Human Papilloma Virus Pictures - Treatment

Klug SJ, Hetzer M, Blettner M. Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University Hospital, University of Mainz, 55101 Mainz, Germany.

Background: Few data exist on attendance for cervical and breast cancer screening, breast self-examination and knowledge about risk factors for cervical cancer among German women. A population-based survey was performed in the city of Bielefeld in Germany. Method: A questionnaire was mailed to 1500 randomly selected women age 25 to 75. Of those, 540 questionnaires were returned and 532 were analysed. Results: Women participating in the survey considered themselves well informed about possibilities for early detection of breast cancer (84.0%). Most information was received from office-based gynaecologists (82.4%). 82.8% had a breast examination by a medical doctor annually and 43.1% practised breast self-examination every month. 55.5% of the women had had a mammography, 72.5% gave screening as a reason for a mammogram. Age at first mammography was associated with social class (p<0.001). Cytological smears for early detection of cervical cancer were common and obtained frequently. Age at first Pap smear was associated with social class (p<0.001). 69.9% of the women considered themselves insufficiently informed on risk factors for cervical cancer. Women were poorly informed about risk factors for cervical cancer. Only 3.2% knew that infection with human papillomavirus (HPV) is a risk factor for cervical cancer. Giving a correct answer was associated with social class (p<0.001) but not with age. Conclusion: Rates of opportunistic mammography screening were high in the study population. Information on risk factors for cervical cancer was scarce. Efforts should be made to improve women's knowledge about risk factors for cervical cancer.

J Obstet Gynaecol Can. 2004 Sep;26(9):788-92.

Human papilloma virus testing knowledge and attitudes among women attending colposcopy clinic with ASCUS/LGSIL pap smears.

Le T, Hicks W, Menard C, Boyd D, Hewson T, Hopkins L, Kee Fung MF. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, Ottawa ON.

OBJECTIVE: To study women's knowledge regarding the role of human papilloma virus (HPV) in cervical intraepithelial neoplasia and their attitudes toward the integration of HPV testing as part of routine follow-up of atypical squamous cell of uncertain significance/low-grade squamous intraepithelial lesion (ASCUS/LGSIL) abnormalities. METHODS: Over a 12-month period, all women attending the University of Ottawa colposcopy clinic for evaluation and follow-up of ASCUS/LGSIL Pap smears were recruited. Demographic data included age, nature of the Pap smear abnormality, gravidity, parity, occupation and education level, smoking history, previous history of abnormal smears, colposcopic examination and treatment, and current method of contraception. The women were asked to rate their level of concern over their Pap smear abnormality, from 0 (not concerned) to 10 (very concerned). Women's knowledge regarding the role of HPV in cervical intraepithelial neoplasia and the rationale behind the use of HPV testing was assessed by the clinic nurse as being minimal, moderate, or good, as defined by pre-specified criteria. Upon explanation by the nurses of the results of the recent ALTS (ASCUS/LGSIL Triage Study) trial, the women were asked to state whether they preferred to continue with regular colposcopic surveillance every 6 months, or to use the results of the HPV test, if negative, to reduce the number of colposcopy examinations to one annually. Descriptive statistics and logistic regression analysis were used to identify significant demographic factors associated with the women's preference for incorporation of HPV testing in their follow-up. All P values less than.10 were considered to be statistically significant, due to the exploratory nature of the study. RESULTS: Of the 100 women who participated in the study, 42% presented with ASCUS. The mean age (+/- SD) of the women was 33.63 +/- 11.25 years (range, 18-75 years); 66% were office workers with at least a community college degree, 86% reported previous abnormal Pap smears, and 67% had previously been seen for colposcopy. Fifty-eight percent of the women rated their concern level as being 6 or more, while 15% ranked their concerns as maximal at 10. In terms of knowledge about HPV, 75% of the women had no or very minimal knowledge of the role of HPV in cervical intraepithelial neoplasia. With regard to HPV testing, 84% of the study group had either never heard of the test or had only a minimal knowledge of HPV testing. After being informed of the ALTS results, 64% of the women chose to use HPV testing to help in triaging the needs for frequent colposcopy. Logistic regression modelling showed that a college level education (odds ratio [OR], 2.27; 95% confidence interval [CI], 0.95-;5.45; P =.06) and history of previous treatment for abnormal Pap smears (OR, 3.31; CI, 0.88- 12.46; P =.07) were closely associated with the adoption of HPV testing in clinical management. CONCLUSION: There exists a significant lack of knowledge about HPV and its role in the pathogenesis of cervical intraepithelial neoplasia.Women who have received previous treatments for cervical intraepithelial neoplasia and those with college-level educations were more likely to adopt this new technology as part of their care.

