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

HPVHPV

American Society of Reproductive MedicineAmerican Society of Reproductive Medicine

New Orleans, October 2006New Orleans, October 2006

ASRM 2006ASRM 2006

Dr. Richard Guido, U of Pittsburg,Dr. Richard Guido, U of Pittsburg,HPV presentation at ASRM 2006HPV presentation at ASRM 2006

N Munoz, International Agency for Research on N Munoz, International Agency for Research on Cancer, France,Cancer, France, NEJM 348:518, 2003NEJM 348:518, 2003

AR Kreimer, NCI Bethesda, Cancer Epidem AR Kreimer, NCI Bethesda, Cancer Epidem Biomarkers and Prevention 15:908, 2006Biomarkers and Prevention 15:908, 2006

– American Society of Reproductive MedicineAmerican Society of Reproductive MedicineNew Orleans, October 2006New Orleans, October 2006

Learning ObjectivesLearning Objectives

Following the presentation Following the presentation “HPV“HPV””

participants should be able to:participants should be able to:

Clarify the concepts of “high risk” and Clarify the concepts of “high risk” and “low risk” HPV“low risk” HPV

Understand the implications of HPV typesUnderstand the implications of HPV types

Determine the need for colposcopy.Determine the need for colposcopy.

HPVHPV

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

HPV TypeHPV Type

High Risk = CarcinogenicHigh Risk = Carcinogenic– 16, 18, 31, 33, 35, 39, 45, 16, 18, 31, 33, 35, 39, 45,

51, 52, 56, 58, 59, 68 and 69 51, 52, 56, 58, 59, 68 and 69 – 16 and 18 cause 70 % of cervical cancers16 and 18 cause 70 % of cervical cancers

Low Risk = Non-carcinogenicLow Risk = Non-carcinogenic– 6 and 11 cause 90 % of warts6 and 11 cause 90 % of warts

http://www.cancer.gov/cancertopics/factsheet/Risk/HPVhttp://www.cancer.gov/cancertopics/factsheet/Risk/HPV

Relative RiskRelative Risk

HRT / Breast Cancer (WHI)HRT / Breast Cancer (WHI) ______

Smoking / Lung CancerSmoking / Lung Cancer ______

HPV 16 / Cervical CancerHPV 16 / Cervical Cancer ______

- - Munoz NEJM 348:518, 2003Munoz NEJM 348:518, 2003

- - Guido ASRM 2006Guido ASRM 2006

Choices for RR: 0.7 / 1.3 / 8 / 15 / 25 / 100 / >200Choices for RR: 0.7 / 1.3 / 8 / 15 / 25 / 100 / >200


HRT / Breast Cancer (WHI)HRT / Breast Cancer (WHI) 1.3 1.3

Smoking / Lung CancerSmoking / Lung Cancer ______







Smoking / Lung CancerSmoking / Lung Cancer 8 8







Smoking / Lung CancerSmoking / Lung Cancer 8 8

HPV 16 / Cervical CancerHPV 16 / Cervical Cancer 434434



Female CancersFemale Cancersin the United States 2006in the United States 2006

NumberNumberCasesCases DeathsDeaths

LungsLungs 81,77081,770 72,13072,130BreastBreast 212,920212,920 40,97040,970ColonColon 57,46057,460 27,30027,300OvaryOvary 20,18020,180 15,31015,310PancreasPancreas 16,58016,580 16,21016,210CervixCervix 9,7109,710 3,7003,700

American Cancer Society, Cancer Facts and Figures 2006American Cancer Society, Cancer Facts and Figures 2006http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdfhttp://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf


Recurrent CIN II+ after LEEPRecurrent CIN II+ after LEEP

GeneralGeneral ___ ___

HPV NegativeHPV Negative ___ ___

Low Risk HPVLow Risk HPV ___ ___

High Risk – Not 16High Risk – Not 16 ___ ___

+ HPV 16+ HPV 16 ___ ___- - Kreimer CEBP 15:908, 2006Kreimer CEBP 15:908, 2006




GeneralGeneral 7% 7%

HPV NegativeHPV Negative ___ ___








HPV NegativeHPV Negative 0% 0%









Low Risk HPVLow Risk HPV 1.5% 1.5%









High Risk – Not 16High Risk – Not 16 10%10%








High Risk – Not 16High Risk – Not 16 10%10%

+ HPV 16+ HPV 16 37% 37%- - Kreimer CEBP 15:908, 2006Kreimer CEBP 15:908, 2006


Persistent HPVPersistent HPV

Persistent HPV is an indication for Persistent HPV is an indication for colposcopycolposcopy

ASCUS and positive HPV is evidence of ASCUS and positive HPV is evidence of persistence.persistence.

LabCorp Guidelines 2006LabCorp Guidelines 2006

TestingTesting

Pap smear at 1 to 3 years Pap smear at 1 to 3 years with negative Pap and HPVwith negative Pap and HPV

Pap smear at 12 monthsPap smear at 12 monthswith ASCUS but negative HPVwith ASCUS but negative HPV

Pap smear at 6 to 12 monthsPap smear at 6 to 12 monthswith negative Pap but first + HPVwith negative Pap but first + HPV

Colposcopy with persistent HPVColposcopy with persistent HPV

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

Documents

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