Infection with genital warts is associated
with an increased risk of ano-genital cancers, malignancies of the head and
neck and cancers in some other sites, according to the results of a large
Danish study published in the online edition of the Journal of Infectious Diseases.
Many of these cancers were associated with
high-risk strains of human papilloma virus (HPV), and the risk of these cancers
remained elevated up to ten years after diagnosis with genital warts.
“Our findings indicate that patients with
genital warts belong to a high risk group in regard to subsequent HPV related
cancer,” write the authors. They believe their findings have implications for
HPV surveillance and vaccination programmes.
Genital warts are a common sexually
transmitted infection affecting millions of patients worldwide. They are caused
by HPV, most often HPV-6 and HPV-11, neither of which cause cell changes that
can lead to cancer. However, it is
common for patients to be infected with multiple strains of HPV, including those
which have been associated with an increased risk of cancer.
Previous studies examining the association
between genital warts and the risk of cancer have produced conflicting results.
To establish a clearer understanding of this issue, investigators from Denmark
examined the medical records of almost 50,000 patients diagnosed with genital
warts between 1978 and 2008. They calculated the incidence of anogenital
cancers in these patients as well as cancers of the head and neck and
malignancies in other sites. These incidences were compared to those observed
in the general Danish population cancer registry.
Over 16,000 men and 33,000 women were
diagnosed with genital warts in the 30 years of the study. The men were
followed for a mean of twelve years after diagnosis, the women for a mean of 13
The total number of cancers observed during
the study was 2362. This compared to an estimated 1807 cancers in the general
population. Overall, patients with genital warts were 30% more likely to
develop a cancer compared to individuals without this malignancy
This elevated risk was mainly attributable
to an increased incidence of cancers at HPV-related sites. This risk was higher
for men (SIR = 7.2; 95% CI, 5.5-9.2) than women (Standardised Incidence Ratio [SIR] = 2.8; 95% CI, 2.4-3.1).
A total of 29 cases of anal cancer were
diagnosed in men diagnosed with genital warts (SIR = 21.5; 95% CI, 14.4-30.9).
Men diagnosed with genital warts also had an increased risk of penile cancer
(SIR = 8.2; 95% CI, 4.1-14.6).
For women, diagnosis with genital warts was
associated with a substantial increase in the risk of cancer of the vulva (SIR
= 14.8; 95% CI, 11.7-18.6), followed by anal cancer (SIR = 7.8; 95% CI,
5.4-11.0), vaginal cancer (SIR = 5.9; 95% CI, 2.2-12.9) and cervical cancer
(SIR = 1.5; 95% CI, 1.3-1.8).
For both sexes, genital warts were
associated with an increased risk of cancers of the head and neck, especially
cancer of the tonsils (men, SIR = 4.6; 95% CI, 2.7-72; women, SIR = 4.7; 95%
CI, 2.3-8.4). An increased risk of cancers of the mouth, pharynx and larynx was
also observed in both sexes.
A diagnosis with genital warts was also
associated with the development of cancers at body sites not normally
associated with HPV-related cancers.
This included non-melanoma skin cancer, as
well as lung, liver and bladder cancer and Hodgkin and non-Hodgkin lymphoma.
The increased risk of many cancers
persisted for over ten years after diagnosis with genital warts.
The risk of developing cancer of the anus
or vulva was greatest in the first year after diagnosis with genital warts and
then fell gradually. However, ten years after diagnosis, the risk of most HPV-related
cancers was still moderately increased (SIR = 3.8; 95% CI, 0.8-11.0).
“We found significantly increased rates of
anogenital and certain head and neck cancers in individuals diagnosed with
genital warts,” write the authors. “For most HPV-related cancers, a sustained
excess risk was evident even 10 years after the genital warts diagnosis.”
The investigators offer several possible
explanations for the association between genital warts and an increase in the
risk of cancer. These include:
Infection with high-risk
strains of HPV.
Life-style factors such as
multiple sexual partners and smoking.
Localised immune suppression
They believe that further research is
needed into the association between genital warts and the risk of skin cancers.
“The results add to the evidence of a link
between HPV and ano-genital cancer, head and neck cancer and possibly
non-melanoma skin cancer,” conclude the authors. “This study is important to
clinicians in relation to the identification of cancers at an early stage…in
addition, the results may direct future studies of HPV DNA detection toward
different types of tumour and be valuable when estimating health benefits of