Human Papillomavirus Burden in Different Cancers in Iran: a Systematic Assessment

  • Jalilvand, Somayeh (Virology Department, School of Public Health, Tehran University of Medical Sciences) ;
  • Shoja, Zabihollah (Virology Department, Pasteur Institute of Iran) ;
  • Hamkar, Rasool (Virology Department, School of Public Health, Tehran University of Medical Sciences)
  • Published : 2014.09.15


Certain types of human papillomaviruses (HPVs) are undoubtedly involved in genesis of human malignancies. HPV plays an etiological role in cervical cancer, but also in many vaginal, vulvar, anal and penile cancers, as well as head and neck cancers. In addition, a number of non-malignant diseases such as genital warts and recurrent respiratory papillomatosis are attributable to HPV. Moreover, HPV forms have detected in several other cancers including esophageal squamous cell carcinoma, lung, prostate, ovarian, breast, skin, colorectal and urinary tract cancers, but associations with etiology in these cases is controversial. The aim of this systematic assessment was to estimate the prevalence of HPV infection and HPV types in HPV-associated cancers, HPV-related non-malignant diseases and in cancers that may be associated with HPV in Iran. The present investiagtion covered 61 studies on a variety of cancers in Iranian populations. HPV prevalence was 77.5 % and 32.4% in cervical cancer and head and neck cancers, respectively. HPV was detected in 23.1%, 22.2%, 10.4%, 30.9%, 14% and 25.2% of esophageal squamous cell, lung, prostate, urinary tract cancers, breast and skin cancers, respectively. HPV16 and 18 were the most frequent HPV types in all cancers. The findings of present study imply that current HPV vaccines for cervical cancer may decrease the burden of other cancers if they are really related to HPV.


Human papillomaviruses;prevalence;HPV types;cancer types;Iran


  1. Eslami G, Golshani M, RAKHSHAN M, et al (2008b). PCR detection and high risk typing of human papillomavirus DNA in cervical cancer in Iranian women. Cancer Therapy, 6, 361-6.
  2. Esmaeili M, Bonyadi M, Dastranj A, et al (2008). HPV typing in women with cervical precancerous and cancerous lesions in northwestern Iran. Gynecol Obstet Invest, 66, 68-72.
  3. Far AE, Aghakhani A, Hamkar R, et al (2007). Frequency of human papillomavirus infection in oesophageal squamous cell carcinoma in Iranian patients. Scand J Infect Dis, 39, 58-62.
  4. Farhadi M, Tahmasebi Z, Merat S, et al (2005). Human papillomavirus in squamous cell carcinoma of esophagus in a high-risk population. World J Gastroenterol, 11, 1200-3.
  5. Farjadian S, Asadi E, Doroudchi M, et al (2003). High risk HPV types in southern Iranian patients with cervical cancer. Pathol Oncol Res, 9, 121-5.
  6. Ghaffari SR, Sabokbar T, Meshkat Z, et al (2011). Tracing human papilloma virus in breast tumors of Iranian breast cancer patients. Breast J, 17, 218-9.
  7. Ghaffari SR, Sabokbar T, Mollahajian H, et al (2006). Prevalence of human papillomavirus genotypes in women with normal and abnormal cervical cytology in Iran. Asian Pac J Cancer Prev, 7, 529-32.
  8. Ghasemian E, Monavari SH, Irajian GR, et al (2013). Evaluation of human papillomavirus infections in prostatic disease: a cross-sectional study in Iran. Asian Pac J Cancer Prev, 14, 3305-8.
  9. Gillison ML, Alemany L, Snijders PJ, et al (2012). Human papillomavirus and diseases of the upper airway: head and neck cancer and respiratory papillomatosis. Vaccine, 30, 34-54.
  10. Haeri H, Mardany O, sadi-Amoli F, Shahsiah R (2013). Human papilloma virus and esophageal squamous cell carcinom. Acta Med Iran, 51, 242-5.
  11. Haghshenas M, Golini-Moghaddam T, Rafiei A, Emadeian O, Shykhpour A, Ashrafi GH (2013). Prevalence and type distribution of high-risk human papillomavirus in patients with cervical cancer: a population-based study. Infect Agent Cancer, 8, 20.
