Cervical Cancer Screening and Human Papilloma Virus Flashcards
Objectives
- Review the epidemiology of cervical cancer
- Understand HV infection in relation to cervical cancer
- Review USPSTF, ACS, and ACOG cervical cancer screening guidelines for average risk women
- Recognize the Bethesda pap smear reporting system and terminology: ASCUS, LSIL, HSIL
- Download the ACSSP APP for management of abnormal paps
HPV vaccination could prevent more than ____ of cancers caused by HPV
Cancers caused by HPV (5)
- In the US: 35,000 women and men dx’d with HPV related cancers each year
- Estimated new cases cervical ca 2020: 13,800
- Estimated deaths cervical ca 2020: 4,290
- Median age at dx cvx ca: 50
90%
Cervical Cancer/Precancer, Oropharyngeal Cancer, Anal Cancer, Vulvar and Vagina Cancer, Penile Cancer
5 Year Survival Rate
Cervical Cancer =
Relative to breast and uterine cancer - in a developed world is very ____
Low and middle income countries don’t have the ____ for vaccination programs, screening, tertiary prevention (tx)
66.1%
uncommon
infrastructure
Relationship between Cervical CA rate and HPV Vaccination coverage
=
Higher rates of cervical ca associated with lower vaccination in southern states
US Cervical Cancer Disparities
=
Again we see a health disparity in incidence vs. mortality rates in different races >in AA/hispanic/native american
WHO: Global strategy towards eliminating cervical cancer as a public health problem
“Through cost effective, evidence-based interventions, including human papilloma vaccination of girls, screening and tx of precancerous lesions, and improving access to diagnosis and treatment of invasive cancers, we can _____ cervical cancer as a public health problem and make it a disease of the ____”
eliminate, past
**HPV Causes Cervical Cancer**
- >150 types: 40 infect surface epithelia and mucous membranes of genitalia
- 13 types: ___ Risk/_____ (cancer causing)
- Transmission routes (2)
-
Detected in 99.7% of Cervical Cancers
- Two High Risk Types (2), cause 70% of cervical cancers and pre-cancers
- Two Low Risk Types (2), cause 90-100% of (1)
- High Risk/Oncogenic
- sexually acquired, skin to skin
- 16, 18
- 6, 11, condyloma (genital warts)
Risk Factors for Acquiring HPV infection
- ____ age at 1st intercourse
- ____ sexual partners
- Partners w _____
- Oral ____ use
- Imm_______
- Early
- Multiple
- multiple partners
- contraceptive
- Immunosuppression
Risk Factors for Persistent HPV Infection
- _____ age
- HPV ____
- Imm_____ (e.g HIV) or immunosuppression
- High P____
- ______ Predisposition (rare)
- S_____
- Diet:
- ____: CT and HSV
- Pov____
- ___ Exposure
- Increasing
- type
- Immunodeficiency
- Parity
- Genetic
- Smoking
- Lack of fruits/veggies: C, E, folate
- STIs
- Poverty
- DES
Prophylactic HPV Vaccines
**APIC Rec: All children aged __-__**
- __ vaccine series: age > 15: 0, 1-2, 6 mos
- __ vaccine series: age < 15: 0, 6-12 mos
- What is the vaccine called?
**11-12**
- 3
- 2
- Gardasil 9
CDC: Talking to Parents About HPV Vaccine
- Recommend HPV vaccination in the ____ ____ and on the ___ ___ you recommend other vaccines for adolescents
Same way, same day
You can say, “Now that your son is 11, he is due for vaccinations today to help from meningitis, HPV cancers, and whooping cough. Do you have any questions?”
HPV Vaccination Quick Facts
- Safety
- 57 million doses of HPV vaccine distributed - 2013
- 22,000 Adverse events
- 92% ___ serious (pain at site, hives, fainting); serious included HA, n/v, fatigue
- Does NOT increase (1)
- Younger = _____ immune response
- non
- X sexual activity
- better immune response (when you get it before any exposure)
Screening Strategy Options
(3)**
Know that other countries (europe) don’t start screening till __ bc its very ___ and most likely will ____
Pap Test Alone Q3
HPV alone Q5
Co-testing (Pap and HPV)
30, common, will regress
All based on sensitivity and specificity and age based bc HPV is v common in young ages - concern with finding things vs. overtesting -> we are moving starting age 21/25, it will probably move up and up
ACOG Cervical Cancer Screening Guidelines 2016: Average Risk
Age to initiate?
21
HPV is Common, Cervical Cancer Uncommon
-
*Typical HPV Infection is ____
- Average episode lasts 4-20 months
- 90% regress to undetectable w/in 2 yrs P
- ______ is necessary for progression**
- 10% have ____ infx, <2% develop __**
- transient
- Persistence
- persistent, CA
**Even when someone tests positive -> HIGHLY LIKELY IT WILL REGRESS ON ITS OWN**