011; 17: 1185
Croatia Contributing studies: Grce M, Anticancer Res 2001; 21: 579 | Grce M, J Clin
Microbiol 2004; 42: 1341
Hungary Contributing studies: Szoke K, J Med Virol 2003; 71: 585
Ireland Contributing studies: Butler D, J Pathol 2000; 192: 502 | Keegan H, J Virol
Methods 2014; 201: 93 | Murphy N, J Clin Pathol 2003; 56: 56 | O’Leary JJ, J
Clin Pathol 1998; 51: 576
Iceland Contributing studies: Sigurdsson K, Int J Cancer 2007; 121: 2682
Italy Contributing studies: Agarossi A, J Med Virol 2009; 81: 529 | Capra G, Virus
Res 2008; 133: 195 | Carozzi F, J Clin Virol 2014; 60: 257 | Carozzi FM, Cancer
Epidemiol Biomarkers Prev 2010; 19: 2389 | Gargiulo F, Virus Res 2007; 125:
176 | Giorgi Rossi P, BMC Infect Dis 2010; 10: 214 | Laconi S, Pathologica 2000;
92: 524 | Sandri MT, J Med Virol 2009; 81: 271 | Spinillo A, J Med Virol 2014;
86: 1145 | Tornesello ML, J Med Virol 2006; 78: 1663 | Venturoli S, J Med Virol
2008; 80: 1434 | Zerbini M, J Clin Pathol 2001; 54: 377
Lithuania Contributing studies: Gudleviciene Z, Medicina (Kaunas) 2005; 41: 910 |
Simanaviciene V, J Med Virol 2014
Latvia Contributing studies: Kulmala SM, J Med Virol 2007; 79: 771
Netherlands Contributing studies: Bulkmans NW, Int J Cancer 2005; 117: 177 | Cornelissen
MT, Virchows Arch, B, Cell Pathol 1992; 62: 167 | Prinsen CF, BJOG 2007; 114:
951 | Reesink-Peters N, Eur J Obstet Gynecol Reprod Biol 2001; 98: 199 | Tang
N, J Clin Virol 2009; 45 Suppl 1: S25 | van Duin M, Int J Cancer 2003; 105: 577
Norway Contributing studies: Kraus I, Br J Cancer 2004; 90: 1407 | Molden T, Cancer
Epidemiol Biomarkers Prev 2005; 14: 367 | Roberts CC, J Clin Virol 2006; 36:
277 | Sjoeborg KD, Gynecol Oncol 2010; 118: 29
J Med Virol 2010; 82: 1024 | Pista A, Clin Microbiol Infect 2011; 17: 941 | Pista
A, Int J Gynecol Cancer 2013; 23: 500
Romania Contributing studies: Anton G, APMIS 2011; 119: 1 | Ursu RG, Virol J 2011; 8:
558
Russian Federation Contributing studies: Kulmala SM, J Med Virol 2007; 79: 771
Slovenia Contributing studies: Kovanda A, Acta Dermatovenerol Alp Pannonica Adriat
2009; 18: 47
Sweden Contributing studies: Andersson S, Br J Cancer 2005; 92: 2195 | Kalantari M,
Hum Pathol 1997; 28: 899 | Zehbe I, Virchows Arch 1996; 428: 151
HPV type distribution for cervical low grade squamous intraepithelial lesions
Epidemiology Group up to November 2011, the ICO HPV Information Centre has
updated data until June 2015. Reference publications: 1) Guan P, Int J Cancer
2012;131:2349 2) Clifford GM, Cancer Epidemiol Biomarkers Prev 2005;14:1157
(Continued)

Country Study
Europe
Belgium Contributing studies: Arbyn M, Cancer Epidemiol Biomarkers Prev 2009; 18:
321 | Baay MF, Eur J Gynaecol Oncol 2001; 22: 204 | Beerens E, Cytopathology
2005; 16: 199 | Depuydt CE, Br J Cancer 2003; 88: 560 | Weyn C, Cancer
Epidemiol 2013; 37: 457
Switzerland Contributing studies: Dobec M, J Med Virol 2011; 83: 1370
Czech Republic Contributing studies: Tachezy R, PLoS ONE 2011; 6: e21913
Germany Contributing studies: de Jonge M, Acta Cytol 2013; 57: 591 | Klug SJ, J Med
Virol 2007; 79: 616 | Merkelbach-Bruse S, Diagn Mol Pathol 1999; 8: 32 | Meyer
T, Int J Gynecol Cancer 2001; 11: 198 | Nindl I, J Clin Pathol 1999; 52: 17
Denmark Contributing studies: Hording U, Eur J Obstet Gynecol Reprod Biol 1995; 62: 49
| Kjaer SK, Int J Cancer 2008; 123: 1864 | Kjær SK, Cancer Causes Control
2014; 25: 179
Spain Contributing studies: Conesa-Zamora P, BMC Infect Dis 2009; 9: 124 | de
Méndez MT, Acta Cytol 2009; 53: 540 | de Oña M, J Med Virol 2010; 82: 597 |
Doménech-Peris A, Gynecol Obstet Invest 2010; 70: 113 | García-Sierra N, J
Clin Microbiol 2009; 47: 2165 | Herraez-Hernandez E, J Virol Methods 2013;
193: 9 | Martín P, BMC Infect Dis 2011; 11: 316
France Contributing studies: Bergeron C, Am J Surg Pathol 1992; 16: 641 | Humbey O,
Eur J Obstet Gynecol Reprod Biol 2002; 103: 60 | Monsonego J, Int J STD AIDS
2008; 19: 385 | Prétet JL, Gynecol Oncol 2008; 110: 179 | Vaucel E, Arch
Gynecol Obstet 2011; 284: 989
United Kingdom Contributing studies: Anderson L, J Med Virol 2013; 85: 295 | Arends MJ, Hum
Pathol 1993; 24: 432 | Cuschieri KS, J Clin Pathol 2004; 57: 68 | Cuzick J, Br J
Cancer 1994; 69: 167 | Cuzick J, Br J Cancer 1999; 81: 554 | Giannoudis A, Int
J Cancer 1999; 83: 66 | Hibbitts S, Br J Cancer 2008; 99: 1929 | Howell-Jones
R, Br J Cancer 2010; 103: 209 | Jamison J, Cytopathology 2009; 20: 242 |
Sargent A, Br J Cancer 2008; 98: 1704 | Southern SA, Hum Pathol 2001; 32:
1351 | Woo YL, Int J Cancer 2010; 126: 133
Greece Contributing studies: Adamopoulou M, Anticancer Res 2009; 29: 3401 | Argyri
E, BMC Infect Dis 2013; 13: 53 | Kroupis C, Epidemiol Infect 2007; 135: 943 |
Labropoulou V, Sex Transm Dis 1997; 24: 469 | Mammas IN, Oncol Rep 2008;
20: 141 | Panotopoulou E, J Med Virol 2007; 79: 1898 | Tsiodras S, Clin
Microbiol Infect 2011; 17: 1185
Croatia Contributing studies: Grce M, Anticancer Res 2001; 21: 579 | Grce M, Eur J
Epidemiol 1997; 13: 645 | Grce M, J Clin Microbiol 2004; 42: 1341
Ireland Contributing studies: Butler D, J Pathol 2000; 192: 502 | Keegan H, J Virol
Methods 2014; 201: 93 | Murphy N, J Clin Pathol 2003; 56: 56
Italy Contributing studies: Agarossi A, J Med Virol 2009; 81: 529 | Agodi A, Int J
Gynecol Cancer 2009; 19: 1094 | Astori G, Virus Res 1997; 50: 57 | Capra G,
Virus Res 2008; 133: 195 | Chironna M, J Prev Med Hyg 2010; 51: 139 |
Gargiulo F, Virus Res 2007; 125: 176 | Giorgi Rossi P, BMC Infect Dis 2010; 10:
214 | Laconi S, Pathologica 2000; 92: 524 | Menegazzi P, Infect Dis Obstet
Gynecol 2009; 2009: 198425 | Sandri MT, J Med Virol 2009; 81: 271 | Spinillo A,
Gynecol Oncol 2009; 113: 115 | Spinillo A, J Med Virol 2014; 86: 1145 |
Tornesello ML, J Med Virol 2006; 78: 1663 | Venturoli S, J Clin Virol 2002; 25:
177 | Venturoli S, J Med Virol 2008; 80: 1434 | Voglino G, Pathologica 2000; 92:
516 | Zerbini M, J Clin Pathol 2001; 54: 377
Lithuania Contributing studies: Gudleviciene Z, Medicina (Kaunas) 2005; 41: 910
Latvia Contributing studies: Kulmala SM, J Med Virol 2007; 79: 771
Netherlands Contributing studies: Bollen LJ, Am J Obstet Gynecol 1997; 177: 548 | Prinsen
CF, BJOG 2007; 114: 951 | Reesink-Peters N, Eur J Obstet Gynecol Reprod Biol
2001; 98: 199
Norway Contributing studies: Molden T, Cancer Epidemiol Biomarkers Prev 2005; 14:
367 | Roberts CC, J Clin Virol 2006; 36: 277
(Continued)

