| Clinicians who provide care for women receiving
this diagnosis must be prepared to answer
questions factually and to clarify the questions
that do not yet have answers. This is especially
true given the availability of testing for HPV.
Clinicians who order HPV testing must understand
the key issues and implications of HPV
testing and be able to responsibly communicate
these topics to women. Clinicians and patients
also should be aware that the availability of
HPV testing and the potential for reducing
the frequency of cervical screening for women
with normal results do not negate the need for
routine preventive health maintenance visits that
include pelvic bimanual examinations and breast
cancer screening—examinations that historically
have been performed at the time of “the
annual Pap.”
Most women are still unfamiliar with HPV and
are understandably uncertain of the ramifications
of the diagnosis. Ideally, providers should
teach their patients about HPV at the beginning
of the cervical screening experience. HPV is a
virus that most people are exposed to. In this
way, HPV is very much like a “cold” virus. HPV
infection is not a marker of aberrant behavior or
cheating on the part of a partner. However, even
with counseling, learning that one has a sexually
transmitted infection is usually alarming, and
women who receive an abnormal Pap result may
be quite anxious.
Nervous patients may confuse the acronym
“HPV” with the more commonly heard “HIV”
because they sound alike. The distinction
between these two sexually transmitted infections
should be made absolutely clear at the
beginning of any discussion.
It is important for patients to understand that
the majority of sexually active individuals will
be infected with HPV at some point in their lifetime
and that the infection is generally transient
and cleared by the immune system. They should
understand that most young women with mild
cellular changes have been infected with highrisk
HPV types. They should also understand
that most infections are cleared to undetectable
viral levels, so a diagnosis of HPV only rarely
leads to the development of a significant
lesion. Only women with persistent infection
with a high-risk HPV type are at risk.
Women should know that cervical cancer is
rare, and that it can be prevented or successfully
treated with proper follow-up and
early intervention.
It is also helpful to empower patients by exploring behavior changes
that have the potential to reduce their risk of developing cervical cancer,
such as smoking cessation. Practicing safer sex can reduce their risk
for sexually transmitted infections, including HPV and HIV. However, condoms
are not entirely effective in preventing HPV infections. (For information
about safer sex practices, please refer to http://www.plannedparenthood.org/sti/.)
A woman’s usual system of support on which
she has depended for other crises in her life
may or may not seem appropriate when
addressing the diagnosis of HPV. Culturally
sensitive, educationally appropriate written
information can reinforce your counseling
and give the patient another opportunity to
process helpful information in the privacy
of her own home. Patients usually do not
absorb all of the information that is discussed
when they first receive the diagnosis.
Give them an opportunity to return and discuss
the information at a later date. Support
groups can be helpful. Remember that some
patients who are dealing with other stressful
events in their lives may need to be referred
for psychological counseling if concerns do
not diminish.
The following
section of questions and responses about issues related to HPV and
cervical screening were prepared by Drs. Thomas Cox and Debbie Saslow
with input from many other individuals who have expertise in cervical
screening and HPV. This information is posted and updated regularly at
the American Cancer Society’s Web site, http://
www.cancer.org. We hope that these will be helpful for counseling
patients with HPV. |
