HPV and Cervical Cancer

            Prior to the use of the Pap smear test the incidence of cervical cancer was much higher than it is presently. The incidence and mortality of cervical cancer has decreased significantly over the past four decades (Mandelblatt, 2002, 2372). The success of the widespread use of the Pap smear has led to earlier detection of cervical cancer (Mandelblatt, 2002, 2372). Currently, about fifty million Pap smears are performed each year in the United States but the high rates of false negative (as high as 25% – 50%) has required that more advanced tests be developed and used (Mandelblatt, 2002, 2372). The HPV test is becoming a more common measure to detect cervical cancer when used alone or more often in combination with a Pap smear (Mandelblatt, 2002, 2372).

            Up until now, Pap smears have been the primary intervention used to detect cervical cancer as soon as possible. Recently, HPV tests and liquid-based cytology tests have been added to detect cervical cancer better and more often (Saslow, 2007, 7). In addition, two vaccines (Gardasil and Cervarix)  have been developed that can help protect a woman from both HPV and cervical cancer as testing positive for HPV may lead to cervical cancer (Saslow, 2007, 7). However, education must be the first step in ensuring that women go to the doctor and get the necessary tests. Further, young women must be educated about unprotected sex and the lifetime risk of contracting HPV (Saslow, 2007, 7). HPV affects millions of women across the country and this has a very real impact on society as it is the most common sexually transmitted disease in the world (Saslow, 2007, 11). HPV can lead to cervical cancer which in 2006 was diagnoses in 9710 women of which 3700 died (Saslow, 2007, 10). Approximately 70% of all cervical cancers are caused by HPV types 16 or 18 (Saslow, 2007, 10). Therefore, education about lifetime risk as well as ways to reduce the risk is crucial for young girls.

            In studies of the natural history of cervical cancer it has been shown that infection with carcinogenic HPV can lead to low-grade or high-grade lesions. High-grade lesions can lead to cervical cancer if not treated (Saslow, 2007, 11). Women often get HPV infections and they go away on their own in a relatively short amount of time. “Approximately 75% of low-grade lesions in adults and 90% of low-grade lesions in adolescents resolve without treatment” (Saslow, 2007, 11).  However, some women experience persistent infection and these women are at the highest risk for developing precancerous legions and cancer (Saslow, 2007, 11). The longer the infection persists the less likely that a woman will be able to clear the infection on her own (Saslow, 2007, 11). Therefore, early detection is key and this is done through the use of HPV tests and Pap smears.

            Intervention is necessary in protecting women from both HPV and cervical cancer. The primary method used to reduce HPV risk is education. Education provides healthy young girls with the information necessary to stay healthy. Secondary measures include HPV vaccines given to young girls between the ages of 9 and 26, HPV gene testing and Pap smears so that a problem can be detected as soon as possible (Saslow, 2007, 11). However, if HPV or cervical cancer is diagnosed, tertiary interventions would include any medical treatment mandated by the doctor including medications and doctor visits.

            In the Healthy People 2010 guidelines, reducing the risks associated with HPV is mentioned in the Responsible Sexual Behavior section. One goal is to reduce the rates of HPV as a sexually transmitted disease (Healthy People 2010, 1). One way this is being done is by educated young people about the importance of using condoms or abstaining from sexual activity all together (Healthy People 2010, 1). Currently, only 23% of females report making their partner use a condom and Healthy People 2010 hopes this number rises to 50% by 2010 (Healthy People 2010, 1).

Healthy People 2010. (2008). Leading Health Indicators. Retrieved on November 14, 2008 from

            http://www.healthypeople.gov/Document/html/uih/uih_bw/uih_4.htm#sex.

Mandelblatt, Jeanne S. (2002). Benefits and Costs of Using HPV Testing to Screen for Cervical

            Cancer. Journal of American Medicine, 287 (18): 2372 – 2383.

Saslow, Debbie. (2007). American Cancer Society Guideline for Human Papillomavirus (HPV)

            Vaccine Use to Prevent Cervical Cancer and Its Precursors. A Cancer Journal for

            Clinicians, 57 (1): 7 – 31.

 

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