Country Study
J Med Virol 2010; 82: 1024
Romania Contributing studies: Anton G, APMIS 2011; 119: 1 | Ursu RG, Virol J 2011; 8:
558
Russian Federation Contributing studies: Kulmala SM, J Med Virol 2007; 79: 771
Sweden Contributing studies: Andersson S, Br J Cancer 2005; 92: 2195 |
Brismar-Wendel S, Br J Cancer 2009; 101: 511 | Kalantari M, Hum Pathol 1997;
28: 899 | Söderlund-Strand A, Am J Obstet Gynecol 2011; 205: 145.e1 | Zehbe I,
Virchows Arch 1996; 428: 151
HPV type distribution for invasive anal cancer
General sources 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 ICO HPV
Information Centre has updated data until June 2015. Reference publications: 1)
Bouvard V, Lancet Oncol 2009;10:321 2) De Vuyst H, Int J Cancer 2009;124:1626
Europe
Bosnia & Herzegovina Alemany L, Int J Cancer 2015; 136: 98
Czech Republic Alemany L, Int J Cancer 2015; 136: 98 | Tachezy R, PLoS ONE 2011; 6: e21913
Germany Alemany L, Int J Cancer 2015; 136: 98 | Rödel F, Int J Cancer 2015; 136: 278 |
Varnai AD, Int J Colorectal Dis 2006; 21: 135
Denmark Serup-Hansen E, J Clin Oncol 2014; 32: 1812
Spain Alemany L, Int J Cancer 2015; 136: 98
France Abramowitz L, Int J Cancer 2011; 129: 433 | Alemany L, Int J Cancer 2015;
136: 98 | Valmary-Degano S, Hum Pathol 2013; 44: 992 | Vincent-Salomon A,
Mod Pathol 1996; 9: 614
United Kingdom Alemany L, Int J Cancer 2015; 136: 98 | Baricevic I, Eur J Cancer 2015; 51: 776
Italy Indinnimeo M, J Exp Clin Cancer Res 1999; 18: 47
Poland Alemany L, Int J Cancer 2015; 136: 98
Portugal Alemany L, Int J Cancer 2015; 136: 98
Slovenia Alemany L, Int J Cancer 2015; 136: 98
Sweden Laytragoon-Lewin N, Anticancer Res 2007; 27: 4473
HPV type distribution for anal intraepithelial neoplasia (AIN)
Europe
Bosnia & Herzegovina Alemany L, Int J Cancer 2015; 136: 98
Czech Republic Alemany L, Int J Cancer 2015; 136: 98
Germany Alemany L, Int J Cancer 2015; 136: 98 | Hampl M, Obstet Gynecol 2006; 108:
1361 | Silling S, J Clin Virol 2012; 53: 325 | Varnai AD, Int J Colorectal Dis
2006; 21: 135 | Wieland U, Arch Dermatol 2006; 142: 1438
Spain Alemany L, Int J Cancer 2015; 136: 98 | García-Espinosa B, Diagn Pathol 2013;
8: 204 | Sirera G, AIDS 2013; 27: 951 | Torres M, J Clin Microbiol 2013; 51:
3512
France Alemany L, Int J Cancer 2015; 136: 98
United Kingdom Alemany L, Int J Cancer 2015; 136: 98 | Fox PA, Sex Transm Infect 2005; 81:
142
Italy Tanzi E, Vaccine 2009; 27 Suppl 1: A17
Netherlands Richel O, J Infect Dis 2014; 210: 111
Poland Alemany L, Int J Cancer 2015; 136: 98
Portugal Alemany L, Int J Cancer 2015; 136: 98
Slovenia Alemany L, Int J Cancer 2015; 136: 98
(Continued)

Country Study
HPV type distribution for invasive vulvar cancer
Europe
Austria de Sanjosé S, Eur J Cancer 2013; 49: 3450
Bosnia & Herzegovina de Sanjosé S, Eur J Cancer 2013; 49: 3450
Belarus de Sanjosé S, Eur J Cancer 2013; 49: 3450
Czech Republic de Sanjosé S, Eur J Cancer 2013; 49: 3450 | Tachezy R, PLoS ONE 2011; 6:
e21913
Germany Choschzick M, Int J Gynecol Pathol 2011; 30: 497 | de Sanjosé S, Eur J Cancer
2013; 49: 3450 | Hampl M, Obstet Gynecol 2006; 108: 1361 | Milde-Langosch K,
Int J Cancer 1995; 63: 639 | Reuschenbach M, J Low Genit Tract Dis 2013; 17:
289 | Riethdorf S, Hum Pathol 2004; 35: 1477
Denmark Bryndorf T, Cytogenet Genome Res 2004; 106: 43 | Hørding U, Gynecol Oncol
1994; 52: 241 | Hørding U, Int J Cancer 1993; 55: 394 | Madsen BS, Int J
Cancer 2008; 122: 2827
Spain Alonso I, Gynecol Oncol 2011; 122: 509 | de Sanjosé S, Eur J Cancer 2013; 49:
3450 | Guerrero D, Int J Cancer 2011; 128: 2853 | Lerma E, Int J Gynecol
Pathol 1999; 18: 191
Finland Iwasawa A, Obstet Gynecol 1997; 89: 81
France de Sanjosé S, Eur J Cancer 2013; 49: 3450
United Kingdom Abdel-Hady ES, Cancer Res 2001; 61: 192 | de Sanjosé S, Eur J Cancer 2013; 49:
3450
Greece de Sanjosé S, Eur J Cancer 2013; 49: 3450
Italy Bonvicini F, J Med Virol 2005; 77: 102 | de Sanjosé S, Eur J Cancer 2013; 49:
3450
Netherlands Kagie MJ, Gynecol Oncol 1997; 67: 178 | Trietsch MD, Br J Cancer 2013; 109:
2259 | van de Nieuwenhof HP, Cancer Epidemiol Biomarkers Prev 2009; 18:
2061 | van der Avoort IA, Int J Gynecol Pathol 2006; 25: 22
Poland Bujko M, Acta Obstet Gynecol Scand 2012; 91: 391 | de Sanjosé S, Eur J Cancer
2013; 49: 3450 | Liss J, Ginekol Pol 1998; 69: 330
Portugal de Sanjosé S, Eur J Cancer 2013; 49: 3450
Sweden Larsson GL, Int J Gynecol Cancer 2012; 22: 1413 | Lindell G, Gynecol Oncol
2010; 117: 312
HPV type distribution for vulvar intraepithelial neoplasia (VIN)
Europe
Austria de Sanjosé S, Eur J Cancer 2013; 49: 3450
Bosnia & Herzegovina de Sanjosé S, Eur J Cancer 2013; 49: 3450
Belarus de Sanjosé S, Eur J Cancer 2013; 49: 3450
Czech Republic de Sanjosé S, Eur J Cancer 2013; 49: 3450 | Tachezy R, PLoS ONE 2011; 6:
e21913
Germany de Sanjosé S, Eur J Cancer 2013; 49: 3450 | Hampl M, Obstet Gynecol 2006;
108: 1361 | Riethdorf S, Hum Pathol 2004; 35: 1477
Denmark Junge J, APMIS 1995; 103: 501
Spain de Sanjosé S, Eur J Cancer 2013; 49: 3450 | Lerma E, Int J Gynecol Pathol
1999; 18: 191
France de Sanjosé S, Eur J Cancer 2013; 49: 3450
(Continued)

