Changes in incidence of HPV-related cancers in South Africa (2011–21): a cross-sectional analysis of the South African National Cancer Registry
Understanding human papillomavirus (HPV)-related cancer epidemiology in South Africa is crucial for informing cancer prevention in this high-burden country. We aimed to describe HPV-related cancer incidence in South Africa between 2011 and 2021. For this cross-sectional study, we obtained data on cancer incidence from the South African National Cancer Registry and population estimates from Statistics South Africa. We calculated age-standardised incidence per 100 000 person-years for cervical carcinoma, and vulvar, vaginal, penile, oropharyngeal, and anal squamous cell carcinoma among people aged 15 years and older by sex, year, age, and race. Average annual percentage changes (AAPCs) were calculated using the Joinpoint Regression Program. Between Jan 1, 2011 and Dec 31, 2021, the overall cervical carcinoma incidence was 30·4 cases per 100 000 person-years (95% CI 30·2 to 30·6), which was highest in females aged 55-64 years (58·5 cases per 100 000 person-years [57·5 to 59·5]); incidence was stable between 2011 and 2016 and began to decline in 2016 (AAPC -2·7% [95% CI -10·8 to -0·2]). The incidence of vulvar squamous cell carcinoma (2·3 cases per 100 000 person-years [2·2 to 2·4]), vaginal squamous cell carcinoma (0·7 cases per 100 000 person-years [0·7 to 0·7]), and female-anal squamous cell carcinoma (0·6 cases per 100 000 person-years [0·6 to 0·7]) increased between 2011 and 2021 (AAPC 8·0% [95% CI 5·3 to 13·9] for vulvar squamous cell carcinoma; 3·2% [0·5 to 6·6] for vaginal squamous cell carcinoma; and 8·5% [2·0 to 23·2] for anal squamous cell carcinoma). The largest increase in vulvar squamous cell carcinoma between 2011 and 2021 was observed among females aged 15-44 years (AAPC 10·0% [8·2 to 13·4]) and 45-54 years (AAPC 10·7% [8·2 to 14·1]). The incidence of penile squamous cell carcinoma (1·4 cases per 10 000 person-years [1·3 to 1·4]) and anal squamous cell carcinoma in males (0·4 cases per 100 000 person-years [0·4 to 0·5]) increased between 2011 and 2021 (AAPC 6·9% [3·8 to 10·7] for penile squamous cell carcinoma; 9·3% [6·7 to 12·7] for anal squamous cell carcinoma). For both sexes, oropharyngeal squamous cell carcinoma trends were stable. The incidence of cervical carcinoma, vulvar squamous cell carcinoma, and vaginal squamous cell carcinoma was highest among Black females; penile squamous cell carcinoma was highest among Black males; anal squamous cell carcinoma in males was similar by race; and oropharyngeal squamous cell carcinoma was highest among White and Coloured individuals. The incidence of non-cervical anogenital cancers is rapidly increasing in South Africa. The incidence of most HPV-related cancers is high among Black individuals, especially for cervical and vulvar cancers, potentially due to disproportionately high HPV-HIV co-infection prevalence among young Black females. HIV prevention and continued HPV vaccination efforts are crucial for reducing HPV-driven cancers in the future. South African National Health Laboratory Services and US National Cancer Institute Intramural Research Program.