(Published January 2009)
Using This Guide
Cervical cancer is highly preventable with screening and early intervention. Despite this fact, about 11,150 new cases of cervical cancer occur annually in the United States.
Cervical cancer is the long-term sequela of a sexually transmitted and persistent infection with the human papillomavirus (HPV). Evidence suggests that persistent infection with a high-risk type of HPV is necessary for progression to a cancer precursor lesion and to invasive cervical cancer. Current evidence also suggests a strong association between infection with high-risk HPV and cancer of the penis, vagina, vulva, anus, and oropharynx.
For a patient with cervical cytology abnormalities and a positive HPV DNA test result, ideal management must balance (1) the need to identify and treat abnormalities that are likely to progress to invasive cancer with (2) the need to avoid unnecessary treatment of abnormalities related to transient HPV infection that is unlikely to lead to invasive cancer. Testing for HPV infection, screening for HPV-related disease, and managing HPV-associated conditions can be challenging topics for health care providers to master, especially with the shifts in recommendations about management that have occurred in response to the introduction of HPV DNA testing and liquid-based Pap tests.
This Quick Reference Guide for Clinicians offers concise guidance on the HPV-related issues that tend to be the most perplexing for front-line providers: the realities of HPV transmission and natural history, current recommendations for cervical cancer screening, efficacy and safety of the HPV vaccine, and key counseling messages for HPV and HPV-related diseases. For information about related topics that are covered thoroughly elsewhere, such as diagnosis and management of external genital warts and management of abnormal screening results for cervical cancer, please refer to Appendix B or visit ARHP’s online HPV resource center at www.arhp.org/Topics/Reproductive-Cancers.
Only a well-informed health care professional can effectively communicate with patients about HPV-related risks, dispel myths, and supply accurate information about the virus, associated conditions, and appropriate medical care. We hope this Quick Reference Guide will highlight important areas of concern, clarify the optimal screening for and management of HPV-related disease, and provide useful tips for counseling patients about HPV, ultimately helping providers close the gap between ideal and delivered care.
Abbreviations and Acronyms used in this Guide:
- ACIP Advisory Committee on Immunization Practices
- ACS American Cancer Society
- AGC atypical glandular cells
- ACOG American College of Obstetricians and Gynecologists
- AIN anal intraepithelial neoplasia
- AIS adenocarcinoma in situ
- ASCCP American Society for Colposcopy and Cervical Pathology
- ASC-H atypical squamous cells cannot exclude HSIL
- ASC-US atypical squamous cells of undetermined significance
- CDC Centers for Disease Control and Prevention
- CIN cervical intraepithelial neoplasia
- DES diethylstilbestrol
- FDA Food and Drug Administration
- HIV human immunodeficiency virus
- HPV human papillomavirus
- HSIL high-grade squamous intraepithelial lesion
- ITT intention to treat
- LSIL low-grade squamous intraepithelial lesion
- NOS not otherwise specified
- OC oral contraceptive
- SCC squamous cell carcinoma
- STIs sexually transmitted infections
- USPSTF United States Preventive Services Task Force