Country Study
United Kingdom Abdel-Hady ES, Cancer Res 2001; 61: 192 | Baldwin PJ, Clin Cancer Res 2003;
9: 5205 | Bryant D, J Med Virol 2011; 83: 1358 | Daayana S, Br J Cancer 2010;
102: 1129 | de Sanjosé S, Eur J Cancer 2013; 49: 3450 | Winters U, Clin Cancer
Res 2008; 14: 5292
Greece de Sanjosé S, Eur J Cancer 2013; 49: 3450 | Tsimplaki E, J Oncol 2012; 2012:
893275
Italy Bonvicini F, J Med Virol 2005; 77: 102 | de Sanjosé S, Eur J Cancer 2013; 49:
3450
Netherlands van Beurden M, Cancer 1995; 75: 2879 | van der Avoort IA, Int J Gynecol Pathol
2006; 25: 22 | van Esch EM, Int J Cancer 2014; 135: 830
Poland de Sanjosé S, Eur J Cancer 2013; 49: 3450
Portugal de Sanjosé S, Eur J Cancer 2013; 49: 3450
HPV type distribution for invasive vaginal cancer
Europe
Austria Alemany L, Eur J Cancer 2014; 50: 2846
Belarus Alemany L, Eur J Cancer 2014; 50: 2846
Czech Republic Alemany L, Eur J Cancer 2014; 50: 2846
Germany Alemany L, Eur J Cancer 2014; 50: 2846
Denmark Madsen BS, Int J Cancer 2008; 122: 2827
Spain Alemany L, Eur J Cancer 2014; 50: 2846 | Fuste V, Histopathology 2010; 57: 907
France Alemany L, Eur J Cancer 2014; 50: 2846
United Kingdom Alemany L, Eur J Cancer 2014; 50: 2846
Greece Alemany L, Eur J Cancer 2014; 50: 2846
Poland Alemany L, Eur J Cancer 2014; 50: 2846
Portugal Ferreira M, Mod Pathol 2008; 21: 968
Sweden Larsson GL, Gynecol Oncol 2013; 129: 406
HPV type distribution for vaginal intraepithelial neoplasia (VAIN)
Europe
Austria Alemany L, Eur J Cancer 2014; 50: 2846
Belarus Alemany L, Eur J Cancer 2014; 50: 2846
Czech Republic Alemany L, Eur J Cancer 2014; 50: 2846
Germany Alemany L, Eur J Cancer 2014; 50: 2846 | Hampl M, Obstet Gynecol 2006; 108:
1361
Spain Alemany L, Eur J Cancer 2014; 50: 2846
France Alemany L, Eur J Cancer 2014; 50: 2846
United Kingdom Alemany L, Eur J Cancer 2014; 50: 2846
Greece Alemany L, Eur J Cancer 2014; 50: 2846 | Tsimplaki E, J Oncol 2012; 2012:
893275
Italy Frega A, Cancer Lett 2007; 249: 235
Poland Alemany L, Eur J Cancer 2014; 50: 2846
HPV type distribution for invasive penile cancer
General sources The ICO HPV Information Centre has updated data until June 2015. Reference
publications (up to 2008): 1) Bouvard V, Lancet Oncol 2009;10:321 2)
Miralles-Guri C,J Clin Pathol 2009;62:870
(Continued)

Country Study
Europe
Austria Mannweiler S, J Am Acad Dermatol 2013; 69: 73
Belgium D’Hauwers KW, Vaccine 2012; 30: 6573
Germany Poetsch M, Virchows Arch 2011; 458: 221
Spain Ferrándiz-Pulido C, J Am Acad Dermatol 2013; 68: 73 | Guerrero D, BJU Int
2008; 102: 747 | Pascual A, Histol Histopathol 2007; 22: 177
France Humbey O, Eur J Cancer 2003; 39: 684 | Perceau G, Br J Dermatol 2003; 148:
934
United Kingdom Stankiewicz E, Histopathology 2011; 58: 433
Italy Barzon L, Am J Pathol 2014; 184: 3376 | Gentile V, Int J Immunopathol
Pharmacol 2006; 19: 209 | Tornesello ML, Cancer Lett 2008; 269: 159
Netherlands Heideman DA, J Clin Oncol 2007; 25: 4550
HPV type distribution for penile intraepithelial neoplasia (PEIN)
General sources The ICO HPV Information Centre has updated data until June 2014. Reference
publication (up to 2008): Bouvard V, Lancet Oncol 2009;10:321
Europe
Austria Mannweiler S, J Am Acad Dermatol 2013; 69: 73
Belgium D’Hauwers KW, Vaccine 2012; 30: 6573
Sweden Wikström A, J Eur Acad Dermatol Venereol 2012; 26: 325
The anogenital prevalence of HPV-DNA in men: HPV in men
General sources Based on published systematic reviews, the ICO HPV Information Centre has
updated data until October 2015. Reference publications: 1) Dunne EF, J Infect
Dis 2006; 194: 1044 2) Smith JS, J Adolesc Health 2011; 48: 540 3) Olesen TB,
Sex Transm Infect 2014; 90: 455 4) Hebnes JB, J Sex Med 2014; 11: 2630.
Europe
Germany Grussendorf-Conen EI, Arch Dermatol Res 1987; 279 Suppl: S73 | Vardas E, J
Infect Dis 2011; 203: 58
Denmark Hebnes JB, Sex Transm Dis 2015; 42: 463 | Kjaer SK, Cancer Epidemiol
Biomarkers Prev 2005; 14: 1528
Spain Franceschi S, Br J Cancer 2002; 86: 705 | Vardas E, J Infect Dis 2011; 203: 58
Finland Hippeläinen M, Sex Transm Dis 1993; 20: 321 | Kero K, J Sex Med 2011; 8: 2522
Croatia Grce M, Anticancer Res 1996; 16: 1039 | Vardas E, J Infect Dis 2011; 203: 58
Italy Lorenzon L, J Clin Virol 2014; 60: 264 | Nasca MR, Int J Dermatol 2006; 45: 681
Sweden Forslund O, J Clin Microbiol 1993; 31: 1975 | Kataoka A, J Med Virol 1991; 33:
159
The anogenital prevalence of HPV-DNA in men: HPV in special subgroups (HIV, MSM, etc)
General sources Based on published systematic reviews, the ICO HPV Information Centre has
updated data until October 2015. Reference publications: 1) Dunne EF, J Infect
Dis 2006; 194: 1044 2) Smith JS, J Adolesc Health 2011; 48: 540 3) Olesen TB,
Sex Transm Infect 2014; 90: 455 4) Hebnes JB, J Sex Med 2014; 11: 2630.
Europe
Germany Goldstone S, J Infect Dis 2011; 203: 66 | Schneider A, J Urol 1988; 140: 1431 |
Wieland U, Int J Med Microbiol 2015; 305: 689
Denmark Svare EI, Sex Transm Infect 2002; 78: 215
Spain Álvarez-Argüelles ME, PLoS ONE 2013; 8: 129 | Franceschi S, Br J Cancer
2002; 86: 705 | Goldstone S, J Infect Dis 2011; 203: 66 | Hidalgo-Tenorio C,
PLoS One 2015; 10: 120 | Sendagorta E, Dis Colon Rectum 2014; 57: 475 |
Sendagorta E, J Med Virol 2015; 87: 1397 | Torres M, J Clin Microbiol 2013; 51:
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France Aynaud O, Urology 2003; 61: 1098 | Damay A, J Med Virol 2010; 82: 592 |
Philibert P, J Clin Med 2014; 3: 1386 | Piketty C, Sex Transm Dis 2004; 31: 96
United Kingdom Bissett SL, J Med Virol 2011; 83: 1744 | Cuschieri K, J Med Virol 2011; 83: 1983
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1999; 75: 172
(Continued)