  12. Halimi M, Morshedi AS (2011a). Human papillomavirus infection in lung vs oral squamous cell carcinomas: a polymerase chain reaction study. Pak J Biol Sci, 14, 641-6.
  13. Hamkar R, Mokhtari-Azad T, Mahmoodi M, et al (2004). Prevalence of various types of HPV among cervical cancer and normal biopsy in North of Iran. Iranian J Infect Diseases, 8, 9-15.
  14. Hamkar R, Azad TM, Mahmoodi M, et al (2002). Prevalence of human papillomavirus in Mazandaran Province, Islamic Republic of Iran. East Mediterr Health J, 8, 805-11.
  15. Haratian K, Mohseni Meybodi A, Zari Moradi S, Vosough P (2010). Detection of high risk human papillomavirus dna sequences in head and neck squamous cell carcinoma in iranian fanconi anemia patients. Yakhteh Med J, 12, 43-50.
  16. Allameh T, Moghim M, Farahbod F (2013). Reviewing the prevalence of human papillomavirus (HPV) in married women aged 18-60 years with normal pap smear and referring to gynecology clinics in hospitals affiliated to isfahan university of medical sciences, Iran J Isfahan Medical School, 29, 2048-54.
  17. Allameh T, Moghim S, sadi-Zeidabadi M (2011). A survey on the prevalence of high-risk subtypes of human papilloma virus among women with cervical neoplasia in Isfahan university of medical science. Arch Gynecol Obstet, 284, 1509-13.
  18. Asadi-Amoli F, Heidari AB, Jahanzad I, Jabbarvand M (2011). Detection of human papillomavirus in squamous cell carcinoma of conjunctiva by nested PCR: a case control study in Iran. Acta Medica Iranica, 49, 707-14.
  19. Asvadi Kermani I, Seifi S, Dolatkhah R, et al (2012). Human papilloma virus in head and neck squamous cell cancer. Iran J Cancer Prev, 5, 21-6.
  20. Barghi MR, Hajimohammadmehdiarbab A, Moghaddam SM, KAZEMI B (2005). Correlation between human papillomavirus infection and bladder transitional cell carcinoma. BMC Infect Dis, 5, 102.
  21. Bouvard V, Baan R, Straif K, et al (2009). A review of human carcinogens-Part B: biological agents. Lancet Oncol, 10, 321-2.
  22. Burnett-Hartman AN, Newcomb PA, Potter JD (2008). Infectious agents and colorectal cancer: a review of Helicobacter pylori, Streptococcus bovis, JC virus, and human papillomavirus. Cancer Epidemiol Biomarkers Prev, 17, 2970-9.
  23. Castellsague X, de Sanjose S, Aguado T, et al (2007). HPV and cervical cancer in the world 2007 report. Vaccine, 25, C1-230.
  24. Chelimo C, Wouldes TA, Cameron LD, Elwood JM (2013). Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. J Infect, 66, 207-17.
  25. Cogliano V, Baan R, Straif K, et al (2005). Carcinogenicity of human papillomaviruses. Lancet Oncol, 6, 204.
  26. Doorbar J, Quint W, Banks L, et al (2012). The biology and life-cycle of human papillomaviruses. Vaccine, 30, 55-70.
  27. Abdirad A, Eram N, Behzadi AH, et al (2012). Human papillomavirus detected in esophageal squamous cell carcinoma in Iran. Eur J Intern Med, 23, 59-62.
  28. Aghakhani A, Hamkar R, Parvin M, et al (2011). The role of human papillomavirus infection in prostate carcinoma. Scand J Infect Dis, 43, 64-9.
  29. Eghbali SS, Amirinejad R, Obeidi N, et al (2012). Oncogenic human papillomavirus genital infection in southern Iranian women: population-based study versus clinic-based data. Virol J, 9, 194.
  30. Emadeian O, Naghshvar F, Rafiei A, et al (2011). Corroletion of Human Papillomavirus Infection with Esophageal Squamous Cell Carcinoma. J Babol University of Med Sciences, 13, 54-59.
  31. Eslami G, Golshani M, Rakhshon M, (2008a). The study on relation of human papillomavirus with bladder transitional cell carcinoma. Cancer Therapy, 6, 355-60.
