HPV (human papillomavirus) causes or contributes to six types of cancer: cervical, oropharyngeal (throat), anal, vaginal, vulvar, and penile. The CDC estimates that about 39,300 cancers each year in the United States are attributable to HPV, representing roughly 79% of all cancers found in body sites where the virus is commonly present.
The Six HPV-Related Cancers
HPV doesn’t cause cancer everywhere it infects. It targets specific tissues, and cancers in those locations are the ones linked to the virus. Here’s how they break down.
Oropharyngeal cancer is the most common HPV-related cancer by sheer numbers. About 22,585 cases are diagnosed each year in the back of the throat, base of the tongue, and tonsils, and roughly 70% of those (around 16,000 cases) are caused by HPV. This type is far more common in men than women.
Cervical cancer is the most tightly linked to HPV. About 91% of the roughly 12,287 cervical cancers diagnosed annually are caused by the virus, making it responsible for an estimated 11,100 cases per year. It’s also the most common HPV-related cancer in women specifically.
Anal cancer is caused by HPV in about 90% of cases. Vaginal and vulvar cancers are HPV-positive in roughly 70% of cases. Penile cancer has the lowest HPV attribution of the six, with about 60% of cases linked to the virus.
How HPV Turns Cells Into Cancer
Most HPV infections never become cancer. About 80% are cleared by the immune system within two years without causing any lasting harm. The remaining 20% can persist, and it’s persistent infection with high-risk HPV types that creates the danger.
When a high-risk strain sticks around, it produces two proteins that essentially disarm your cells’ built-in cancer defenses. One protein latches onto p53, a molecule your cells use to detect and repair DNA damage, and flags it for destruction. Without p53, damaged cells that would normally be repaired or killed off instead survive and keep dividing. The second protein disables another protective molecule called pRb, which normally acts as a brake on cell growth. With both safeguards knocked out, infected cells can accumulate genetic errors and multiply unchecked.
This process is slow. It typically takes 5 to 10 years for HPV-infected cervical cells to become precancerous, and roughly 20 years to progress to invasive cancer. Other HPV-related cancers follow similarly long timelines, often taking years or decades to develop.
Throat Cancer Has Overtaken Cervical Cancer
One of the most striking shifts in HPV-related cancer is what’s happened with oropharyngeal cancer. Throat cancers linked to HPV now outnumber cervical cancers in the United States, with an estimated 16,000 HPV-attributable throat cancers per year compared to 11,100 cervical cancers. This is partly because decades of Pap smear screening have driven down cervical cancer rates, while no equivalent screening test exists for the throat.
Oropharyngeal cancer symptoms can be subtle and easy to dismiss: a persistent sore throat, earaches, hoarseness, swollen lymph nodes, pain when swallowing, or unexplained weight loss. Some people have no symptoms at all, which means the cancer is often caught at a later stage. The overwhelming majority of HPV-positive throat cancers occur in men, making this a particularly important cancer for men to be aware of.
HPV Types That Matter Most
There are more than 200 types of HPV, but only a handful are considered high-risk for cancer. HPV types 16 and 18 are responsible for the largest share of HPV-related cancers across all six sites. HPV 16 alone drives the vast majority of HPV-positive oropharyngeal cancers and is the dominant type in cervical cancer as well. The current vaccine available in the United States, Gardasil 9, targets nine HPV types, including 16 and 18 along with seven other strains that contribute to cancer or genital warts.
Vaccination Is Already Reducing Cancer Rates
The HPV vaccine has been available since 2006, and the effects are now measurable. Cervical precancer rates among screened women aged 18 to 20 dropped by 50% between 2008 and 2015. Among women aged 21 to 24, the drop was 36%. The proportion of cervical lesions caused by the specific HPV types targeted by the vaccine has fallen by 40% in vaccinated women. Data from other countries are starting to show early reductions in actual cervical cancer cases, not just precancers.
The vaccine is most effective when given before any exposure to HPV, which is why it’s recommended starting at age 11 or 12. But it’s approved for people up to age 45, and even those who have already been infected with one HPV type can benefit from protection against the others.
Screening for HPV-Related Cancers
Cervical cancer is the only HPV-related cancer with a well-established screening program. The U.S. Preventive Services Task Force recommends Pap smears every three years for women aged 21 to 29. Starting at age 30 and continuing to 65, the preferred approach shifts to HPV testing alone every five years. This can be done through a clinician-collected or self-collected sample. Alternatively, women in this age range can opt for Pap smears every three years or a combination of HPV testing and Pap smear (cotesting) every five years.
For the other five cancer types, there are no routine screening tests recommended for the general population. Anal cancer screening with anal Pap smears is sometimes used for people at higher risk, such as those living with HIV, but it isn’t a standard recommendation for everyone. This gap in screening is one reason HPV-related cancers of the throat, anus, vulva, vagina, and penis are often caught later than cervical cancer.
Who Is Most at Risk
Since about 80% of sexually active people will contract HPV at some point, the virus itself is nearly universal. What separates those who develop cancer from those who don’t is whether the infection persists. A weakened immune system, including from HIV or immunosuppressive medications, makes clearance less likely. Smoking also impairs the body’s ability to fight off HPV and is an independent risk factor for cervical and oropharyngeal cancers.
Men who have sex with men face a significantly elevated risk of anal cancer. Unvaccinated individuals of any gender remain at higher risk simply because they lack antibody protection against the most dangerous HPV types. And because the timeline from infection to cancer stretches over decades, people in their 40s, 50s, and 60s who were infected long before the vaccine existed make up the bulk of current HPV-related cancer diagnoses.