HPV and Cervical Cancer Screening

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  • HPV and Cervical Cancer Screening

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

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