The global landscape of HPV-associated cancers beyond the cervix: a comparative epidemiological analysis

Background Although cervical cancer remains the primary focus of HPV prevention, non-cervical HPV-associated cancers have attracted increasing attention in recent years. However, comparative global analyses examining patterns of cervical and non-cervical HPV-associated cancers remain limited. Methods Global Cancer Observatory data were used to estimate age-standardised incidence rates (ASIRs) of cervical cancer, female non-cervical HPV-associated cancers, and male HPV-associated cancers in 2022. Among females, relative burden patterns were characterised using country-specific ASIR ratios and quartile-based classification. Associations between incidence rate and Human Development Index (HDI) were evaluated. Temporal trends during 1998–2017 were analysed using joinpoint regression among 40 countries with data from Cancer Incidence in Five Continents Plus. Ecological analyses examined associations between years since HPV vaccine introduction into national immunisation programmes and incidence rates in 2022, and were further adjusted for HDI, with additional adjustment for cervical screening coverage in cervical cancer analyses. Results In 2022, 0.66 million cervical cancer cases and 0.26 million female non-cervical HPV-associated cancer cases occurred worldwide, while 0.58 million occurred among males. In 24 countries and territories, the ASIR of female non-cervical HPV-associated cancers exceeded that of cervical cancer. Cervical cancer incidence was inversely associated with HDI, whereas female non-cervical and male HPV-associated cancers showed positive associations, with nonlinear associations for cervical and female non-cervical cancers. Between 1998 and 2017, cervical cancer ASIR decreased in 23 of 40 countries, whereas female non-cervical HPV-associated cancers and male HPV-associated cancers increased in 23 and 13, respectively. The inverse association between years since HPV vaccine introduction and cervical cancer incidence was no longer significant after adjustment for screening coverage (β = −0.19, P = 0.537). The positive association with female non-cervical HPV-associated cancers was attenuated after adjustment for HDI (β = 0.11, P = 0.022). Conclusions Cervical cancer remains a major burden in low HDI countries, whereas several non-cervical HPV-associated cancers are increasingly prominent in higher HDI settings. Progress in cervical cancer prevention may support control of the broader HPV-associated cancer spectrum. Future strategies should be tailored to local contexts, with gender-neutral HPV vaccination considered where appropriate alongside integrated management of shared behavioural risk factors.