Country Study
Greece Hadjivassiliou M, Int J STD AIDS 2007; 18: 329
Croatia Goldstone S, J Infect Dis 2011; 203: 66
Ireland Sadlier C, HIV Med 2014; 15: 499
Italy Barzon L, J Med Virol 2010; 82: 1424 | Benevolo M, J Med Virol 2008; 80: 1275
| Chiarini F, Minerva Urol Nefrol 1998; 50: 225 | Della Torre G, Am J Pathol
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Acquir Immune Defic Syndr 2008; 47: 129 | Pierangeli A, AIDS 2008; 22: 1929 |
Sammarco ML, J Med Virol 2016; 88: 911
Netherlands Bleeker MC, J Am Acad Dermatol 2002; 47: 351 | Bleeker MC, Int J Cancer
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Sex Transm Dis 2003; 30: 639 | Van Doornum GJ, Genitourin Med 1994; 70: 240
| van Rijn VM, PLoS ONE 2014; 9: 133 | Vriend HJ, PLoS ONE 2013; 8: 130 |
Welling CA, Sex Transm Dis 2015; 42: 297
Russian Federation Wirtz AL, Euro Surveill 2015; 20: 23
Slovenia Golob B, Biomed Res Int 2014; 2014: 117 | Milosevic M, Cent Eur J Med 2010; 5:
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Sweden Kataoka A, J Med Virol 1991; 33: 159 | Löwhagen GB, Int J STD AIDS 1999; 10:
615 | Strand A, Genitourin Med 1993; 69: 446 | Voog E, Int J STD AIDS 1997;
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AIDS 2000; 11: 80
HPV prevalence and type distribution in oral specimens collected from healthy population
General sources Systematic review and meta-analysis was performed by ICO HPV Information
Centre until July 2012. Pubmed was searched using the keywords oral and
papillomavirus. Inclusion criteria: studies reporting oral HPV prevalence in
healthy population in Europe; n > 50. Exclusion criteria: focused only in children
or immunosuppressed population; not written in English; case-control studies;
commentaries and systematic reviews and studies that did not use HPV DNA
detection methods.
Europe
Denmark Eike A, Clin Otolaryngol 1995;20:171
Spain Cañadas MP, J Clin Microbiol 2004;42:1330
Finland Kero K, J Sex Med 2011;8:2522
Finland Kero K, Eur Urol 2012;62(6):1063-70
Finland Leimola-Virtanen R, Clin Infect Dis 1996;22:593
United Kingdom Kujan O, Oral Oncol 2006;42:810
Greece Lambropoulos AF, Eur J Oral Sci 1997;105:294
Italy Migaldi M, J Oral Pathol Med 2012;41:16
Italy Montaldo C, J Oral Pathol Med 2007;36:482
HPV prevalence and type distribution in invasive oral cavity squamous cell carcinoma
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publications: 1) Ndiaye C, Lancet Oncol 2014; 15: 1319 2) Kreimer AR, Cancer
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Europe
Belgium Duray A, Laryngoscope 2012; 122: 1558
Belarus Gudleviciene Z, J Med Virol 2014; 86: 531
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2014; 42: 1506 | Ostwald C, Med Microbiol Immunol 2003; 192: 145 | Weiss D,
Head Neck 2011; 33: 856
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Natl Cancer Inst 2003; 95: 1772 | Llamas-Martínez S, Anticancer Res 2008; 28:
3733
Finland Koskinen WJ, Int J Cancer 2003; 107: 401 | Mork J, N Engl J Med 2001; 344:
1125
(Continued)

Country Study
United Kingdom Lopes V, Oral Oncol 2011; 47: 698 | Snijders PJ, Int J Cancer 1996; 66: 464 |
Yeudall WA, J Gen Virol 1991; 72 ( Pt 1): 173
Greece Aggelopoulou EP, Anticancer Res 1999; 19: 1391 | Blioumi E, Oral Oncol 2014;
50: 840 | Romanitan M, Anticancer Res 2008; 28: 2077
Hungary Nemes JA, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 344 |
Szarka K, Oral Microbiol Immunol 2009; 24: 314
Ireland Herrero R, J Natl Cancer Inst 2003; 95: 1772
Italy Badaracco G, Anticancer Res 2000; 20: 1301 | Badaracco G, Oncol Rep 2007; 17:
931 | Herrero R, J Natl Cancer Inst 2003; 95: 1772 | Rittà M, Head Neck 2009;
31: 318 | Scapoli L, Mod Pathol 2009; 22: 366
Netherlands Braakhuis BJ, J Natl Cancer Inst 2004; 96: 998 | Cruz IB, Eur J Cancer, B, Oral
Oncol 1996; 32B: 55 | van Monsjou HS, Int J Cancer 2012; 130: 1806
Norway Matzow T, Acta Oncol 1998; 37: 73 | Mork J, N Engl J Med 2001; 344: 1125
Poland Herrero R, J Natl Cancer Inst 2003; 95: 1772 | Ribeiro KB, Int J Epidemiol
2011; 40: 489 | Snietura M, Pol J Pathol 2010; 61: 133
Romania Ribeiro KB, Int J Epidemiol 2011; 40: 489
Russian Federation Ribeiro KB, Int J Epidemiol 2011; 40: 489
Serbia Kozomara R, J Craniomaxillofac Surg 2005; 33: 342
Slovakia Ribeiro KB, Int J Epidemiol 2011; 40: 489
Slovenia Kansky AA, Acta Virol 2003; 47: 11
Sweden Dahlgren L, Int J Cancer 2004; 112: 1015 | Mork J, N Engl J Med 2001; 344:
1125 | Sand L, Anticancer Res 2000; 20: 1183
HPV prevalence and type distribution in invasive oropharyngeal squamous cell carcinoma
Europe
Switzerland Lindel K, Cancer 2001; 92: 805
Czech Republic Klozar J, Eur Arch Otorhinolaryngol 2008; 265 Suppl 1: S75 | Ribeiro KB, Int J
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Germany Andl T, Cancer Res 1998; 58: 5 | Hoffmann M, Acta Otolaryngol 1998; 118: 138
| Hoffmann M, Int J Cancer 2010; 127: 1595 | Holzinger D, Cancer Res 2012;
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Weiss D, Head Neck 2011; 33: 856 | Wittekindt C, Adv Otorhinolaryngol 2005;
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Spain Herrero R, J Natl Cancer Inst 2003; 95: 1772
Finland Jouhi L, Tumour Biol 2015; 36: 7755
France Charfi L, Cancer Lett 2008; 260: 72 | Fonmarty D, Eur Ann Otorhinolaryngol
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United Kingdom Anderson CE, J Clin Pathol 2007; 60: 439 | Conway C, J Mol Diagn 2012; 14:
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2015; 68: 849
Greece Romanitan M, Anticancer Res 2008; 28: 2077
Italy Boscolo-Rizzo P, J Cancer Res Clin Oncol 2009; 135: 559 | Herrero R, J Natl
Cancer Inst 2003; 95: 1772 | Licitra L, J Clin Oncol 2006; 24: 5630 | Rittà M,
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Netherlands Braakhuis BJ, J Natl Cancer Inst 2004; 96: 998 | Henneman R, Anticancer Res
2015; 35: 4015 | van Monsjou HS, Int J Cancer 2012; 130: 1806
Norway Hannisdal K, Acta Otolaryngol 2010; 130: 293
Poland Ribeiro KB, Int J Epidemiol 2011; 40: 489 | Snietura M, Pol J Pathol 2010; 61:
133 | Szkaradkiewicz A, Clin Exp Med 2002; 2: 137
(Continued)

