Human Papilloma Virus (HPV) have been implicated in the development of cancer of the cervix, mouth and throat, anus, penis, vulva, or vagina, but it has not been much considered as a cause of breast cancer. However, a growing number of investigations have linked breast cancer to viral infections, including Human Papillomavirus (HPV), Epstein–Barr virus (EBV), Mouse Mammary Tumor Virus (MMTV), and Human Cytomegalovirus (HCMV)(1).
Human papilloma viruses (HPVs) are non-enveloped DNA virus belonging to the Papillomaviridae family (2, 3). Over 170 types of HPV have been identified (3), the majority of which affect the genital tract epithelia, the mucosa of the upper respiratory tract and the skin (2, 3). HPVs are categorized as high risk or low risk, depending on their carcinogenic potential. High-risk HPV types causes cancer, however Low‐risk types are not carcinogenic but cause benign anogenital warts and recurrent respiratory papillomatosis(3, 4).
High-risk HPV types, predominantly (HPV-16, -18, -31, -33, -35, -39, -45, -51, -52, -56, -58, and − 59) are established as carcinogens in humans, while HPV-68 is probably carcinogenic (5). HPV types 16 and 18 are the most common high-risk types and are responsible for > 70% of all cervical cancer cases (5). HPV are characterized by the presence of three functional code regions in their genome: The E region that codes the early viral function, the L region which is responsible for the late viral function and the long control region (LCR)(2). Even though HPVs are known to be responsible for the development of cervical cancers, HPV infections are often asymptomatic, and most sexually active individuals become infected with HPV at least once in their lifetime (3). A recent systematic review and metanalysis by Ren et al examined 37 Case–control studies containing 3,607 Breast cancer cases and 1,728 controls in a wide range of countries that compare the prevalence of high-risk HPVs in breast cancer as compared to benign breast or normal breast (6). In their study Ren et al showed an increase in breast risk with human papillomavirus (HPV) positive [summary odds ratio (SOR) = 6.22, 95% confidence interval 4.25 to 9.12; P = 0.0002]. Ren et al. also showed three high risk HPV types (HPV16, 18 and 33) to be positively correlated to breast cancer(6). Similarly, a metanalysis conducted by Lawson et al in 2015 showed prevalence of HPV is fourfold higher in breast cancer (21.5%) than controls (5.1%)(7). In their study Lawson et al has shown that HPVs are detected from 2 to 74% of all case (7).
In another study, it has been shown that women with HPV- associated cervical pathology are at increased risk from the same HPV type positive breast cancer which implies a possible link between HPV and breast carcinogenesis(8). There is only one published study so far done to assess the prevalence of HPV in the African continent. This study from Rwanda (9)was conducted in 47 archived formalin-fixed paraffin-embedded tissues to detect and genotype HPV DNA. They reported prevalence of HPV at 46.81% of cases. The most common genotype in this study were HPV16 (77%) followed by HPV33 (14%) and HPV31 (9%)(9).
According to the 2019 IARC report, about 6,294 new cervical cancer cases are diagnosed annually in Ethiopia and HPV is the cause of almost all cases (10). The IARC report also indicates cervical cancer as the 2nd leading cause of female cancer following breast cancer in Ethiopia (10). A study done in 2014 found the most common genotype among cervical cancer patients in Ethiopia was HPV 16, followed by HPV 52, HPV 56 and HPV 31 (11). Another study done in 2013 also found HPV 16 as the most common genotype followed by HPV 52, 58, and 18 (12). There is no published study so far done to assess the role of HPV among breast cancer cases in Ethiopia. Therefore, in this study we aimed to detect 19 high risk and 9 low risk HPVs from archived breast tumor tissue to look at the prevalence among Ethiopian women.