Dear Dr G,

I am a father of two boys who is keen to highlight the lack of awareness for cancers in men induced by HPV.

I have two teenage boys who are 13 and 14 years old. Both of them recently came home with HPV vaccination consent forms.

Initially, I found it amusing as I thought the boys had brought back the consent forms by mistake, since I assumed HPV only affects women.

As the boys explained to me that HPV-induced cancer is a serious condition that affects both boys and girls, I began to pay attention.

I realized HPV is so serious that it causes many types of cancers, including cancers that can affect men too.

I am not sure what I read is true and hope to put Dr G on the spot for clarification.

Can you tell me what HPV is and how it is transmitted?

What is the scale of HPV induced cancers affecting both men and women?

What sorts of cancers can HPV cause in men?

Can HPV affect different races differently?

Look forward to your valuable responses.

Yours truly,

Worried William

Human papillomavirus (HPV) is one of the most prevalent sexually transmitted infections globally and a well-established cause of multiple malignancies. It plays a significant role in the global cancer burden, contributing to approximately 690,000 cancer cases each year and accounting for about 4.5–5% of all cancers worldwide. HPV is unique among infectious carcinogens because of its widespread transmission and its ability to cause cancers in both women and men.

Cervical cancer represents the most significant manifestation of HPV-related disease and remains the cornerstone of its global impact. It is the fourth most common cancer among women worldwide, with an estimated 660,000 new cases and approximately 350,000 deaths annually.

More than 90% of cervical cancer cases are attributable to HPV infection, particularly high-risk types such as HPV 16 and HPV-18, which together account for about 70% of cases. The disease disproportionately affects women in low- and middle-income countries, where nearly 90% of deaths occur. The geographical distribution of cervical cancer reflects broader global health disparities. Regions such as sub-Saharan Africa, South Asia, and parts of Latin America bear the highest burden

This stark inequality is largely due to limited access to preventive measures such as HPV vaccination, regular screening through Pap smears or HPV testing, and treatment. In men, HPV-related cancers present a different epidemiological profile. Unlike women, men do not experience a single dominant cancer equivalent to cervical cancer. Instead, HPV contributes to cancers of the oropharynx, anus, and penis, with oropharyngeal cancer emerging as the most common HPV-related malignancy in men.

Although the overall number of HPV-related cancers in men is lower than in women, the incidence of certain cancers, particularly oropharyngeal cancer, has been increasing in many parts of the world. In some high-income countries, the incidence of HPV-related oropharyngeal cancer in men now surpasses that of cervical cancer in women.

The rising burden of HPV-related cancers in men can be attributed to several factors. Unlike cervical cancer, there are no widely implemented screening programs for HPV-related cancers in men, resulting in later detection and poorer outcomes. Additionally, HPV vaccination programs initially focused on girls, leading to lower vaccination coverage among males, particularly in older cohorts.

Behavioral factors, including changes in sexual practices, have also contributed to increased transmission of oral HPV infections. Studies indicate that approximately one in three men worldwide is infected with genital HPV, highlighting the widespread nature of the virus in the male population.

A comparison between HPV-related cancers in women and men reveals important differences in disease burden, prevention, and trends. Women bear a significantly higher overall burden due to the predominance of cervical cancer, but benefit from established screening programs that enable early detection and treatment. In contrast, men experience a lower overall burden but face increasing incidence rates of certain cancers, particularly oropharyngeal cancer, and lack comparable screening strategies.

As a result, while cervical cancer incidence is declining in many high-income settings, HPV-related cancers in men are rising, suggesting a potential convergence in disease burden between genders in the future.

Looking ahead, the global trajectory of HPV-related cancers will depend heavily on the implementation of effective prevention strategies. HPV vaccination has the potential to prevent more than 90% of HPV-related cancers caused by vaccine covered strains and represents a cornerstone of cancer prevention efforts. The World Health Organisation has set ambitious targets for the elimination of cervical cancer as a public health problem, emphasizing widespread vaccination, screening, and treatment.

However, achieving these goals will require addressing disparities in vaccine access and healthcare infrastructure, particularly in low and middle-income countries. Expanding vaccination programmes to include boys and improving awareness of HPV-related risks in men will also be critical in reducing the overall burden of disease.

HPV has a profound and multifaceted impact on global cancer epidemiology. Cervical cancer remains the dominant HPV-related malignancy, particularly affecting women in low-resource settings, while other HPV-related cancers, especially oropharyngeal cancers in men, are increasing in incidence. Without significant global efforts, the burden of HPV-related cancers is likely to rise, particularly in underserved populations.

Conversely, with comprehensive vaccination and screening strategies, there is a realistic opportunity to substantially reduce the most devastating consequences of HPV infection.

Malala Yousafzai famously said: “We cannot succeed when half of us are held back.”

Admittedly, this is in reference to discrimination against women. However, when HPV-induced malignancy indiscriminately affects both genders, awareness is crucial to ensure equity.

Men surprised by the fact HPV can cause cancer in them often put Dr G on the spot. His opinion is: “We cannot succeed in fighting cancer when anyone is held back by lack of knowledge!”