Hpv Virus - Treating

Aschkenazi-Steinberg SO, Spitzer BJ, Spitzer M. Department of Obstetrics and Gynecology, North Shore University Hospital, Manhasset, NY, USA.

OBJECTIVE: To explore the role played by excision of the transformation zone in women diagnosed with cervical intraepithelial neoplasia (CIN) in the disappearance of human papillomavirus (HPV). MATERIAL AND METHODS: In a retrospective, cohort study, women with CIN who were treated by loop electrosurgical excision procedure of the transformation zone were compared with another group of women with CIN who were managed expectantly. The decision to treat or manage expectantly was made by one of the authors on clinical grounds. All patients were evaluated with cervical cytologic analysis, pathologic examination of excised tissue, and HPV DNA testing, which was considered positive when high-risk HPV types were detected. Among women treated with loop electrosurgical excision procedure, the median lag time was calculated from diagnosis of CIN to treatment. The median time for conversion from HPV-positive to HPV-negative status in both groups was compared, as well as the 1- and 2-year cure rates (defined as converting to HPV-negative status) in the treated and untreated groups. RESULTS: In the treated group, 12% had CIN 1, 83% had CIN 2,3, 2% had cancer, and 3% had normal pathologic results. In the untreated group, 82% had CIN 1, 16% had CIN 2,3, and 2% had normal pathologic results (p < 0.0001). The lag time from the initial diagnosis of CIN to treatment was less than 1 month. The median follow-up time was 7 months (range, 1-121 months) in the treated group and 13 months (range, 1-70 months) in the untreated group. The 1-year rates of conversion to HPV-negative status, defined as the cure rates in the treated and untreated groups, were 65% (+/- 6%) and 23% (+/- 7%), respectively, and the 2-year cure rates in the treated and untreated groups were 90% (+/- 4%) and 56% (+/- 11%), respectively (p < 0.0001). Median time to conversion to a negative HPV status was 7.7 months for the treated patients compared with 19.4 months in the untreated patients (p < 0.0001). CONCLUSIONS: Women treated by loop electrosurgical excision procedure are more likely convert to HPV-negative status at 1 and 2 years and do so significantly sooner than those managed expectantly.

Curr Opin Pediatr. 2004 Aug;16(4):344-9.

New strategies for cervical cancer screening in adolescents.

Gray SH, Walzer TB. Division of Adolescent/Young Adult Medicine, Department of Medicine, Children's Hospital Boston, MA 02115, USA.

PURPOSE OF REVIEW: This paper reviews the epidemiology and natural history of human papillomavirus (HPV) infection in young women, the development of new technologies for cervical cytology screening, proper cervical cytology sampling technique, the new Bethesda system for reporting cervical cytology findings, and several recent professional society guidelines for cervical cytology screening and management of cytologic abnormalities in adolescents. RECENT FINDINGS: Natural history studies of HPV infection in healthy young women show that infection is quite prevalent, but is generally transient. New and sensitive technologies such as HPV DNA testing and liquid-based cytology are more likely to detect cytologic abnormalities in young women who are at low risk for actual invasive cervical disease. This sensitivity potentially places adolescents at risk for increased anxiety, testing, and intervention. The multi-center ASCUS-LSIL Triage Study has shown that HPV DNA testing can be used safely to minimize intervention in many cases. SUMMARY: HPV infection is common in young women, but rarely progresses to invasive cervical disease. Providers need to inform themselves about new professional society guidelines that suggest delaying initiation of cervical cancer screening to within 3 years of onset of sexual activity. Given the idiosyncrasies of this population, the authors counsel using clinical discretion when applying these guidelines to individual teenagers. In light of the extremely low likelihood of invasive disease in this age group, providers must separate the provision of contraceptive services and sexually transmitted disease screening from requirements for cervical cancer screening.

Publication Types:
• Review
• Review, Tutorial

Salud Publica Mex. 2003;45 Suppl 3:S367-75.

Prospects for controlling cervical cancer at the turn of the century.

