Human Papillomavirus and Cervical Cancer

Sexually Transmitted Diseases/Infections

HUMAN PAPILLOMAVIRUS AND CERVICAL CANCER

Vaccines for human papillomavirus (HPV) represent the next major breakthrough in prevention of cancer and sexually transmitted infections. The Association of Reproductive Health Professionals (ARHP) supports the development of and widespread access to HPV vaccines as part of a comprehensive prevention screening and treatment strategy for cervical cancer and other HPV-related conditions, such as genital warts. HPV vaccines will be able to prevent some of the most virulent strains of HPV that cause cervical cancer and genital warts.

Cervical cancer has become the second most common female malignancy worldwide and kills nearly 250,000 women each year.[1,2] In the United States alone, every year close to 12,000 women are diagnosed with cervical cancer, resulting in 4,000 deaths.[3] Nearly half of the women who are diagnosed with cervical cancer in the United States have not been properly screened.[4] For this reason, routine visits to a health care provider for ongoing surveillance remain a critical component in the fight against cervical cancer. ARHP encourages health care providers to adopt screening for HPV using the latest technologies available, including the liquid-based Pap test and HPV DNA testing, for all appropriate candidates.

ARHP encourages HPV vaccines to become the standard of care. ARHP supports the recommendation of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) that HPV vaccines be added to the routine schedule for girls and women throughout the age ranges as deemed appropriate by ACIP. ARHP supports the vaccines’ placement on CDC’s “Vaccines for Children” program, which helps ensure that girls from low-income families are immunized. ARHP strongly encourages all states within the United States to adopt vaccination policies to ensure that all people can easily access this important method of prevention.

ARHP supports and encourages access to HPV and cervical cancer prevention, screening, and treatment for women and girls, regardless of age, race, ethnicity, income, sexual orientation, or immigration status. Although HPV vaccines are important developments in efforts to eradicate cervical cancer and genital warts, disparities in access to health care continue to be a public health challenge. Lack of access leaves many girls and women without regular and adequate preventive health care services. To encourage equal access to these technologies by all people who need them, ARHP supports private insurance coverage and public funding for the vaccines and related prevention, screening, and treatment technologies and encourages the US Department of Health and Human Services to make the vaccines available through the Title X program initiative.

HPV vaccines can be effective only if providers and the public are educated about their safety and efficacy and are encouraged to offer and receive them. ARHP supports provider training for the vaccine and related screening and treatment technologies and their incorporation into practice and for public education about the benefits of these new tools. While vaccines offer a new approach to preventing HPV and cervical cancer, ARHP encourages health care providers to continue promoting safe sex practices and choices to their patients.

1. Eddy DM. Screening for cervical cancer. Ann Intern Med 1990;113(3):214-26.
2. Sawaya GF, Brown AD, Washington AE, Garber AM. Clinical practice. Current approaches to cervical cancer screening. N Engl J Med 2001;344:1603-7.
3. American Cancer Society. (2004, accessed October 27, 2004) Cancer Facts & Figures 2004. [Online] www.cancer.org/downloads/STT/CAFF_FinalPWSecured.pdf.
4. National Institutes of Health. Cervical Cancer. NIH Consensus Statement. 1996;14:1-38.

ARHP's position statement on HPV and cervical cancer was recommended by ARHP's policy committee on August 25, 2006 and approved by ARHP's board of directors on September 6, 2006. This Position Statement is currently under Policy Committee review for update.

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SEXUALLY TRANSMITTED DISEASES/INFECTIONS

Sexually transmitted disease/infection (STD/STI) prevention education, screening, and treatment services should be incorporated into medical care wherever appropriate. This includes not only family planning clinics, where many do provide STD/STI prevention services, but also primary care clinics.

All health care providers should be trained to diagnose, treat, and promote prevention of STD/STI. Services should be provided with cultural competency appropriate to the particular individual being served.

Research on prevention, cures, and treatment, including vaccines, for STD/STIs should be a priority for government and private industry. Because women are disproportionately affected by STD/STIs and their consequences, an emphasis should be placed on female-controlled methods.

Public education programs that use a combination of approaches to prevent STD/STIs transmission are essential.

• Promoting abstinence is a useful and important way to prevent the transmission of STD/STIs; promoting abstinence at the expense of education about effective condom use can only increase the incidence of STD/STIs. Educational programs should highlight the fact that the consistent and correct use of condoms during sexual activity is very effective in preventing the spread of STD/STIs.[1]
• Comprehensive school-based STD/STIs education that is appropriate to students' age and developmental level is an essential part of education programs. Effective programs respect the diversity of values and beliefs represented in the community and complement and augment the STD/STIs education children receive from their families.
• Effective school-based STD/STIs education curricula provide comprehensive, medically accurate information on sexual and reproductive behavior and health. ARHP supports abstinence education as a component of an overall STD/STIs prevention strategy, and recommends that abstinence be taught in the context of a comprehensive program of sexuality education so that individuals have all the information they need to make safe and informed choices about their sexual behavior.
• Within public education programs, particular emphasis should be placed on special populations most at risk for STD/STIs in the United States and abroad.

Health care providers should consider routine and confidential testing for STD/STIs for patients at high risk. Testing for STD/STIs is a matter between patients and health care providers and justification for these tests to government agencies is an invasion of privacy.

All individuals, regardless of insurance status or coverage, should have full and equal access to available HIV/AIDS treatments.

Reference:
1. Warner DL. Male condoms. In: Hatcher RA, Trussell J, Stewart F, et al (eds): Contraceptive Technology, Seventeenth Revised Edition. New York: Ardent Media, 1998, pp. 325-355.

ARHP's Sexually Transmitted Diseases/Infections statement was approved by ARHP's board of directors on September 12, 2003. This Position Statement is currently under Policy Committee review for update.