  32. Sigaroodi A, Nadji SA, Naghshvar F, et al (2012). Human papillomavirus is associated with breast cancer in the north part of Iran. Scientific World J, 2012, 837191.
  33. Simoes PW, Medeiros LR, Simoes Pires PD, et al (2012). Prevalence of human papillomavirus in breast cancer: a systematic review. Int J Gynecol Cancer, 22, 343-7.
  34. Strati K, Pitot HC, Lambert PF (2006). Identification of biomarkers that distinguish human papillomavirus (HPV)-positive versus HPV-negative head and neck cancers in a mouse model. Proc Natl Acad Sci U S A, 103, 14152-7.
  35. Sudhoff HH, Schwarze HP, Winder D, et al (2011). Evidence for a causal association for HPV in head and neck cancers. Eur Arch Otorhinolaryngol, 268, 1541-7.
  36. Syrjanen KJ (2002b). HPV infections and oesophageal cancer. J Clin Pathol, 55, 721-8.
  37. Syrjanen KJ (2002a). HPV infections and lung cancer. J Clin Pathol, 55, 885-91.
  38. Tornesello ML, Monaco R, Nappi O, Buonaguro L, Buonaguro FM (2009). Detection of mucosal and cutaneous human papillomaviruses in oesophagitis, squamous cell carcinoma and adenocarcinoma of the oesophagus. J Clin Virol, 45, 28-33.
  39. Yahyapour Y, Shamsi-Shahrabadi M, Mahmoudi M, et al (2012). High-risk and low-risk human papillomavirus in esophageal squamous cell carcinoma at mazandaran, Northern Iran. Pathol Oncol Res, 19, 385-91.
  40. Yarandi F, Izadi Mood N, Eftekhar Z, Niakan R, Tajziachi S (2007). HPV infection among patients with high grade cervical intraepithelial neoplasia and squamous cell carcinoma of cervix. Tehran University Med J, 65, 5-11.
  41. Zandi K, Eghbali SS, Hamkar R, et al (2010). Prevalence of various human papillomavirus (HPV) genotypes among women who subjected to routine Pap smear test in Bushehr city (south west of Iran) 2008-2009. Virol J, 7, 65.
  42. Zarei MR, Moradie A, Hamkar R, et al (2007). Detection of human papillomavirus dna sequences in oral lesions using polymerase chain reaction. Acta Med Iranica, 45, 177-82.
  43. Rodriguez AC, Schiffman M, Herrero R, et al (2010). Longitudinal study of human papillomavirus persistence and cervical intraepithelial neoplasia grade 2/3: critical role of duration of infection. J Natl Cancer Inst, 102, 315-24.
  44. Rosa MI, Silva GD, de Azedo Simoes PW, et al (2013). The prevalence of human papillomavirus in ovarian cancer: a systematic review. Int J Gynecol Cancer, 23, 437-41.
  45. Safaei A, Khanlari M, Momtahen M, et al (2010). Prevalence of high-risk human papillomavirus types 16 and 18 in healthy women with cytologically negative pap smear in Iran. Indian J Pathol Microbiol, 53, 681-5.
  46. Saghravanian N, Ghazvini K, Babakoohi S, Firooz A, Mohtasham N (2011). Low prevalence of high risk genotypes of human papilloma virus in normal oral mucosa, oral leukoplakia and verrucous carcinoma. Acta Odontol Scand, 69, 406-9.
  47. SahebJamee M, Boorghani M, Ghaffari S, AtarbashiMoghadam F, Keyhani A (2009). Human papillomavirus in saliva of patients with oral squamous cell carcinoma. J Oral Med Pathology, 14, 525-8.
  48. Salehi Z, Hadavi M (2012). Analysis of the codon 72 polymorphism of TP53 and human papillomavirus infection in Iranian patients with prostate cancer. J Med Virol, 84, 1423-7.
  49. Salehipour M, Khezri A, Behzad-Behbahani A, et al (2012). Role of viruses in renal cell carcinoma. Saudi J Kidney Dis Transpl, 23, 53-7.