Country Study
Sweden Attner P, Int J Cancer 2010; 126: 2879 | Dahlgren L, Int J Cancer 2004; 112:
1015 | Hammarstedt L, Int J Cancer 2006; 119: 2620 | Lindquist D, Anticancer
Res 2012; 32: 153 | Näsman A, Int J Cancer 2009; 125: 362
HPV prevalence and type distribution in invasive hypopharyngeal squamous cell carcinoma
Europe
Belgium Duray A, Int J Oncol 2011; 39: 51
Belarus Gudleviciene Z, J Med Virol 2014; 86: 531
Switzerland Adams V, Anticancer Res 1999; 19: 1
Czech Republic Ribeiro KB, Int J Epidemiol 2011; 40: 489
Germany Fischer M, Acta Otolaryngol 2003; 123: 752 | Hoffmann M, Acta Otolaryngol
1998; 118: 138 | Hoffmann M, Anticancer Res 2006; 26: 663 | Hoffmann M,
Oncol Rep 2009; 21: 809 | Kleist B, J Oral Pathol Med 2000; 29: 432 |
Klussmann JP, Cancer 2001; 92: 2875 | Krupar R, Eur Arch Otorhinolaryngol
2014; 271: 1737
Denmark Lindeberg H, Cancer Lett 1999; 146: 9
Spain Alvarez Alvarez I, Am J Otolaryngol 1997; 18: 375 | Pérez-Ayala M, Int J
Cancer 1990; 46: 8
Finland Koskinen WJ, Int J Cancer 2003; 107: 401 | Koskinen WJ, J Cancer Res Clin
Oncol 2007; 133: 673 | Mork J, N Engl J Med 2001; 344: 1125
France Fouret P, Arch Otolaryngol Head Neck Surg 1997; 123: 513
United Kingdom Anderson CE, J Clin Pathol 2007; 60: 439 | Conway C, J Mol Diagn 2012; 14:
104 | Salam M, Eur J Surg Oncol 1995; 21: 290 | Snijders PJ, Int J Cancer
1996; 66: 464
Greece Gorgoulis VG, Hum Pathol 1999; 30: 274 | Vlachtsis K, Eur Arch
Otorhinolaryngol 2005; 262: 890
Hungary Major T, J Clin Pathol 2005; 58: 51
Italy Azzimonti B, Histopathology 2004; 45: 560 | Badaracco G, Anticancer Res 2000;
20: 1301 | Badaracco G, Oncol Rep 2007; 17: 931 | Boscolo-Rizzo P, J Cancer
Res Clin Oncol 2009; 135: 559 | Cattani P, Clin Cancer Res 1998; 4: 2585 |
Gallo A, Otolaryngol Head Neck Surg 2009; 141: 276
Lithuania Gudleviciene Z, J Med Virol 2014; 86: 531 | Gudleviciene Z, Oncology 2009; 76:
205
Norway Koskinen WJ, J Cancer Res Clin Oncol 2007; 133: 673 | Lie ES, Acta
Otolaryngol 1996; 116: 900 | Mork J, N Engl J Med 2001; 344: 1125
Poland Morshed K, Eur Arch Otorhinolaryngol 2008; 265 Suppl 1: S89 | Ribeiro KB, Int
J Epidemiol 2011; 40: 489 | Snietura M, Eur Arch Otorhinolaryngol 2011; 268:
721
Slovenia Poljak M, Acta Otolaryngol Suppl 1997; 527: 66
Sweden Koskinen WJ, J Cancer Res Clin Oncol 2007; 133: 673 | Mork J, N Engl J Med
2001; 344: 1125
Sexual behaviour: Median age at first sexual intercourse
Albania Family Health International and Albanian Institute of Public Health. Albania
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Albania Demographic and Health Survey 2008-09. Tirana, Albania: Institute of
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(Continued)

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Austria Cibula D. Women’s contraceptive practices and sexual behaviour in Europe. Eur
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Belarus Syrjänen S, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J,
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New Independent States of the former Soviet Union. Sex Transm Dis. 2003
Sep;30(9):680-684.
Belgium Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
comparisons of national surveys. London: UCL Press; 1998.
Fronteira I, Oliveira da Silva M, Unzeitig V, Karro H, Temmerman M. Sexual
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Czech Republic Czech Statistical Office, WHO Collaboranting Center for Perinatal
Medicine/Institute for the Care of Mother and Child, Centers for Disease Control
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Centersfor Disease Control and Prevention, Atlanta, Georgia. March 1995.
Crochard A, Luyts D, di Nicola S, Gonçalves MAG. Self-reported sexual debut
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Denmark Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Jensen KE, Munk C, Sparen P, Tryggvadottir L, Liaw K-L, Dasbach E, et al.
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Estonia Part K, Laanpere M, Rahu K, Haldre K, Rahu M, Karro H. Estonian women’s
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Finland Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
France Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Beltzer N, Lagarde M, Wu-Zhou X, Vongmany N, Grémy I. Les connaissances,
attitudes, croyances et comportements face au VIH/sida en France -Evolutions
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Bajos N, Boson M, Beltzer N, Laborde C, Andro A, Ferrand M, et al. Changes in
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Germany Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
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Chlamydia trachomatis infections in German female urban adolescents, 2004.
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Greece Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Tsitsika A, Greydanus D, Konstantoulaki E, Bountziouka V, Deligiannis I,
Dimitrakopoulou V, Critselis E, Tounissidou D, Tsolia M, Papaevagelou V,
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Iceland Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Bender SS. Attitudes of Icelandic Young People Toward Sexual and Reproductive
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Ireland Layte R, McGee H, Quail A, Rundle K, Cousins G, Donnelly C et al. The Irish
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O’Connell E, Brennan W, Cormican M, Glacken M, O’Donovan D, Vellinga A,
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Italy Signorelli C, Pasquarella C, Limina RM, Colzani E, Fanti M, Cielo A, et al. Third
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(Continued)

Country Study
Panatto D, Amicizia D, Trucchi C, Casabona F, Lai PL, Bonanni P, Boccalini S,
Bechini A, Tiscione E, Zotti CM, Coppola RC, Masia G, Meloni A, Castiglia P,
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Latvia Syrjänen S, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J,
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Portugal Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
(Continued)

Country Study
Ferreira MM, Torgal MC. Estilos de vida na adolescência: comportamento sexual
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Russian Federation Syrjänen S, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J,
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Serbia Delva W, Wuillaume F, Vansteelandt S, Claeys P, Verstraelen H, Temmerman M.
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Spain Suarez Cardona M. Encuesta de Salud y Habitos Sexuales 2003. Informe
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de Sanjosé, Cortés X, Méndez C, Puig-Tintore L, Torné A, Roura E, Bosch FX,
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(Continued)

Country Study
Sweden Priebe G, Svedin CG. Prevalence, characteristics, and associations of sexual
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Switzerland Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
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Turkey Hacettepe University, Institute of Population Studies, Ankara, Turkey and
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Ukraine Ukrainian Center for Social Reforms (UCSR), State Statistical Committee (SSC)
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2008. Ukraine Demographic and Health Survey 2007. Calverton, Maryland,
USA: UCSR and Macro International.
UK of Great Britain and Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Northern Ireland comparisons of national surveys. London: UCL Press; 1998.
Wellings K, Nanchahal K, Macdowall W, McManus S, Erens B, Mercer CH,
Johnson AM, Copas AJ, Korovessis C, Fenton KA, Field J. Sexual behaviour in
Britain: early heterosexual experience. Lancet. 2001 Dec 1;358(9296):1843-50.
Sexual behaviour: 15-year-olds who have had sex

Currie C, Nic Gabhainn S, Godeau E, Roberts C, Smith R, Currie D, Pickett W, Richter M, Morgan A &
Barnekow V (eds.) (2008) Inequalities in young people’s health HBSC international report from the 2005/06
Survey. Health Policy for Children and Adolescents, No. 5, WHO Regional Office for Europe, Copenhagen,
Denmark. Available at: http//www.euro.who.int/en/what-we-do/health-topics/Life-stages/
child-and-adolescent-health/publications2/2011/inequalities-in-young-peoples-health.
-hbsc-international-report-from-the-20052006-survey
Sexual behaviour: Marriage patterns