Cancer Genet Cytogenet. 2005 Apr 1;158(1):35-42.

cDNA array analysis of cytobrush-collected normal and malignant cervical epithelial cells: a feasibility study.

Hudelist G, Czerwenka K, Singer C, Pischinger K, Kubista E, Manavi M. Department of Gynecology and Obstetrics, Division of Special Gynecology, University of Vienna Medical Center, Vienna, Austria.

Analysis of gene expression pattern is a useful approach to evaluating the biological behavior and clinical outcome of several human malignancies. Differentially expressed genes in malignant squamous cervical cells and the feasibility of gene expression profiling on squamous cervical cells obtained from cervical swabs were investigated. Cervical squamous cells from three women with high-risk human papilloma virus (HR-HPV) positive invasive squamous cervical carcinoma and from three HPV-negative women with normal ectocervical smears were analyzed with cDNA array. Immunoblot analysis was performed to detect the proteins corresponding to the highest upregulated genes with cDNA array. mRNA expression of ERBB2, KIT, FLT1, MYCN, RAS, CDKN2A, CCND1, NME1, NME2, MET, FGF7, FGFR2, and STAT1 was increased in malignant samples. Several expressed genes associated with antiapoptosis (such as BCL2), cell structuring, or cell attachment were also upregulated in carcinoma cells. Decreased gene expression was observed for members of the transforming growth factor receptor superfamily (TGF) and integrin family, interleukin 1 (IL1), and insulin-like growth factor binding proteins (IGFBPs). This study shows the feasibility of gene expression profiling of cervical squamous cells obtained with cytobrushes by identifying a characteristic gene expression pattern that clearly distinguishes between malignant and normal cervical epithelia of squamous type. We hypothesize that this noninvasive technique could be used in the evaluation of ambiguous Papanicolaou (PAP) smears.

J Am Acad Nurse Pract. 2004 Oct;16(10):455-61.

Evidence for practice: oral contraception and risk of cervical cancer.

Bertram CC. Queen's Medical Center, University of Hawaii School of Nursing and Dental Hygiene, USA. ccramer@queens.org

PURPOSE: The issue of continued oral contraceptive use among women with abnormal Pap smears may be controversial due to reported evidence of an increased risk of cervical cancer among long term oral contraceptive users. This article reviews the evidence concerning oral contraception and cervical cancer risk. The role of Human Papilloma virus (HPV) and proposed mechanisms for the development of cervical cancer are explained. Evidence from World Health Organization (WHO) studies and additional research evidence are discussed. Implications for clinical practice are included. DATA SOURCES: WHO commissioned studies, additional relevant studies searchable from an EBSCO database, and texts that describe the natural history of HPV. CONCLUSIONS: Epidemiological studies and biomedical research suggest a role for steroid hormones, such as oral contraceptives, in facilitating the action of HPV. However, a majority of HPV infections resolve spontaneously, despite widespread use of oral contraception. Oral contraception does not appear to increase incident HPV infection or persistence of HPV infection. The benefits of oral contraceptives appear to outweigh the risks associated with HPV facilitation. IMPLICATIONS FOR PRACTICE: NPs inform patients of abnormal Pap smears, manage the clinical care of women at risk of cervical cancer, and provide educational counseling regarding contraceptive choices. Ethical considerations include clear disclosure of potential risk. However, a risk-benefit analysis supports continued use of oral contraception among women who have abnormal Pap smears but also have access to clinical surveillance.

Publication Types:
• Review
• Review, Tutorial

BMC Womens Health. 2004 Aug 25;4 Suppl 1:S13.

Cancer of the Uterine Cervix.

