1. HPV American Society of Reproductive Medicine New Orleans, October 2006

2. ASRM 2006 Dr. Richard Guido, U of Pittsburg, HPV presentation at ASRM 2006 N Munoz, International Agency for Research on Cancer, France, NEJM 348:518, 2003 AR Kreimer, NCI Bethesda, Cancer Epidem Biomarkers and Prevention 15:908, 2006 –American Society of Reproductive Medicine New Orleans, October 2006

3. Learning Objectives Following the presentation “HPV” participants should be able to: Clarify the concepts of “high risk” and “low risk” HPV Understand the implications of HPV types Determine the need for colposcopy.

4. HPV Human papillomaviruses (HPVs) are a group of more than 100 types of viruses. Most HPV infections go away on their own. HPVs are the major cause of cervical cancer. HPVs may also play a role in cancers of the anus, vulva, vagina, and penis, and some cancers of the oropharynx. Although there is no cure for HPV infection, the warts and lesions these viruses cause can be treated –http://www.cancer.gov/cancertopics/factsheet/Risk/HPV

5. HPV Type High Risk = Carcinogenic –16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 and 69 –16 and 18 cause 70 % of cervical cancers Low Risk = Non-carcinogenic –6 and 11 cause 90 % of warts http://www.cancer.gov/cancertopics/factsheet/Risk/HPV

6. Relative Risk HRT / Breast Cancer (WHI)___ Smoking / Lung Cancer___ HPV 16 / Cervical Cancer___ - Munoz NEJM 348:518, 2003 - Guido ASRM 2006 Choices for RR: 0.7 / 1.3 / 8 / 15 / 25 / 100 / >200

7. Relative Risk HRT / Breast Cancer (WHI) 1.3 Smoking / Lung Cancer___ HPV 16 / Cervical Cancer___ - Munoz NEJM 348:518, 2003 - Guido ASRM 2006 Choices for RR: 0.7 / 1.3 / 8 / 15 / 25 / 100 / >200

8. Relative Risk HRT / Breast Cancer (WHI) 1.3 Smoking / Lung Cancer 8 HPV 16 / Cervical Cancer___ - Munoz NEJM 348:518, 2003 - Guido ASRM 2006 Choices for RR: 0.7 / 1.3 / 8 / 15 / 25 / 100 / >200

9. Relative Risk HRT / Breast Cancer (WHI) 1.3 Smoking / Lung Cancer 8 HPV 16 / Cervical Cancer434 - Munoz NEJM 348:518, 2003 - Guido ASRM 2006

10. Female Cancers in the United States 2006 Number CasesDeaths Lungs81,77072,130 Breast212,92040,970 Colon57,46027,300 Ovary20,18015,310 Pancreas16,58016,210 Cervix9,7103,700 American Cancer Society, Cancer Facts and Figures 2006 http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf

11. Relative Risk Recurrent CIN II+ after LEEP General ___ HPV Negative ___ Low Risk HPV ___ High Risk – Not 16 ___ + HPV 16 ___ - Kreimer CEBP 15:908, 2006 - Guido ASRM 2006

12. Relative Risk Recurrent CIN II+ after LEEP General 7% HPV Negative ___ Low Risk HPV ___ High Risk – Not 16 ___ + HPV 16 ___ - Kreimer CEBP 15:908, 2006 - Guido ASRM 2006

13. Relative Risk Recurrent CIN II+ after LEEP General 7% HPV Negative 0% Low Risk HPV ___ High Risk – Not 16 ___ + HPV 16 ___ - Kreimer CEBP 15:908, 2006 - Guido ASRM 2006

14. Relative Risk Recurrent CIN II+ after LEEP General 7% HPV Negative 0% Low Risk HPV 1.5% High Risk – Not 16 ___ + HPV 16 ___ - Kreimer CEBP 15:908, 2006 - Guido ASRM 2006

15. Relative Risk Recurrent CIN II+ after LEEP General 7% HPV Negative 0% Low Risk HPV 1.5% High Risk – Not 16 10% + HPV 16 ___ - Kreimer CEBP 15:908, 2006 - Guido ASRM 2006

16. Relative Risk Recurrent CIN II+ after LEEP General 7% HPV Negative 0% Low Risk HPV 1.5% High Risk – Not 16 10% + HPV 16 37% - Kreimer CEBP 15:908, 2006 - Guido ASRM 2006

17. Persistent HPV Persistent HPV is an indication for colposcopy ASCUS and positive HPV is evidence of persistence.

18. LabCorp Guidelines 2006

19. Testing Pap smear at 1 to 3 years with negative Pap and HPV Pap smear at 12 months with ASCUS but negative HPV Pap smear at 6 to 12 months with negative Pap but first + HPV Colposcopy with persistent HPV