Burden of HPV-Associated Cancers in Peruvian Men: Evidence from National Health Data

Five of seven authors work for Merck; their study finds 208 HPV-attributable male cancer deaths in Peru (2015–2019), penile cancer driving most hospitalizations

Journal: Human Vaccines & Immunotherapeutics | Published: 2026-06-12 | Type: Journal Article | PMID: 42283540 Authors: Otoya I (Instituto Nacional de Enfermedades Neoplásicas, Lima); Blas M (Universidad Peruana Cayetano Heredia, Lima); da Silva ZM, Pereira CV, Orengo JC, Pungartnik PC, Parellada CI (MSD Brazil / MSD LATAM — five of seven authors are Merck employees) Funding/COI: Funding not disclosed. Five of seven authors are employed by MSD Brazil or MSD LATAM (Merck Sharp & Dohme), maker of Gardasil. COI is listed as "not listed" in the paper metadata.

Summary

Using Peruvian national health records from 2015–2019, this study tallied outpatient visits, hospitalizations, and deaths from HPV-associated cancers in men, then applied published attributable fractions to estimate how much is specifically caused by HPV. Penile cancer and head-and-neck cancers dominate the male burden. The conclusion — strengthen HPV vaccination — is unsurprising given that five of the paper's seven authors work for the company that sells Gardasil.

Claims

• 5,996 outpatient consultations for HPV-associated cancers over 5 years (age-standardized rate: 8.2 per 100,000 men)
• Head and neck cancers: 56.3% of consultations; penile cancer: 30.4%
• 1,136 hospitalizations (ASR: 1.6/100,000); penile (45.9%) and head/neck (46.3%) split nearly equally
• HPV-attributable share: 2,056 consultations (ASR: 2.8) and 402 hospitalizations (ASR: 0.6)
• 859 total deaths from HPV-associated cancers; 208 deemed HPV-attributable (ASR: 0.3)
• 77.2% of HPV-attributable deaths in men ≥60 years; burden present but lower under age 30 and ages 30–59

Study Quality

This is a descriptive epidemiological analysis of national administrative data — not a clinical trial, cohort, or causal study. The "HPV-attributable" figures are derived by applying site-specific attributable fractions from external literature to raw Peruvian case counts. The accuracy of the headline numbers therefore depends entirely on how well those fractions generalize to this population. Age-standardization to the WHO World Standard Population is methodologically appropriate and aids international comparisons.

Data quality is a stated concern: the authors ran a sensitivity analysis excluding 2015–2016 mortality records because cause-of-death coding completeness improved over the study period. That the sensitivity analysis had minimal impact is reassuring but doesn't resolve uncertainty about miscoding in the earlier years. Administrative records in Peru also capture only patients who engaged with the formal health system — rural and underserved populations are systematically undercounted.

Red Flags

• Undisclosed conflict of interest: Five of seven authors are employed by MSD Brazil or MSD LATAM. The paper concludes by advocating for expanded HPV vaccination — the product their employer sells. The paper metadata lists COI as "not listed."
• Attributable fractions are imported, not measured: The study doesn't confirm HPV causation in these patients directly; it applies external fractions. If those fractions don't hold for the Peruvian population, the HPV-attributable burden estimates are wrong.
• Administrative data undercount: National health records miss patients who bypass formal care. Peru's rural access disparities are significant.
• No denominator validation: The paper doesn't establish whether the national data covers the full care-seeking population or only the public system.
• Advocacy language from industry authors: The abstract closes with a specific policy recommendation list (universal vaccination, multi-age catch-up programs, improved diagnostic access) — language that goes beyond descriptive epidemiology, authored by vaccine manufacturer employees.

Strengths

• Five-year national dataset is a wider window than most single-site studies
• Age-standardization enables cross-country comparisons
• Covers multiple cancer sites, not just penile cancer alone
• Sensitivity analysis for cause-of-death data quality was performed and reported
• Combines outpatient, inpatient, and mortality data for a fuller burden picture

Verdict

The underlying data — Peru's national cancer records — tells a real story: HPV-associated cancers hit Peruvian men primarily in the head/neck and penis, mostly after age 60, with a non-trivial death toll of 208 HPV-attributable deaths over five years. But five of seven authors work for Merck, the conflict of interest goes undisclosed, and every methodological choice in a burden-of-disease study — which attributable fractions to use, how to handle incomplete data, what to emphasize in the conclusion — has directional implications when the researchers have a financial interest in larger numbers. Read the raw counts; be skeptical of the HPV-attributable fractions; ignore the policy recommendations section entirely.