HPV and Cervical Cancer.docx

HPV and Cervical Cancer: High-risk HPV is necessary, but not sufficient for the development of squamous cervical neoplasia HPV infectiontransient or persistent infection HPV 16 and 18 are responsible for most types of HPV Factors in persistence: genotype of HPV: HPV 16 accounts for 60% of cases,...

HPV and Cervical Cancer: High-risk HPV is necessary, but not sufficient for the development of squamous cervical neoplasia HPV infectiontransient or persistent infection HPV 16 and 18 are responsible for most types of HPV Factors in persistence: genotype of HPV: HPV 16 accounts for 60% of cases, HPV 18 accounts for 15%, twelve other types responsible for the rest cigarette smoking compromised immune system HIV age \> 30 years at time of infection: most young AFAB effectively clear infection in 8-24 months Risk Factors for cervical CA: - Age: coitarche \ 25 years old OR conventional (slide based) which does not do HPV. Reflex HPV will test for hrHPV if the cytology is ASCUS (but only order this hrHPV in women \>25 yrs old). The conventional (slide based) you cannot order HPV testing. 2. Cotest Pap: only liquid based; does cytology and HPV high risk are both performed. Reflex to 16, 18/45 will test for genotypes if hrHPV is positive Primary hrHPV test: only 2 FDA approved primary tests same collection procedure as liquid pap tests for genotypes 16 and 18 and twelve other hrHPV types if positive, reflex to cytology is preferred if 16/18 positive and unable to reflex from same sample, colposcopy plus cytology are acceptable **Cervical CA Screening Guidelines:** ACS- start at 25 years old, 25-65 years old and do the primary HPV test alone every 5 years; co-test every 5 years or cytology only every 3 years USPSTF- start at 21 years old; 21-29 cytology alone every 3 years; 30-65 years do cytology alone every 3 years or primary hrHPV testing every 5 years or cotest every 5 years If there is an ASCUS pap result in 21-24 year-olds no need to reflex to HPV. Screening Special Populations: - HIV-infected and immunocompromised: start cytology alone within 1 yr of onset of sexual activity or within 1^st^ year of HIV diagnosis, no later than 21 - Under 30 years old need to repeat cytology in 1 yr after normal pap; after 3 consecutive normal annual paps then can screen every 3 years - Over 30 years old need to do cytology alone or contesting, contesting can go to every 3 years after 1 negative cotest Colposcopy: - Use of a colposcope to provide an illuminated, magnified view - The goal is to identify precancerous and cancerous lesions - Acetic acid is used to improve visualization of abnormal areas, the areas will appear white - Should biopsy abnormal areas Is the high risk HPV transient or chronic? This is why you're doing re-check yearly Remember under 29 we do not routinely check for HPV Remember to use the algorithm from the age of the original abnormal PAP If hrHPV positive do a reflex to 16/18 test, if the reflex test is positive then do a colposcopy