UN 2009 United Nations, Department of Economic and Social Affairs, Population Division (2009). World
Marriage Data 2008 (POP/DB/Marr/Rev2008). Available at:
http//www.un.org/esa/population/publications/WMD2008/Main.html
Sexual behaviour: Average N sexual partners

Albania Institute of Statistics, Institute of Public Health [Albania] and ICF Macro. 2010.
Albania Demographic and Health Survey 2008-09. Tirana, Albania: Institute of
Statistics, Institute of Public Health and ICF Macro.
Belarus Syrjänen S, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J,
Sep;30(9):680-684.
Check Republic Crochard A, Luyts D, di Nicola S, Gonçalves MA. Self-reported sexual debut and
behavior in young adults aged 18-24 years in seven European countries:
implications for HPV vaccination programs.Gynecol Oncol. 2009 Dec;115(3
Suppl):S7-S14.
(Continued)

Country Study
Denmark Kjaer SK, Tran TN, Sparen P, Tryggvadottir L, Munk C, Dasbach E, et al. The
burden of genital warts: a study of nearly 70,000 women from the general female
population in the 4 Nordic countries. J. Infect. Dis. 2007 nov 15;196(10):1447-54.
Buttmann N, Nielsen A, Munk C, Liaw KL, Kjaer SK. Sexual risk taking
behaviour: prevalence and associated factors. A population-based study of
22,000 Danish men. BMC Public Health. 2011 Oct 5;11:764.
Estonia Lõhmus L, Trummal A, Harro M. Knowledge, attitudes and behaviour related to
HIV/AIDS among Estonian youth. Tallinn: National Institute for Health
Development; 2003.
Part K, Laanpere M, Rahu K, Haldre K, Rahu M, Karro H. Estonian women’s
France Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Suppl):S7-S14.
Bajos N, Bozon M, Beltzer N, Laborde C, Andro A, Ferrand M, et al. Changes in
15;24(8):1185-91.
Germany Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in
Europe:comparisons of national surveys. London: UCL Press; 1998.
Griesinger G, Gille G, Klapp C, von Otte S, Diedrich K. Sexual behaviour and
Chlamydia trachomatis infections in German female urban adolescents, 2004.
Clin. Microbiol. Infect. 2007 abr;13(4):436-9.
Kordoutis PS, Loumakou M, Sarafidou JO. Heterosexual relationship
characteristics, condom use and safe sex practices. AIDS Care. 2000
Dec;12(6):767-82.
Hungary Takacs J, Amirkhanian YA, Kelly JA, Kirsanova AV, Khoursine RA, Mocsonaki
L. Condoms are reliable but I am not: A qualitative analysis of AIDS-related
beliefs and attitudes of young heterosexual adults in Budapest, Hungary, and St.
Petersburg, Russia. Cent Eur J Public Health. 2006 Jun;14(2):59-66.
Iceland Ljaer SK, Tran TN, Sparen P, Tryggvadottir L, Munk C, Dasbach E, et al. The
the Department of Health and Children, 2006. Ref Type: Report
Crochard A, Luyts D, di Nicola S, Gonçalves MA. Self-reported sexual debut and
Suppl):S7-S14.
O’Connell E, Brennan W, Cormican M, Glacken M, O’Donovan D, Vellinga A,
Cahill N, Lysaght F, O’Donnell J. Chlamydia trachomatis infection and sexual
behaviour among female students attending higher education in the Republic of
Ireland. BMC Public Health. 2009 Oct 29;9:397.
Israel Ben-Zur H, Breznitz S, Wardi N, Berzon Y. Denial of HIV/AIDS and preventive
behaviour among Israeli adolescents. J Adolesc. 2000 Apr;23(2):157-74.
Chemtob D, Damelin B, Bessudo-Manor N, Hassman R, Amikam Y, Zenilman
JM, Tamir D. Getting AIDS: not in my back yard. Results from a national
knowledge, attitudes and practices survey. Isr Med Assoc J. 2006 Sep;8(9):610-4.
(Continued)

Country Study
Italy Crochard A, Luyts D, di Nicola S, Gonçalves MA. Self-reported sexual debut and
Suppl):S7-S14.
Panatto D, Amicizia D, Trucchi C, Casabona F, Lai PL, Bonanni P, Boccalini S,
Bechini A, Tiscione E, Zotti CM, Coppola RC, Masia G, Meloni A, Castiglia P,
Piana A, Gasparini R. Sexual behaviour and risk factors for the acquisition of
human papillomavirus infections in young people in Italy: suggestions for future
vaccination policies. BMC Public Health. 2012 Aug 7;12:623.
Latvia Syrjänen S, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J,
Sep;30(9):680-684.
Montenegro Labovic I, Terzic N, Strahinja R, Mugosa B, Lausevic D, Vratnica Z. HIV-related
Netherlands Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Suppl):S7-S14.
de Graaf H, Vanwesenbeeck I, Woertman L, Keijsers L, Meijer S, Meeus W.
Parental support and knowledge and adolescents’ sexual health: testing two
mediational models in a national Dutch sample. J Youth Adolesc. 2010
Feb;39(2):189-98.
Kuyper L, Vanwesenbeeck I. Examining sexual health differences between
lesbian, gay, bisexual, and heterosexual adults: the role of sociodemographics,
sexual behavior characteristics, and minority stress. J Sex Res. 2011
Mar;48(2-3):263-74.
Norway Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Træen B, Stigum H, Magnus P. Rapport fra seksualvaneundersøkelsene i 1987,
1992, 1987 og 2002. Nydalen, Folkehelseinstitutt, Divisjon Nasjonalt for
epidemiologi 2003. Ref Type: Report
Bakken IJ, Skjeldestad FE, Halvorsen TF, Thomassen T, Størvold G, Nordbø SA.
Chlamydia trachomatis among young Norwegian men: sexual behavior and
genitourinary symptoms. Sex Transm Dis. 2007 Apr;34(4):245-9.
Kjaer SK, Tran TN, Sparen P, Tryggvadottir L, Munk C, Dasbach E, et al. The
burden of genital warts: a stusy of nearly 70,000 women from the general female
Poland Crochard A, Luyts D, di Nicola S, Gonçalves MA. Self-reported sexual debut and
Suppl):S7-S14.
Portugal Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Republic of Moldova National Scientific and Applied Center for Preventive Medicine (NCPM)
[Moldova] and ORC Macro. 2006. Moldova Demographic and Health Survey
2005. Calverton, Maryland: National Scientific and Applied Center for
Preventive Medicine of the Ministry of Health and Social Protection and ORC
Macro.
Russian Federation Syrjänen S, Shabalova I, Petrovichev N, Kozachenko V, Zakharova T, Pajanidi J,
Sep;30(9):680-684.
(Continued)

