Elimination of HPV-associated cancers: universal HPV vaccination and the role of anal screening – a meeting report

Résumé

The HPV Prevention and Control Board convened its 18th technical meeting in Antwerp, Belgium (June 2025) to review the evidence on universal HPV vaccination and the role of anal cancer screening in the elimination of HPV-associated cancers. While HPV prevention has historically focused on cervical cancer in women, growing evidence supports extending both primary and secondary prevention to male cohorts and non-cervical anatomical sites. HPV causes approximately 148,072 cancer cases in men annually in the world - likely a substantial undercount - affecting primarily the oropharynx, anus, and penis. Men's lower seroconversion rates after natural HPV infection and sustained HPV prevalence across age groups makes vaccination an essential tool to prevent HPV-related disease in this population. Community-randomised trial evidence confirms that universal vaccination delivers stronger herd protection than girls-only strategies and may accelerate elimination of the most oncogenic types within 15-30 years. While modelling analyses identify high coverage in girls as the most efficient strategy for cervical cancer elimination, universal vaccination is justified on broader public health grounds, including equity, programme resilience, reduced vaccine hesitancy, and prevention of non-cervical cancers. Country experiences from Scotland and Cameroon highlight persistent equity gaps and the critical role of community engagement. Given the direct epidemiological link between HPV infection in males - particularly gay, bisexual, and other men who have sex with men and immunocompromised populations, such as people living with HIV - and anal cancer risk, the meeting identified anal cancer screening as the most advanced non-cervical secondary prevention strategy warranting immediate attention. The ANCHOR trial demonstrated that treating anal high-grade squamous intraepithelial lesions reduces anal cancer incidence by 57%. Despite the publication of the first evidence-based U.S. Health and Human Services and International Anal Neoplasia Society guidelines in 2024, implementation remains constrained by high-resolution anoscopy capacity, workforce shortages, stigma, and limited evidence on optimal screening algorithms. The meeting concluded that integrating universal vaccination with targeted anal cancer screening - supported by equitable access, biomarker development, and living guidelines that evolve with emerging evidence - is essential to reducing HPV-related cancer burden in both women and men.

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