  50. Sargolzaie S, Keikhaie M, Moradi A, Ghanbari M, Najmabadi H (2005). Human papillomavirus genotypes among patients with oral squamous cell carcinoma. J Dental School, Shahid Beheshti University Med Sci, 23, 438-48.
  51. Seifi S, Asvadi K, I, Dolatkhah R, et al (2013). Prevalence of oral human papilloma virus in healthy individuals in East azerbaijan province of iran. Iran J Public Health, 42, 79-85.
  52. Seraj JM, Yazdani N, Ashtiani ZO, et al (2011). TP53 gene expression in HPV-positive oral tongue SCC and its correlation with nodal metastasis. Pathol Res Pract, 207, 758-61.
  53. Shafaghi B, Sabeti S, Mohammadi F, et al (2004). Detection of Human Papillomavirus in Squamous Cell Carcinoma of the Lung by Semi-nested PCR. Tanaffos, 3, 15-21.
  54. Shahmahmoudi S, Mahmoodi M, Azad TM, et al (2007). Prevalence of mucosal types of human papillomavirus in skin lesions in north part of Iran. Cancer Lett, 247, 72-6.
  55. Shahsiah R, Khademalhosseini M, Mehrdad N, Ramezani F, Nadji SA (2011). Human papillomavirus genotypes in Iranian patients with cervical cancer. Pathol Res Pract, 207, 754-7.
  56. Sharbatdaran M, Siadati S, Zeinalzadeh M, et al (2013). The frequency of HPV 16 and 18 in cervical discharge by PCR in women with abnormal pap smear or biopsy. Iranian J Pathology, 8, 17-20.
  57. Shayanfar N, Hosseini N, Panahi M, et al (2013). Detection of mucosal type human papillomavirus in cutaneous squamous cell carcinoma in Iran. Pathol Res Pract, 209, 90-4.
  58. Mokhtari M, Bayat Z (2005). Detection of human papillomavirus in cutaneous squamous cell carcinoma using polymerase chain reaction. J Hamedan Med Sciences, 12, 5-9.
  59. Mokhtari M, Taghizadeh F, Rouzbahani E, Narimani T (2011). Comparison of Relative Frequency of Human Papillomatous Virus by Using of Immiunohistochemistry Method between Patients with Prostatic Adenocarcinoma or Benign Prostatic Hyperplasia. J Isfahan Med School, 29, 80-5.
  60. Moradi A, de Villiers EM, Mokhtari-Azad T, et al (2002). Detection of human papillomavirus DNA by PCR in esophageal squamous cell carcinoma from turkmen sahra, North-East of Iran. Iranian Biomed J, 6, 19-23.
  61. Moradi A, Mobasheri E, Tabaraie A, et al (2009). Molecular epidemiology of HPV in breast cancer in golestan province. J Laboratory Sciences, 3, 9-14.
  62. Moradi A, Bakhshandeh Nosrat S, Besharat S (2011). Molecular epidemiology of high-risk types of human papillomaviruses (16, 18) in pap-smear, the North East of Iran. Iran J Cancer Prev, 3, 135-40.
  63. Mortazavi S, Zali M, Raoufi M, et al (2002). The prevalence of human papillomavirus in cervical cancer in Iran. Asian Pac J Cancer Prev, 3, 69-72.
  64. Moscicki AB, Schiffman M, Burchell A, et al (2012). Updating the natural history of human papillomavirus and anogenital cancers. Vaccine, 3, 24-33.
  65. Munoz JP, Gonzalez C, Parra B, et al (2012). Functional interaction between human papillomavirus type 16 E6 and E7 oncoproteins and cigarette smoke components in lung epithelial cells. PLoS One, 7, 38178.
  66. Munoz N, Bosch FX, de SS, et al (2003). Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med, 348, 518-27.
  67. Munoz N, Castellsague X, de Gonzalez AB, Gissmann L (2006). Chapter 1: HPV in the etiology of human cancer. Vaccine, 24, 3-1-310.
  68. Nadji SA, Mahmoodi M, Ziaee AA, et al (2007). An increased lung cancer risk associated with codon 72 polymorphism in the TP53 gene and human papillomavirus infection in Mazandaran province, Iran. Lung Cancer, 56, 145-51.
