Emerging Challenges in Primary Care. Cervical Cancer Screening: Appropriate Use of Pap & HPV Testing
|
|
- Austin Miller
- 6 years ago
- Views:
Transcription
1 Emerging Challenges in Primary Care Cervical Cancer Screening: Appropriate Use of Pap & HPV Testing
2 Faculty Nancy R. Berman, MSN, ANP-BC, NCMP, FAANP Adult Nurse Practitioner Certified Menopause Practitioner Millennium Affiliated Physicians Division of Michigan Healthcare Professionals Farmington Hills, MI
3 Disclosures Nancy R. Berman, MSN, ANP-BC, NCMP, FAANP serves as an advisory board committee member and speaker for Hologic (Self), Bayer (Spouse). Additionally, her spouse serves as a speaker for Smith and Nephew.
4 Learning Objectives 1. Describe the role of persistent oncogenic HPV in the development of pre-cancer and cancer of the cervix. 2. Describe the use of HPV testing as co-testing along with the Pap in cervical cancer screening in women 30 and older. 3. Describe the use of HPV primary screening in women 25 and older. 4. Describe 3 important messages that clinicians will teach women regarding HPV infection.
5 Goal of Cervical Cancer Screening Prevent morbidity and mortality from cervical cancer by: Identifying and treating high-grade cervical cancer precursors Avoiding unnecessary and potentially hazardous evaluations and treatment Minimizing costs to healthcare system Increase benefit and decrease harm! Saslow D, et al. CA Cancer J Clin
6 Being rarely or never screened is the major contributing factor to most cervical cancer deaths today.
7 Who are the Rarely and Never Screened? Descriptions Minorities Low SES* Foreign born Living in the US < 10 years No usual source of health care Where are the data? US Census NCHS Cervical cancer mortality BRFSS µ NHIS** * Socio-economic status National Center for Health Statistics, CDC µ Behavioral Risk Factor Surveillance System, CDC ** National Health Interview Survey, CDC
8 What s to Know, What s New and What s Changed HPV Natural History
9 HPV and Cervical Cancer Virtually all cervical cancers are associated with persistent infection with high-risk HPV types Data from a variety of studies have confirmed that certain HPV types are associated with cervical cancer: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 Others are probably associated, including: 26, 53, 66, 68, 73, 82 IARC. Monographs on the Evaluation of Carcinogenic Risks to Humans.; Munoz N. Vaccine
10 HPV Impact: Cervical Cancer In the US (2014 estimate): 12,340 cases per year 4,030 deaths per year Worldwide (2008 estimate): 530,000 cases per year 275,000 deaths per year 85% of deaths occur in developing countries Cervical cancer screening: costs $3.4 billion annually American Cancer Society. Cancer Facts and Figures. 2012; GLOBOCAN 2008 (IARC). Insinga RP. AJOG
11 HPV and Non-Cervical Cancers HPV 16 Evidence of causal role in cancer of vagina, vulva, penis, anus, oral cavity, oropharynx; limited evidence for carcinogenicity in the larynx HPV 18 Limited evidence of carcinogenicity in vagina, vulva, penis, anus, oral cavity, larynx HPV 6 and 11 Limited evidence of carcinogenicity in vulva, penis, anus, larynx Munoz N. Vaccine IARC. Monographs on the Evaluation of Carcinogenic Risks to Humans
12 High Lifetime Risk of HPV Infection 6.2 million new infections Approximately 20 million people in US currently are infected with HPV By age 50, 80% of sexually active women will have acquired genital HPV infection Weinstock H. Perspect Sex Reprod Health. 2004; CDC. Self-Study STD Module HPV Infection.
13 Role of Persistent Infection Persistent infection with high-risk types of HPV is necessary for the progression of high-grade lesions to invasive cancer Trottier H. Vaccine more
14 Role of Persistent Infection (Continued) Average episode lasts 4-20 months <50% of women have same type 1 year later Type 16 has a greater risk of persistence Trottier H. Vaccine
15 HPV and Cervical Cancer Putting Risk Into Perspective Risk (odds) of cervical cancer with HPV 16 compared with HPV ( ) is 455. Risk of lung cancer in U.S. white male smoker compared with nonsmoker is only 8. Risk of breast cancer with hormone replacement therapy is only 1.8. Educate the Educator: ASCCP 2016
16 Natural History of HPV & Cervical Cancer Persistence Normal Cervix Infection HPV Progression Invasion Infection Pre-cancer Clearance Regression Cancer Courtesy of M. Schiffman, National Cancer Institute.
