Program Overview
Human papillomavirus (HPV), the most common newly acquired sexually transmitted infection in the United States, is a cause of cervical cancer and its precursor lesions. High-risk oncogenic HPV types, the most common of which are HPV 16 and 18, cause 70% of cervical cancers as well as vulvovaginal and other anogenital cancers. Low-risk HPV types, the most common of which are HPV 6 and 11, cause 90% of genital warts, low-grade cervical dysplasias, and recurrent respiratory papillomatosis, a rare but potentially fatal disease caused predominantly by vertical transmission from mother to infant, or less frequently, through direct sexual contact in adults.
The history of cervical cancer treatment is one of progressive innovation and accompanying reductions in morbidity and mortality. Pap testing revolutionized prevention, allowing for screening and treatment of early-stage abnormalities. Routine HPV DNA testing for common high-risk, oncogenic HPV types further improved clinicians’ ability to identify those at highest risk, but both Pap testing and HPV testing constitute reactive measures that could prevent cervical cancer only by identifying precursor lesions. In contrast, HPV vaccination prevents infection with common HPV types, and thus reduces the incidence of cervical cancer and precursor lesions. A quadrivalent HPV (types 6, 11, 16, 18) vaccine has been approved by the US Food and Drug Administration (FDA) for the prevention of cervical intraepithelial neoplasias 1 to 3, cervical adenocarcinoma in situ, cervical cancer, vulvar and vaginal intraepithelial neoplasia 2 and 3, and genital warts. The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommends that the quadrivalent HPV vaccine be given to all 11- and 12-year-old girls, girls and women 13 to 26 years of age who have not yet been vaccinated, and girls as young as 9 years of age, at the clinician’s discretion. A bivalent HPV (types 16, 18) vaccine is currently being reviewed by the FDA.
HPV vaccination is expected to reduce the incidence of cervical cancer; however, Pap testing and HPV DNA testing will still play a crucial role in cervical cancer prevention efforts in patients who are already infected with HPV and for the detection of cervical abnormalities caused by less common types of oncogenic HPV not protected against by vaccination.
This activity will review the latest data supporting the efficacy of HPV vaccination, review current guidelines for cervical screening and HPV DNA testing, including the most recent American Society for Colposcopy and Cervical Pathology (ASCCP) Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities, and discuss how widespread vaccination against HPV can be expected to impact morbidity, mortality, and cervical screening.