Country Study
Takacs J, Amirkhanian YA, Kelly JA, Kirsanova AV, Khoursine RA, Mocsonaki
L. Condoms are reliable but I am not: A qualitative analysis of AIDS-related
beliefs and attitudes of young heterosexual adults in Budapest, Hungary, and St.
Petersburg, Russia. Cent Eur J Public Health. 2006 Jun;14(2):59-66.
Suppl):S7-S14.
Slovenia Klavs I, Rodrigues LC, Wellings K, Weiss HA, Hayes R. Sexual behaviour and
HIV/sexually transmitted infection risk behaviours in the general population of
Slovenia, a low HIV prevalence country in central Europe. Sex Transm Infect.
2009 Abr;85(2):132-8.
Spain Suarez Cardona M. Encuesta de Salud y Habitos Sexuales 2003. Informe
general. ISBN 10 84-260-3732-1. Madrid: Instituto Nacional de Estadística,
Ministerio de Sanidad y Consumo, 2006.
Vaccarella S, Franceschi S, Herrero R, Muñoz N, Snijders PJ, Clifford GM, Smith
JS, Lazcano-Ponce E, Sukvirach S, Shin HR, de Sanjosé S, Molano M, Matos E,
Ferreccio C, Anh PT, Thomas JO, Meijer CJ; IARC HPV Prevalence Surveys
Study Group. Sexual behavior, condom use, and human papillomavirus: pooled
analysis of the IARC human papillomavirus prevalence surveys. Cancer
Epidemiol Biomarkers Prev. 2006 Feb;15(2):326-33.
Gomez MA, Sola A, Cortés MJ, Mira JJ. Sexual behaviour and contraception in
people under the age of 20 in Alicante, Spain. Eur J Contracept Reprod Health
Care. 2007 Jun;12(2):125-30.
Castellsague X, Iftner T, Roura E, Vidart JA, Kjaer SK, Bosch FX, et al.
Prevalence and genotype distribution of human papillomavirus infection of the
cervix in Spain: the CLEOPATRE study. J Med Virol. 2012 Jun;84(6):947-56.
Sweden Långström N, Hanson RK. High Rates of Sexual Behavior in the General
Population: Correlates and Predictors. Arch Sex Behav. 2006 Feb;35(1):37-52.
Kjaer SK, Tran TN, Sparen P, Tryggvadottir L, Munk C, Dasbach E, et al. The
Tyden T, Palmqvist M, Larsson M. A repeated survey of sexual behavior among
female university students in Sweden. Acta Obstet Gynecol Scand. 2012
Feb;91(2):215-9.
Häggström-Nordin E, Borneskog C, Eriksson M, Tydén T. Sexual behaviour and
Switzerland Jeannin A, Meystre-Agustoni, Lociciro S, Dubois-Arber F. Système de suivi de la
stratégie de lutte contre le VIH/sida en Suisse : rapport de synthèse 2004-2008.
Lausanne : Institut universitaire de médecine sociale et préventive, 2009
(Raisons de santé, 155a). Version corrigée septembre 2010.
UK of Great Britain and Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Northern Ireland comparisons of national surveys. London: UCL Press; 1998.
Johnson AM, Mercer CH, Erens B, Copas AJ, McManus S, Wellings K, et al.
Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours.
Lancet. 2001 Dec 1;358(9296):1835-42.
Mercer CH, Copas AJ, Sonnenberg P, Johnson AM, McManus S, Erens B, Cassell
JA. Who has sex with whom? Characteristics of heterosexual partnerships
reported in a national probability survey and implications for STI risk.Int J
Epidemiol. 2009 Feb;38(1):206-14.
Almonte M, Silva Idos S, Asare A, Gilham C, Sargent A, Bailey A, Turner A,
Desai M, Kitchener HC, Peto J. Sexual behavior and HPV infection in British
women, by postal questionnaires and telephone interviews. J Med Virol. 2011
Jul;83(7):1238-46.
(Continued)

Country Study
Ukraine Ukrainian Center for Social Reforms (UCSR), State Statistical Committee (SSC)
[Ukraine], Ministry of Health (MOH) [Ukraine], and Macro International Inc.
2008. Ukraine Demographic and Health Survey 2007. Calverton, Maryland,
USA: UCSR and Macro International.
Sexual behaviour: Receptive anal intercourse

Croatia Stulhofer A, Graham C, Bozicevic I, Kufrin K, Ajdukovic D. An assessment of
HIV/STI vulnerability and related sexual risk-taking in a nationally
representative sample of young Croatian adults. Arch Sex Behav. 2009
Abr;38(2):209-25.
Stulhofer A, Bacak V. Is anal sex a marker for sexual risk-taking? Results from a
population-based study of young Croatian adults. Sex Health. 2011
Sep;8(3):384-9.
Czech Republic Brody S, Weiss P. Heterosexual anal intercourse: increasing prevalence, and
association with sexual dysfunction, bisexual behavior, and venereal disease
history. J Sex Marital Ther. 2011 Sep;37(4):298-306.
Estonia Part K, Laanpere M, Rahu K, Haldre K, Rahu M, Karro H. Estonian women’s
France Bajos N, Bozon M, Beltzer N, Laborde C, Andre A, Ferrand M, et al. Changes in
15;24(8):1185-91.
Finland Hubert M, Bajos N, Sandfort T. Sexual behavious and HIV/AIDS in Europe:
Germany Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
the Department of Health and Children, 2006. Ref Type: Report
Montenegro Labovic I, Terzic N, Strahinja R, Mugosa B, Lausevic D, Vratnica Z. HIV-related
Netherlands Bakker F, Vanwesenbeeck I. (Eds.) (2006). Seksuele gerondheid in Nederland
2006. RNG-studies nr. 9. [Sexual health in the Netherlands 2006. RNG-studies
nr. 9.] Delft, The Netherlands: Eburon.
Hubert M, Bajos N, Sandfort T. Sexual behaviour and HIV/AIDS in Europe:
Slovenia Klavs I, Rodrigues LC, Wellings K, Weiss HA, Hayes R. Sexual behaviour and
HIV/sexually transmitted infection risk behaviours in the general population of
Slovenia, a low HIV prevalence country in central Europe. Sex Transm Infect.
2009 Abr;85(2):132-8.
Spain Faílde Garrido JM, Lameiras Fernández M, Bimbela Pedrola JL. Prácticas
sexuales de chicos y chicas españoles de 14-24 años de edad [Sexual behavior in
a Spanish sample aged 14 to 24 years old]. Gac Sanit. 2008 Nov-Dec;22(6):511-9;
discussion 519. Spanish.
Sweden Häggström-Nordin E, Borneskog C, Eriksson M, Tydén T. Sexual behaviour and
(Continued)

Country Study
Tyden T, Palmqvist M, Larsson M. A repeated survey of sexual behavior among
female university students in Sweden. Acta Obstet Gynecol Scand. 2012
Feb;91(2):215-9.
UK of Great Britain and Johnson AM, Mercer CH, Erens B, Copas AJ, McManus S, Wellings K, et al.
Northern Ireland Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours.
Lancet. 2001 Dec 1;358(9296):1835-42.
Stone N, Hatherall B, Ingham R, McEachran. J Oral sex and condom use among
young people in the United Kingdom. Perspect Sex Reprod Health. 2006
Mar;38(1):6-12.

10 GLOSSARY - 187 -
10 Glossary
Table 37: Glossary

Term Definition
Incidence Incidence is the number of new cases arising in a given period in a specified
population. This information is collected routinely by cancer registries. It can be
expressed as an absolute number of cases per year or as a rate per 100,000
persons per year (see Crude rate and ASR below). The rate provides an
approximation of the average risk of developing a cancer.
Mortality Mortality is the number of deaths occurring in a given period in a specified
population. It can be expressed as an absolute number of deaths per year or as a
rate per 100,000 persons per year.
Prevalence The prevalence of a particular cancer can be defined as the number of persons in
a defined population who have been diagnosed with that type of cancer, and who
are still alive at the end of a given year, the survivors. Complete prevalence
represents the number of persons alive at certain point in time who previously
had a diagnosis of the disease, regardless of how long ago the diagnosis was, or if
the patient is still under treatment or is considered cured. Partial prevalence ,
which limits the number of patients to those diagnosed during a fixed time in the
past, is a particularly useful measure of cancer burden. Prevalence of cancers
based on cases diagnosed within one, three and five are presented as they are
likely to be of relevance to the different stages of cancer therapy, namely, initial
treatment (one year), clinical follow-up (three years) and cure (five years).
Patients who are still alive five years after diagnosis are usually considered
cured since the death rates of such patients are similar to those in the general
population. There are exceptions, particularly breast cancer. Prevalence is
presented for the adult population only (ages 15 and over), and is available both
as numbers and as proportions per 100,000 persons.
Crude rate Data on incidence or mortality are often presented as rates. For a specific
tumour and population, a crude rate is calculated simply by dividing the number
of new cancers or cancer deaths observed during a given time period by the
corresponding number of person years in the population at risk. For cancer, the
result is usually expressed as an annual rate per 100,000 persons at risk.
ASR (age-standardised An age-standardised rate (ASR) is a summary measure of the rate that a
rate) population would have if it had a standard age structure. Standardization is
necessary when comparing several populations that differ with respect to age
because age has a powerful influence on the risk of cancer. The ASR is a
weighted mean of the age-specific rates; the weights are taken from population
distribution of the standard population. The most frequently used standard
population is the World Standard Population. The calculated incidence or
mortality rate is then called age-standardised incidence or mortality rate
(world). It is also expressed per 100,000. The world standard population used in
GLOBOCAN is as proposed by Segi [1] and modified by Doll and al. [2]. The
age-standardised rate is calculated using 10 age-groups. The result may be
slightly different from that computed using the same data categorised using the
traditional 5 year age bands.
Cumulative risk Cumulative incidence/mortality is the probability or risk of individuals
getting/dying from the disease during a specified period. For cancer, it is
expressed as the number of new born children (out of 100, or 1000) who would be
expected to develop/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.
Cytologically normal No abnormal cells are observed on the surface of their cervix upon cytology.
women
(Continued)