Duarte-Franco E, Franco EL. Departments of Oncology and Family Medicine, McGill University, Montreal, Canada. eliane.franco@mcgill.ca

HEALTH ISSUE: Cervical cancer is one of the most common malignant diseases of women; it is diagnosed in almost half a million women every year and half as many die from it annually. In Canada and other industrialized countries, its incidence has decreased due to cytology screening. However, invasive cases still occur, particularly among immigrant groups and native Canadian women. Although incidence of squamous cell carcinomas has decreased, the proportion of adenocarcinomas has increased because Pap cytology is ineffective to detect these lesions. KEY FINDINGS: In Canada, cervical cancer will cause an estimated 11,000 person-years of life lost. In most Canadian provinces, early detection is dependent on opportunistic screening. Primary prevention can be achieved through health education (sexual behavior modification) and vaccination to prevent infection from Human Papillomavirus (HPV). The initial results from vaccination trials are encouraging but wide scale use is more than a decade away. DATA GAPS AND RECOMMENDATIONS: Most cases of cervical cancer occur because the Pap smear was either false negative, was not done or not done often enough. Appropriate recommendations and guidelines exist on implementation of cytology-based programs. However, most Canadian women do not have access to organized screening. Further research is needed to 1) evaluate automated cytology systems; 2) define appropriate management of precursor lesions and 3) deliver definitive evidence of HPV testing efficacy in long-term follow-up studies with invasive cancer as an outcome and 4) provide Canadian data to justify augmenting or modifying current programs to use HPV testing in secondary triage of equivocal Pap smears.

BJOG. 2004 Aug;111(8):842-8.

Comparison of HPV test versus conventional and automation-assisted Pap screening as potential screening tools for preventing cervical cancer.

Nieminen P, Vuorma S, Viikki M, Hakama M, Anttila A. Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland.

OBJECTIVE: To evaluate new techniques in primary cervical cancer screening programmes. DESIGN: Cross sectional pilot study. SETTING: Department of Obstetrics and Gynaecology, Helsinki University Hospital. POPULATION: Consecutive 2032 human papillomavirus (HPV) DNA and Pap smear samples were taken. Histological diagnoses were obtained from 460 patients. METHODS: We compared the validity of the high risk (HR) HPV DNA detection test to automation-assisted and conventional Pap smear screening. MAIN OUTCOME MEASURES: Specificity and sensitivity of screening methods. RESULTS: Twenty-three percent of women were HPV positive. Forty-five of 46 had high grade lesions and cancers were HR HPV DNA positive, whereas 72/93 of low grade and more severe lesions were HR HPV DNA positive. When histologically verified high grade lesions were observed, the relative sensitivity of HR Hybrid Capture 2 (HR HC2) test was 98% compared with conventional Pap smear and Papnet tests, which performed 54%versus 58%, 83%versus 86% and 93%versus 98% relative sensitivity respectively, using cytological diagnoses HSIL (high grade squamous intraepithelial lesion), LSIL (low grade squamous intraepithelial lesion) or ASCUS (atypical squamous cells of undetermined significance) as the cutoff. The specificity of HC2 test (77-79%) was comparable with the ASCUS+ (ASCUS and more severe) cytology (68-79%), but lower when compared with LSIL+ (91-95%) or especially HSIL+ (97-99%) Pap smear results. CONCLUSION: Pap smear, as a screening test, is very different from HPV DNA detecting test HR HC 2. If cutoff LSIL or more severe lesions is used, primary Pap smear is clearly more specific than HR HC2, but markedly less sensitive. Due to high relative sensitivity of the HPV, only very few histologically confirmed high grade lesions would be detected among HPV negatives using simultaneous cytology. On the other hand, using HPV DNA test alone would lead to multifold amounts of referrals for colposcopy. A posterior Pap smear assessment among HPV positives might be helpful in increasing sensitivity and specificity of screening and defining those who need an immediate referral or treatment. We plan to incorporate primary HR HPV DNA test with posterior Pap smear reading of HPV positives into our ongoing randomised prospective multiarm trial evaluating new techniques in organised screening for cervical cancer in Finland.

Publication Types:
• Evaluation Studies

Human Papilloma Virus Pictures - HPV Treatment Links

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