Franco EL, Duarte-Franco E, Ferenczy A. Department of Oncology, Department of Epidemiology and Biostatistics, McGill University, 546 Pine Avenue West, Montreal, QC, Canada H2W 1S6.

Cervical cancer morbidity and mortality have decreased substantially during the last 50 years mostly due to successful organized or opportunistic screening with Pap cytology in high and middle income countries. In many low income countries Pap cytology screening is yet to be effectively implemented or has failed to reduce cervical cancer rates to an appreciable extent. The fact that infection with certain human papillomavirus (HPV) types is now recognized as a necessary cause of this disease has led to new research fronts on prevention of cervical cancer. Testing for HPV DNA has shown great promise as a screening tool with better sensitivity but somewhat lower specificity than Pap cytology. In combination with the latter, HPV testing has the potential to improve the negative predictive value of cytology, thus allowing for increased testing intervals, which would lower program costs with acceptable safety. Advances in cytology processing and automation have also led to new screening approaches that are increasingly gaining acceptance in high and middle income countries. For low income countries, visual inspection with acetic acid has proven to be an effective alternative to conventional Pap cytology, especially in settings where no screening programs have been implemented. Concerning primary prevention of cervical cancer, recent research on the safety and efficacy of candidate prophylactic vaccines against HPV have shown very promising results with nearly 100% efficacy in preventing persistent infections and development of cervical cancer precursors. However, policy makers are strongly cautioned to avoid deferring decisions concerning the implementation of cervical cancer screening under the expectation that a successful vaccine could obviate the need for secondary prevention strategies. This paper is available too at: http://www.insp.mx/salud/index.html.

Publication Types:
• Review
• Review, Tutorial

Salud Publica Mex. 2003;45 Suppl 3:S326-39.

Epidemiology of human papillomavirus infections: new options for cervical cancer prevention.

Bosch FX. Epidemiology and Cancer Registration Unit (SERC), Catalan Institute of Oncology (ICO), Hospital Duran i Reynals, Avenida Gran Via, s/n km. 2,7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.

In the last two decades, the cervical cancer puzzle has become a coherent description that includes the identification of human papillomavirus (HPV) as the sexually transmitted etiologic agent and the characterization of the major determinants of HPV acquisition. Triage studies have consistently shown that HPV testing is more sensitive that repeated cytology in identifying underlying high-grade lesions in women with atypical squamous cells of undetermined significance (ASCUS). Studies that reflect primary screening conditions have shown that the sensitivity of HPV tests is higher than standard cytology in detecting high-grade lesions whereas the specificity is similar only in women aged 30-35 and above. HPV vaccines have an intrinsic attraction as a preventive strategy in populations with limited resources. However, vaccines designed to widespread use are still in development and testing phases. Time is ripe for exploring in depth the clinical implications of current achievements and to devise novel strategies for the prevention of cervical cancer. This paper is available too at: http://www.insp.mx/salud/index.html.

Publication Types:
• Review
• Review, Tutorial

Am J Obstet Gynecol. 2003 Oct;189(4 Suppl):S37-9.

Toward a reduction of the global burden of cervical cancer.

Rohan TE, Burk RD, Franco EL. Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461, USA.

Of the 190,000 deaths from cervical cancer that occur annually worldwide, the majority take place in developing countries. Recent advances in our understanding of the causes and natural history of cervical neoplasia and, in particular, the establishment of the central role of human papilloma virus (HPV) infection have created opportunities for the primary and secondary prevention of cervical cancer. In the future, prevention efforts will include the incorporation of HPV testing as an adjunct to or replacement for cytology-based screening programs and the use of recombinant DNA technologies for the development of prophylactic vaccines.

Publication Types:
• Review
• Review, Tutorial

Hpv Viruses - Treating HPV Manifestations Links

"LEEP" Procedure - Read about one of the methods for treating abnormal Pap smear.

Healing Cervical Dysplasia - A guide on herbs for healing cervical dysplasia and other disorders.