hpv: how to prevent your patients from becoming my patients katina robison, md assistant professor,...
TRANSCRIPT
![Page 1: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/1.jpg)
HPV: How to prevent your
patients from becoming
my patientsKatina Robison, MD
Assistant Professor, Department of Obstetrics & GynecologyDirector of Colposcopy
Brown University / Women and Infants’ HospitalProgram in Women’s Oncology
![Page 2: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/2.jpg)
Oropharyngeal Cancer
Oropharyngeal Cancer
Cervical CancerCervical Cancer
Anal CancerAnal Cancer
![Page 3: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/3.jpg)
HPV Prevalence
• Koutsky LA, Am J med 1997 – estimated
prevalence• 1.4 million (1%) genital warts• 5 million (4%) detected by colposcopy• 14 million (10%) HPV positive – neg colpo• 81 million (60%) HPV negative with detectable
antibodies TOTAL INFECTED = 75% of population
TOTAL INFECTED = 75% of population
![Page 4: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/4.jpg)
There are at least 14 oncogenic HPV
genotypes in the anogenital region
There are at least 14 oncogenic HPV
genotypes in the anogenital region
![Page 5: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/5.jpg)
Most Prevalent HPV Types
Squamous Cervical Cancer
Munoz et al. N Engl J Med. 2003;348:518-527
58%
13%
5% 4% 3%
All
HPV
-infe
cted p
ati
ents
(%
)
60
50
40
30
20
10
0
>70% of cases of cervical cancerare associated with HPV 16 or 18
HPV 16 HPV 18
![Page 6: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/6.jpg)
Most Prevalent HPV Types
Adenocarcinoma
Castellsague X et al. J Natl Cancer Inst. 2006;98:303-315.
Pre
vale
nce
of
HPV
typ
e in
ca
ses
of
ad
en
oca
rcin
on
ma
(%)
HPV DNA was detected in 93% of patients with cervical adenocarcinoma.
HPV 16 HPV 18 HPV 45 Multitype
![Page 7: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/7.jpg)
HPV 16/18
One of highest oncogenic risks known!
• Male 40 pack-yr smoking hx vs nonsmoker• RR of lung cancer: 9.6
• Postmenopausal women on HRT vs no HRT• RR of breast cancer: 1.3
• HPV16+ vs negative• RR of cervical cancer: 434
![Page 8: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/8.jpg)
Prevention
![Page 9: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/9.jpg)
HPV vaccines are 93% effective in
preventing cervical cancers
secondary to HPV 16 and 18
![Page 10: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/10.jpg)
How is Rhode Island doing?
• GIRLS • 39.9% IN KANSAS • 76.6% IN RHODE ISLAND
• BOYS •11.0% IN KANSAS •69.3% IN RHODE ISLAND
![Page 11: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/11.jpg)
HPV Vaccine
$360
Cervical Cancer
Treatment
$40,000
![Page 12: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/12.jpg)
Screening
![Page 13: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/13.jpg)
Cervical PAPANICOLOU Smear
Herrero R. Monogr Natl Cancer Inst 1996; 21:1-6
77% reduction in the incidence of invasive cervical cancer
77% reduction in the incidence of invasive cervical cancer
No RCTs have evaluated efficacyNo RCTs have evaluated efficacy
![Page 14: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/14.jpg)
April 2014: FDA approves cobas
HPV test for primary cervical cancer
screening in women over 25 years
![Page 15: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/15.jpg)
Effectiveness For Screening
HPV versus Cytology
Detect CIN 2+
Sensitivity Specificity
HPV + 97.1% 93.3%
Cytology 76.6% 95.8%
Cuzick, J et al Lancet 2003;362:1871-76
![Page 16: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/16.jpg)
ACOG: When to Start and Why?
• Age 21
• Cancer rarely seen prior to19 years
• Only 1.7% adolescents estimated to have HSIL
• 70-90% HPV regression rates within 3 years1,2
• 80-90% LSIL regression in 13-21 yo (50-80% in adult
women)1
• CIN 2 regresses 65% and 75% of the time after 18
months and 3 years3
1Moscicki AB. J Pediatr 1998; 132:277-2 2Ho GY. NEJM 1998; 338:423-42 3Moore K, et al. AJOG 2007; 197:141e1-141e6 4Fuchs, et al. J Pedi Adol Gyn 2007;20:269-274.
![Page 17: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/17.jpg)
Frequency of screening
• 21 to 29 years• Cytology alone
• Every 3 years
• HPV testing should NOT be used to screen
• 30 to 65 years• Cytology alone (acceptable)
• Every 3 years
• Cytology and HPV testing (preferred)• Every 5 years
![Page 18: HPV: How to prevent your patients from becoming my patients Katina Robison, MD Assistant Professor, Department of Obstetrics & Gynecology Director of Colposcopy](https://reader035.vdocuments.us/reader035/viewer/2022062716/56649dba5503460f94aaaaaa/html5/thumbnails/18.jpg)
Can we screen for other HPV
related cancers?
Formal guidelines are lacking
Consider in HIV positive, MSM, and studies
underway in HIV negative women
Anal CytologyAnal Cytology