Cervical Cancer (HPV)

00:01 Hi.

00:02 Today I'd like to talk to you about HPV (human papilloma virus), cervical cancer and screening.

00:09 Let's talk a little bit about human papilloma virus, HPV for short.

00:14 The HPV genotype appears to be the most important determinant for the persistence and progression of disease.

00:22 There are two different oncogenic types.

00:24 One type is human papilloma virus 16 or HPV-16.

00:29 It has the highest carcinogenic potential and this is very important to remember for your test.

00:35 It accounts for about 55 to 60% of all cases of cervical cancer worldwide.

00:41 The next most carcinogenic type of HPV is HPV-18.

00:46 It's responsible for a lot less, 10 to 15% of all cases of cervical cancer.

00:53 There are risk factors for cervical cancer besides just HPV infection.

00:58 The known risk factors increase the likelihood of persistence of HPV infection which is normally cleared by a young, healthy woman.

01:05 However, if you're a smoker, that incidence of clearing is reduced.

01:12 Also, if you have a compromised immune system, that is with years of taking glucocorticoids, you can potentially have an increased persistence of HPV.

01:23 Also, we know that HIV infection can also increase the persistence of human papilloma virus leading to cervical cancer.

01:33 Let's talk a little bit about the molecular pathogenesis of HPV.

01:37 HPV belongs to the papillomavirus family and is a group of double-stranded DNA viruses.

01:45 HPV 6 and 11 which I have not mentioned yet causes genital warts while 16 and 18 are more likely to cause cervical cancer.

01:54 The progression to invasive cervical cancer is characterized by the viral DNA integrating into the host DNA.

02:01 HPV is very common.

02:04 It's usually an infection that occurs in teenagers and women in their twenties.

02:09 Although the prevalence is not quite known, it decreases as women age.

02:14 The lifetime cumulative risk though of acquiring it is about 80%.

02:20 Most young women, especially those under 21 have a very effective immune system that can clear the infection in about an average of eight months.

02:30 There's some guidelines that we now need to review.

02:33 They're from the United States Preventive Service Task Force, and they only apply to certain women.

02:40 So this is important to remember.

02:41 They apply to women who have a cervix and who are of age, greater than 21 years old, regardless of their sexual history.

02:51 It does not apply to women who have already received a pre-cancer cervical lesion diagnosis or have frank cervical cancer.

02:58 It does not apply to women who've been exposed to DES or diethylstilbestrol It does not apply to women who are immunocompromised such as women who are HIV-positive.

03:09 Here are the guidelines.

03:10 Again, women ages 21 to 65 should be screened with cytology every three years.

03:16 Women who are 30 to 65 who want to lengthen the screening can have intervals of five years with a combination of cytology and HPV screening.

03:26 And there are other recommendations that we no longer follow which are grade D recommendations.

03:32 So if you are younger than 21 or older than 65 or you already have had a hysterectomy due to cancer, or you are younger than 30, we don't do HPV testing alone or in combination with cytology in women again who are younger than 30.

03:50 What about prevention? So how can we prevent all of this morbidity and potentially mortality with HPV.

03:56 Well, now there is a vaccine that protects women against nine strains of HPV.

04:02 While it protects women, both boys and girls should receive the vaccine between the ages of 9 and 26 years old.

04:10 Thank you for listening.