HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy.

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Presentation transcript:

HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy Brown University / Women and Infants’ Hospital Program in Women’s Oncology

Oropharyngeal Cancer Cervical Cancer Anal Cancer

HPV Prevalence Koutsky LA, Am J med 1997 – estimated prevalence 1.4 million (1%) genital warts 5 million (4%) detected by colposcopy 14 million (10%) HPV positive – neg colpo 81 million (60%) HPV negative with detectable antibodies TOTAL INFECTED = 75% of population

There are at least 14 oncogenic HPV genotypes in the anogenital region

Most Prevalent HPV Types Squamous Cervical Cancer Munoz et al. N Engl J Med. 2003;348: % 13% 5% 4% 3% All HPV-infected patients (%) >70% of cases of cervical cancer are associated with HPV 16 or 18 HPV 16 HPV 18

Most Prevalent HPV Types Adenocarcinoma Castellsague X et al. J Natl Cancer Inst. 2006;98: Prevalence of HPV type in cases of adenocarcinonma (%) HPV DNA was detected in 93% of patients with cervical adenocarcinoma. HPV 16 HPV 18 HPV 45Multitype

HPV 16/18 One of highest oncogenic risks known! Male 40 pack-yr smoking hx vs nonsmoker RR of lung cancer: 9.6 Postmenopausal women on HRT vs no HRT RR of breast cancer: 1.3 HPV16+ vs negative RR of cervical cancer: 434

Prevention

HPV vaccines are 93% effective in preventing cervical cancers secondary to HPV 16 and 18

How is Rhode Island doing? GIRLS 39.9% IN KANSAS 76.6% IN RHODE ISLAND BOYS 11.0% IN KANSAS 69.3% IN RHODE ISLAND

HPV Vaccine $360 Cervical Cancer Treatment $40,000

Screening

Cervical PAPANICOLOU Smear Herrero R. Monogr Natl Cancer Inst 1996; 21:1-6 77% reduction in the incidence of invasive cervical cancer No RCTs have evaluated efficacy

April 2014: FDA approves cobas HPV test for primary cervical cancer screening in women over 25 years

Effectiveness For Screening HPV versus Cytology Detect CIN 2+SensitivitySpecificity HPV %93.3% Cytology 76.6%95.8% Cuzick, J et al Lancet 2003;362:

ACOG: When to Start and Why? Age 21 Cancer rarely seen prior to  19 years Only 1.7% adolescents estimated to have HSIL 70-90% HPV regression rates within 3 years 1, % LSIL regression in yo (50-80% in adult women) 1 CIN 2 regresses 65% and 75% of the time after 18 months and 3 years 3 1 Moscicki AB. J Pediatr 1998; 132: Ho GY. NEJM 1998; 338: Moore K, et al. AJOG 2007; 197:141e1-141e6 4 Fuchs, et al. J Pedi Adol Gyn 2007;20:

Frequency of screening 21 to 29 years Cytology alone Every 3 years HPV testing should NOT be used to screen 30 to 65 years Cytology alone (acceptable) Every 3 years Cytology and HPV testing (preferred) Every 5 years

Can we screen for other HPV related cancers? Formal guidelines are lacking Consider in HIV positive, MSM, and studies underway in HIV negative women Anal Cytology

Thank You