Association between Human Papillomavirus and Non-cervical Genital Cancers in Brazil: A Systematic Review and Meta-Analysis

Abstract

Background: Human papillomavirus (HPV) infection is associated with cervical cancer; however, it is<br />controversial whether it is involved in non-cervical genital cancers. Objective: This study aimed to evaluate<br />articles on the prevalence of HPV in penile cancer, vulvar cancer, colorectal cancer, prostate cancer and anal<br />canal cancer in studies conducted in Brazil. Methods: The study was conducted in accordance with the Preferred<br />Reporting of Systematic Reviews and Meta-Analysis Statement. Comprehensive searches for HPV and cancer for<br />the years 2006 to 2016 were conducted in two databases (PubMed and Web of Knowledge) and Google Scholar<br />system. We also tracked the references of all eligible articles to identify additional non-captured publications through<br />online surveys. Results: Eighteen studies, with a combined sample size of 1,552 patients were analyzed. The overall<br />prevalence of HPV was 43% (95% CI: 36–51%; p < 0.001). The pooled prevalence of HPV in penile cancer was 42%<br />(95% CI: 32–55%; p < 0.001), in colorectal cancer it was 67% (95% CI: 64–70%; p < 0.001) and in vulvar cancer 43%<br />(95% CI: 34–55%; p < 0.001). HPV 16 was the most prevalent in all sites evaluated, with prevalence estimated at 54%<br />(95% CI: 44–66%; p < 0.001), followed by genotypes 33 (21%; 95% CI: 17–28; p < 0.001), 6 (15%; 95% CI: 8–26%;<br />p < 0.001), 11 (13%; 95% CI: 5–32%; p < 0.001) and 18 (12%; 95% CI: 7–22%; p < 0.001), respectively. The pooled<br />prevalence of single infection was 82% and infection by multiple genotypes of HPV was 22%. Conclusion: Our study<br />demonstrated a high prevalence of HPV in non-cervical genital cancers in Brazil, with predominance of genotype 16,<br />providing evidence for the need for preventive and control measures to avoid future harm to the population.