10 GLOSSARY - 188 -
Term Definition
Cervical Intraepithelial SIL and CIN are two commonly used terms to describe precancerous lesions or
Neoplasia (CIN) / the abnormal growth of squamous cells observed in the cervix. SIL is an
Squamous Intraepithelial abnormal result derived from cervical cytological screening or Pap smear testing.
Lesions (SIL) 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 Low-grade cervical lesions are defined by early changes in size, shape, and
(LSIL/CIN-1) number of ab-normal cells formed on the surface of the cervix and may be
referred to as mild dysplasia, LSIL, or CIN-1.
High-grade cervical High-grade cervical lesions are defined by a large number of precancerous cells
lesions (HSIL / CIN-2 / on the sur-face of the cervix that are distinctly different from normal cells. They
CIN-3 / CIS) 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 If the high-grade precancerous cells invade the basement membrane is called
(ICC) / Cervical cancer 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 Invasive carcinoma composed of cells resembling those of squamous epithelium
carcinoma
Adenocarcinoma Invasive tumour with glandular and squamous elements intermingled.
Eastern Europe References included in Belarus, Bulgaria, Czech Republic, Hungary, Poland,
Republic of Moldova, Romania, Russian Federation, Slovakia, and Ukraine.
Northern Europe References included in Denmark, Estonia, Finland, Iceland, Ireland, Latvia,
Lithuania, Norway, Sweden, and United Kingdom of Great Britain and Northern
Ireland.
Southern Europe References included in Albania, Bosnia and Herzegovina, Croatia, Greece, Italy,
Malta, Montenegro, Portugal, Serbia, Slovenia, Spain, The former Yugoslav
Republic of Macedonia.
Western Europe References included in Austria, Belgium, France, Germany, Liechtenstein,
Luxembourg, Netherlands, and Switzerland.
Europe PREHDICT References included in Albania, Austria, Belarus, Belgium, Bosnia and
Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,
Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy,
Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Montenegro,
Netherlands, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian
Federation, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, The former
Yugoslav Republic of Macedonia, Turkey, Ukraine, and United Kingdom of Great
Britain and Northern Ireland.

10 GLOSSARY - 189 -
Acknowledgments
This report has been developed by the Unit of Infections and Cancer, Cancer Epidemiology Research Program, at the Institut Català
d’Oncologia (ICO, Catalan Institute of Oncology) within the PREHDICT project (7th Framework Programme grant HEALTH-F3-2010-242061,
PREHDICT). The HPV Information Centre is being developed by the Institut Català d’Oncologia (ICO). The Centre was originally launched
by ICO with the collaboration of WHO’s Immunisation, Vaccines and Biologicals (IVB) department and support from the Bill and Melinda
Gates Foundation.
Institut Català d’Oncologia (ICO), in alphabetic order

Albero G, Barrionuevo-Rosas L, Bosch FX, Bruni L, de Sanjosé S, Gómez D, Mena M, Muñoz J, Serrano B.
7th Framework Programme grant PREHDICT project: health-economic modelling of PREvention strategies for Hpv-related Diseases
in European CounTries. Coordinated by Drs. Johannes Berkhof and Chris Meijer at VUMC, Vereniging Voor Christelijk Hoger Onderwijs
Wetenschappelijk Onderzoek En Patientenzorg, the Netherlands.
(http://cordis.europa.eu/projects/rcn/94423_en.html)
7th Framework Programme grant HPV AHEAD project: Role of human papillomavirus infection and other co-factors in the aetiol-
ogy of head and neck cancer in India and Europe. Coordinated by Dr. Massimo Tommasino at IARC, International Agency of Research on
Cancer, Lyon, France.
(http://cordis.europa.eu/project/rcn/100268_en.html)
International Agency for Research on Cancer (IARC)

- 190 -
Note to the reader

Anyone who is aware of relevant published data that may not have been included in the present report
is encouraged to contact the HPV Information Centre for potential contributions.
Although efforts have been made by the HPV Information Centre to prepare and include as accurately
as possible the data presented, mistakes may occur. Readers are requested to communicate any errors
to the HPV Information Centre, so that corrections can be made in future volumes.
Disclaimer
The information in this database is provided as a service to our users. Any digital or printed publica-
tion of the information provided in the web site should be accompanied by an acknowledgment of the
HPV Information Centre as the source. Systematic retrieval of data to create, directly or indirectly,
a scientific publication, collection, database, directory or website requires a permission from the HPV
Information Centre.
The responsibility for the interpretation and use of the material contained in the HPV Information
Centre lies on the user. In no event shall the HPV Information Centre be liable for any damages arising
from the use of the information.
Licensed Logo Use

Use, reproduction, copying, or redistribution of PREHDICT or HPV Information Centre logos are strictly
prohibited without explicit written permission from the HPV Information Centre.
Contact information:

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Table 2: Key statistics on Europe and its regions

ICO/IARC HPV Information Centre

2 Demographic and socioeconomic factors 3

3 Burden of HPV-related cancers 6

5 Factors contributing to cervical cancer 142

6 Sexual behaviour and reproductive health indicators 146

7 HPV preventive strategies 157

8 Protective factors for cervical cancer 162

ICO/IARC HPV Information Centre

ICO/IARC HPV Information Centre

60 Time trends in vaginal cancer incidence in Netherlands (cancer registry data) . . . . . . . . . . . . . . . . . . . . . 57

ICO/IARC HPV Information Centre

119 Prevalence of male circumcision in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162

ICO/IARC HPV Information Centre

ICO/IARC HPV Information Centre

Figure 1: European regions

ICO/IARC HPV Information Centre

ICO/IARC HPV Information Centre

2 Demographic and socioeconomic factors

Table 3: Population (in millions) estimates in Europe for 2017

Data accessed on 27 Mar 2017.

(Continued on next page)

ICO/IARC HPV Information Centre

( Table 3 – continued from previous page)

Figure 2: Population pyramid of Europe

80+ 12,889,798 24,231,287

Population (in thousands) in Europe by sex and age group

Data accessed on 27 Mar 2017.

Number of women (in millions)

400 All Women

Female population trends in Europe

Data accessed on 27 Mar 2017.

ICO/IARC HPV Information Centre

Table 4: Sociodemographic indicators in Europe

ICO/IARC HPV Information Centre

3 Burden of HPV-related cancers

About 61,072 new cervical cancer cases are diagnosed annually in

Cervical cancer ranks* as the 9 th leading cause of female cancer in Eu-

Eastern Europe 16.0

Northern Europe 9.5

Southern Europe 7.8

Western Europe 6.8

Data accessed on 05 Oct 2018.

ICO/IARC HPV Information Centre

( Figure 4 – continued from previous page)

Data accessed on 05 Oct 2018.

ICO/IARC HPV Information Centre

Cervical cancer: Age−standardised incidence rate per 100,0000 women

** No rates are available.

ICO/IARC HPV Information Centre

Table 5: Incidence of cervical cancer in Europe (estimates for 2018)

ICO/IARC HPV Information Centre

Data accessed on 07 Oct 2018.

ICO/IARC HPV Information Centre

Europe Southern Europe

Breast 74.4 Breast 80.3

Lung 18.3 Colon 15.9

Corpus uteri 15.8 Lung 15.7

Colon 15.3 Thyroid 14.5