HPV and Cervical Cancer Screening
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HPV and Cervical Cancer Screening

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HPV and Cervical Cancer Screening HPV and Cervical Cancer Screening Presentation Transcript

  • HPV and Cervical Cancer Screening Peter Valenzuela, MD, MBA, FAAFP Assistant Dean for Clinical Affairs Assistant Professor/Dept. of Family Medicine
  • Objectives
    • Discuss key aspects of HPV including:
      • Types
      • Transmission
      • Course
      • Detection
      • Vaccine
    • Describe cervical cancer screening guidelines
    • Provide an introduction to colposcopy using cervical images
  • Background
    • Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S.
    • Over half of sexually active men and women are infected with HPV at some point in their lives
    • 6.2 million people in the U.S. become infected annually
  • Economic Impact
    • Approximately $3.5 billion spent on cervical HPV-related disease in the U.S. annually
    • This image is Figure 13 at: http://www.merckmedicus.com/pp/us/hcp/diseasemodules/hpvd/epidemiology.jsp
  • Types
    • There are over 100 different types of HPV
    • Over 40 types infect mucosal surfaces of the ano-genital area
      • High risk (cancer-associated)- 16,18 ,31,33,35,39,45,51,52,56,58,59,68,82
      • Low risk (non-oncogenic)- 6,11 ,40,42,43,44,54,61,72,73,81
  • Types
    • High Risk
      • HPV 16 most common (found in almost half of all cervical CA)
      • HPV 18 accounts for 10%-12% of cervical CA
    • Low Risk
      • HPV 6 & 11 most commonly found in genital warts
  • Transmission
    • Usually transmitted through direct skin-to-skin
    • Can occur from mother to baby in delivery
    • Detected on inanimate objects, but transmission via this route is unknown
    • This image is Figure 14 at: http://www.merckmedicus.com/pp/us/hcp/diseasemodules/hpvd/epidemiology.jsp
  • Risk Factors for HPV Infection
    • Young age (less than 25 years old)
    • Increasing number of sex partners
    • Early age at first intercourse (16 years old or younger)
    • Male partner has (or has had) multiple sex partners
  • Course
    • Typical duration of new infection is 8 months
    • 70% of women become HPV negative within 1 year
    • 91% become HPV negative within 2 years
    • 10% of women infected with HPV will develop persistent HPV infections
    • This image is Figure 19 at: http://www.merckmedicus.com/pp/us/hcp/diseasemodules/hpvd/natural-history.jsp
  • Detection
    • HPV DNA test (Hybrid Capture II)
    • Can be analyzed from the residual fluid of a liquid-based cytology specimen
    • Detects high risk HPV types, but does not identify individual type
    • Indications for use
      • Routine adjunct to Pap in women 30 and over
      • Management of ASCUS
  • Prevention of HPV
    • Quadrivalent HPV vaccine (Gardasil)
    • Protects against HPV 6,11,16,18
    • 3 IM injections over six-month period ($360 for series)
    • Indicated in females 9-26 years old
    • Ideally before onset of sexual activity
  • Cervical Cancer Screening
    • This is table 12 at: http://www.merckmedicus.com/pp/us/hcp/diseasemodules/hpvd/screening.jsp
    •  
  • Cervical Dysplasia Classification
    • Bethesda System- developed by the CDC and NIH to standardize method
    • CIN Grading System
    CIN III HGSIL Carcinoma In Situ CIN II HGSIL CIN I LGSIL Atypia ASCUS CIN GRADING BETHESDA
  • Management of an Abnormal Pap
    • This is the first image on page 22 of the CDC brochure and may be found at: http://www.cdc.gov/std/HPV/common-infection/CDC_HPV_ClinicianBro_LR.pdf
  • Management of an Abnormal Pap
    • This is the second image on page22 of the CDC brochure and may be found at: http://www.cdc.gov/std/HPV/common-infection/CDC_HPV_ClinicianBro_LR.pdf
  • Colposcopy
    • This image can be found at: http://medicalimages.allrefer.com/large/colposcopy-directed-biopsy.jpg
  • Colposcopy
    • Ectopy
    • Nabothian Cyst
    • This image can be found at: http://www.asccp.org/edu/practice/cervix/colposcopy/benign.shtml
    • This image can be found at: http:// www.asccp.org/edu/practice/cervix/colposcopy/benign.shtml
  • Colposcopy
    • Leukoplakia
    • This image can be found at: http://www.asccp.org/edu/practice/cervix/colposcopy/benign.shtml
  • Colposcopy
    • Punctation
    • This is image 7.3 at: http://screening.iarc.fr/colpochap.php?lang=1&chap=7.php
  • Colposcopy
    • Mosaicism
    • CIN I
    • This is image 7.16 at: http://screening.iarc.fr/colpochap.php?lang=1&chap=7.php
  • Colposcopy
    • CIN II
    • CIN III
    • This is image 7.19 at: http://screening.iarc.fr/colpochap.php?lang=1&chap=7.php
    • This is image 7.23 at: http://screening.iarc.fr/colpochap.php?lang=1&chap=7.php
  • Colposcopy
    • Strawberry Cervix
      • Common indicator of cervicitis
      • Trichomoniasis is usually the culprit
    • This image can be found at: http://www.asccp.org/edu/practice/cervix/colposcopy/benign.shtml
  • Summary
    • Discuss key aspects of HPV including:
      • Types
      • Transmission
      • Course
      • Detection
      • Vaccine
    • Describe cervical cancer screening guidelines
    • Provide an introduction to colposcopy using cervical images
  • References
    • Centers for Disease control and Prevention http://www.cdc.gov/std/hpv/hpv-clinicians-brochure.htm
    • American Society for Colposcopy and Cervical Pathology http:// www.asccp.org/edu/practice/cervix.shtml
    • American College of Obstetricians and Gynecologists http:// www.acog.org /
  • References
    • Pfenninger and Fowler’s Procedures for Primary Care, 2 nd Ed. 2003
    • Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A Beginner’s Mannual. Edited by Edited by J.W. Sellors and R. Sankaranarayanan
    • HPV Disease www.merckmedicus
    • Women’s Health Channel www.womenshealthchannel.com