HPV and cervical cancer

Of the more than 50 million to 60 million Pap smears performed annually an estimated 3.5 million are abnormal.16 Approximately 10,520 cases of invasive cervical cancer will be diagnosed in the United States in 2005, and approximately 3,900 women will die from the disease.17

In most women, HPV is a transient infection. Even if high-risk types are present, the infection may spontaneously clear in one to two years without sequelae. The small proportion of women who develop cervical cancers do so over many years.6,15 The disproportionate rates between infection and disease underscore our lack of knowledge related to cancer development. These rates may also reflect cofactors necessary for disease, such as oncogenicity of the viral type in conjunction with previously mentioned risk factors.8


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Of those diagnosed with cervical cancer, 50% have never had a Pap smear, 10% are over the age of 65, and 25% have not had a Pap smear in the past five years.13 The peak incidence of cervical cancer occurs in women older than 40 years of age.6

Counseling messages

The psychological impact of an HPV diagnosis can be severe, oftentimes worse then the actual physical manifestations of infection. Patients can be educated through a series of resources including handouts, pamphlets, hotlines, and Web sites.

It is important to educate patients on the natural history of infection, the high prevalence of HPV among sexually active persons, and low likelihood of cancer development. They should also be told that this infection is almost always sexually transmitted. If the patient has had oral, vaginal, or anal contact with multiple sex partners, it is difficult, if not impossible, to determine the duration of infection. Current sex partners are usually infected by the time of diagnosis.

While the patient should be prepared to have candid discussions with future sex partners, the value of disclosing a past diagnosis is unclear because HPV is so common among sexually active people and the duration of infectivity is unknown. The probability of transmission to future partners is unknown. And although latex condoms do not cover the entire genital area and therefore are not 100% effective in stopping transmission, they are the best option for preventing the spread of HPV, and their use should be strongly encouraged. 

Ms. Grimshaw is a family nurse practitioner and assistant medical director of the Montefiore Medical Center STD Center for Excellence in Bronx, N.Y.

References

  1. Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Eng TR, Butler WT, eds. Washington, D.C.: National Academy Press; 1997.
  2. Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6-10.
  3. Cates W Jr. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. American Social Health Association Panel. Sex Transm Dis. 1999;26(4 Suppl):S2-S7.
  4. Division of STD Prevention. Prevention of Genital HPV Infection and Sequelae: Report of an External Consultants’ Meeting. Atlanta, Ga.: Centers for Disease Control and Prevention: December 1999.
  5. Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med. 1997;102:3-8.
  6. Ho G, Bierman R, Beardsley L, et al. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998;338:423-428.
  7. The Kaiser Family Foundation/Glamour 1998 Survey of Men and Women on Sexually Transmitted Diseases. Menlo Park, Calif.: Kaiser Family Foundation; 1998.
  8. Jay N, Moscicki AB. Human papillomavirus infections in women with HIV disease: prevalence, risk, and management. AIDS Read. 2000;10:659-668.
  9. Sexually transmitted disease treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002;51:1-78.
  10. Galloway DA. Biology of genital human papillomaviruses. In: Holmes KK, Sparling PF, Mardh P-A, et al, eds. Sexually Transmitted Diseases. 3rd ed. New York, N.Y.: McGraw-Hill Inc.;1998:chap. 24.
  11. Evander M, Edlund K, Gustafsson A, et al. Human papillomavirus infection is transient in young women: a population-based cohort study. J Infect Dis. 1995;171:1026-1030.
  12. Winer RL, Lee SK, Hughes JP, et al. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Am J Epidemiol. 2003;157:218-226.
  13. Manhart LE, Koutsky LA. Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sex Transm Dis. 2002;29:725-735.
  14. Medscape. Smith-McKune K. Therapeutic options for genital warts.
  15. Woodman CB, Collins S, Winter H, et al. Natural history of cervical human papillomavirus infection in young women: a longitudinal cohort study. Lancet. 2001;357:1831-1936.
  16. National Cancer Institute. Cancer facts.
  17. American Cancer Society. What are the key statistics about cervical cancer?