  69. Nassiri S, Sarlak M, Bidari Zereh Posh F, et al (2009). Polymerase chain reaction study of anogenital condylomas for high risk HPV types. Iranian J Dermatology, 12, 52-5.
  70. Noori S, Monabati A, Ghaderi A (2012). The Prevalence of human papilloma virus in esophageal squamous cell carcinoma. Iran J Med Sci, 37, 126-33.
  71. Omrani M, Saleh S, Lotfinejad S, et al (2007). Prevalence of HPV16 and 18 in cervical cancer by PCR in Western Azarbaijan. Urmia Med J, 18, 414-21.
  72. Razavi SM, Ghalayan P, Salehi MR, et al (2009). Human papilloma virus as a possible factor in the pathogenesis of oral lichen planus. Dent Res J Isfahan, 6, 82-6.
  73. Rezazadeh A, Laber DA, Ghim SJ, Jenson AB, Kloecker G (2009a). The role of human papilloma virus in lung cancer: a review of the evidence. Am J Med Sci, 338, 64-7.
  74. Heidarpour M, Salehi R, Kamali Z, yaraghi H (2011). The frequency of high risk sub-types of human papillomavirus in the samples with varying degrees of cervical neoplasia. J Isfahan Med School, 28.
  75. IARC. Section of Cancer Information. 2008. Scientific Publications, Lyonn. Ref Type: Report
  76. Iftner A, Klug SJ, Garbe C, et al (2003). The prevalence of human papillomavirus genotypes in nonmelanoma skin cancers of nonimmunosuppressed individuals identifies high-risk genital types as possible risk factors. Cancer Res, 63, 7515-9.
  77. Izadi F, Hamkar R, Ghanbari H, Abdolmotallebi F, Jahandideh H (2012). The role of Human papilloma virus (HPV) genotyping in recurrent respiratory papillomatosis in Rasoul Akram Hospital. Med J Islam Repub Iran, 26, 90-3.
  78. Jafari H, Gharemohammadlou R, Fakhrjou A, et al (2013). Genotyping of human papillomavirus and TP53 mutaions at exons 5 to 7 in lung cancer patients from Iran. Bioimpacts, 3, 135-40.
  79. Jamali Zavarei M, Hamkar R, Ghobadi Dana V, et al (2008). Prevalence of HPV infection and its association with cytological abnormalities of pap smears in Tehran. Iranian J Pub Health, 37, 101-6.
  80. Jamshidi M, Shekari M, Nejatizadeh AA, et al (2012). The impact of human papillomavirus (HPV) types 6, 11 in women with genital warts. Arch Gynecol Obstet, 286, 1261-7.
  81. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90.
  82. Jung AC, Briolat J, Millon R, et al (2010). Biological and clinical relevance of transcriptionally active human papillomavirus (HPV) infection in oropharynx squamous cell carcinoma. Int J Cancer, 126, 1882-94.
  83. Khodakarami N, Clifford GM, Yavari P, et al (2012). Human papillomavirus infection in women with and without cervical cancer in Tehran. Iran. Int J Cancer, 131, 156-61.
  84. Kreimer AR, Clifford GM, Boyle P, Franceschi S (2005). Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review. Cancer Epidemiol Biomarkers Prev, 14, 467-75.
  85. Li N, Yang L, Zhang Y, et al (2011). Human papillomavirus infection and bladder cancer risk: a meta-analysis. J Infect Dis, 204, 217-23.
  86. Lin Y, Mao Q, Zheng X, et al (2011). Human papillomavirus 16 or 18 infection and prostate cancer risk: a meta-analysis. Ir J Med Sci, 180, 497-503.
  87. Lorenzon L, Ferri M, Pilozzi E, et al (2011). Human papillomavirus and colorectal cancer: evidences and pitfalls of published literature. Int J Colorectal Dis, 26, 135-42.
  88. Mahmoodi MM, Hamkar R, Akhavan-Tafti M, et al (2007). HPV genotyping in cervical cancer in Yazd province. Iranian J Infect Diseases, 12, 19-24.
  89. Maleknejad P, Rakhshan M, Kazemi B, Farokh F, Shahsavan S (2006). Detection of human papilomavirus types 16 and 18 in pathologic samples from patients with cervical cancer by pcr and rflp methods. DARU, 14, 78-81.

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