•

Persistent infection with high-risk types required for progression to

precancer and cancer

Peak incidence of precancers in late 20’s and of cancers in mid to late 40’s

Oropharynx

Average Number of New HPV-associated Cancers Overall, and by Sex, in the United States, 2005-2009

n=694

n=4771

n=1003 n=3039

n=694 n=3039 n=2317

n=3084

n=11279 n=9312

n=1687

n=1003

*In addition: Cervical disease and pre-invasive cancers: CIN1,2,3~ 1.4 million; AIN3~4300; VIN3~27,000,VAIN3~7600 (CDC, unpublished data)

Y axis scale is different for cervical cancer.

0.2

-2.5

-0.3

1.7

0.8

4.9

1.0

-1.6

3.9

Hispanic

AI/AN

API

Black

White

-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9

Males

FemalesOropharynx

0.7

1.6

2.5

3.7

0.9

2.1

5.6

2.6

Hispanic

AI/AN

API

Black

White

-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9

Anus

* *

*

*

*

* *

HPV attributable cancers = 26,000 cancers

HPV 16/18 attributable cancers= 21,000 cancers

2006 2007 2008 2009 2010 2011 2012

June October October

http://www.cdc.gov/vaccines/pubs/ACIP-list.htm

0

2

4

6

8

10

12

14

16

18

Pro

po

rtio

n w

ith

gen

ital

war

ts %

Half year

Resident women

73% decrease

in genital warts

Vaccine first introduced in Australia in 2006 (dashed line)

Tdap

MCV4

>1 dose HPV

(girls)

3 doses HPV

(girls)

Alabama

Arizona Arkansas

California Colorado

Connecticut

Delaware

Florida

Georgia

Idaho

Illinois Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

NebraskaNevada

NewHampshire

New Jersey

New Mexico

New York

North Carolina

North

Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South

Carolina

South

Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West

Virginia

Wisconsin

Wyoming

Alaska

Hawaii

Alaska

**

**

**

**

**

**

Perc

en

t

Response categories are not mutually exclusive

Among girls

unvaccinated for

HPV, 78% had a

missed opportunity

booster

3-dose series

1st dose

Annual immunization

1 dose

55

57

59

Perc

en

t

65

*p

67

68

69

Age-standardized incidence(per 100 000 women/year)

42 to 60 (12)39 to 42 (4)36 to 39 (4)33 to 36 (9)30 to 33 (6)27 to 30 (14)24 to 27 (9)21 to 24 (12)18 to 21 (12)15 to 18 (20)12 to 15 (16)9 to 12 (19)6 to 9 (23)3 to 6 (16)0 to 3 (6)

80% of cervical cancer deaths occur in developing countries

No (150 countries or 77%)

Yes (40 countries or 21%)

Yes (Part of the country) (4 countries or 2%)