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

Document Type : Systematic Review and Meta-analysis


1 Postgraduate Program in Bioscience and Physiopathology, State University of Maringa. Maringa, Parana, Brazil.

2 Postgraduate Program in Health Sciences, State University of Maringa. Maringa, Parana, Brazil.

3 Center of Medical and Pharmaceutical Sciences, State University of Western Parana, Cascavel, Parana, Brazil.

4 Laboratory LABCELL Diagnostic Cytology. Cascavel, Paraná, Brazil

5 Department of Clinical Analysis and Biomedicine, State University of Maringa, Maringa, Parana, Brazil.


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


Main Subjects