17 Risk Factors for HPV Infection Sexual Activity Multiple Partners Younger age at sexual debut Lack of condom use Ley C. J Natl Cancer Inst. 1991; Winer RL. N Engl J Med. 2006; Ho GYF. N Engl J Med
18 Condom Use and HPV Prevention Rate of HPV infection per 100 patient-years at risk Winer RL. N Engl J Med
19 HPV Vaccination Before HPV exposure Boys and girls age 11 to 12 Catchup vaccination to age 26 Garland SM. N Engl J Med. 2007; Winer RL. J Infect Dis. 2005; CDC 2013; CDC 2014.
20 What s to Know, What s New and What s Changed Secondary Prevention Identifying and treating high-grade precancerous lesions
21 Current Approach to Cervical Cancer Prevention Requires four separate but linked components: HPV vaccination Screening Cytology with or without HPV testing Stand alone HPV testing: HPV Primary Screening Evaluation of screen-positive women using colposcopy and cervical biopsy Treatment of women with biopsy-confirmed highgrade cervical cancer precursors Wright T. Obst Gynecol Huh WK, Ault KA, Chelmow D, Davey D, Goulart FA, Garcia FA, Kinney WK, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Obstet Gynecol 2015:125:
22 Potential Harms From Cervical Cancer Screening Anxiety from an abnormal test that the patient might fear to be a sign of cancer Stigma from diagnosis of a ubiquitous sexually transmitted infection (HPV) Time and patient expense related to screening and management Pain and injury from the procedures and treatment Increased risk of premature delivery and pregnancy loss Einstein, M, Cox, J.T., Cervical Disease, OBG Management, Vol.25, May 2013
23 2012 ACS/ASCCP/ASCP Cervical Cancer Screening Guidelines Saslow, Solomon, Lawson, et al. JLGTD, March 14, 2012 (online) Saslow, Solomon, Lawson, et al. CA: A Cancer J for Clinicians, March 14, 2012 (online)
24 Age to Start Cervical Cancer Screening Factors to consider HPV infections are common in young women Cervical cancer is rare in adolescents/young women Evaluation of minor cytological abnormalities: Is expensive Causes anxiety Can lead to unnecessary treatments ACOG Committee on Gynecologic Practice. Obstet Gynecol
25 Guidelines: Age to Start Cervical Cancer Screening ACS/ASCCP/ASCP, ACOG, USPSTF agree: Start at age 21 regardless of age of sexual debut Moscicki AB, Cox JT. J Low Genit Tract Dis Saslow D. et al. CA Cancer J Clin. 2012; ACOG Committee on Practice Bulletins. Obstet Gynecol. 2012; USPSTF. Moyer VA on behalf of the USPSTF. Ann Intern Med
26 Cervical Cancer Incidence by Age Group, USCS*, Age Rate per 100, All ages 9.4 *United States Cancer Statistics includes data from CDC s National Program of Cancer Registries and NCI s Surveillance, Epidemiology and End Results Program.Saraiya M et al. Obstet Gynecol 2007;109:
27 Guidelines: Cervical Cancer Screening Interval ACS/ASCCP/ASCP and ACOG Pap testing every 3 years for women ages Preferred for women 30 and older: Cotesting with Pap and HPV test every 5 years Acceptable for women 30 and older: Pap testing alone every 3 years Saslow D. et al. CA Cancer J Clin ACOG. Obstet Gynecol more
28 Guidelines: Cervical Cancer Screening Interval (Continued) USPSTF Pap testing every 3 years for women ages For women ages 30-65, may have Pap test plus HPV test every 5 years to extend screening interval Moyer VA on behalf of the USPSTF. Ann Intern Med
29 Factors Indicating Need for More Frequent Screening HIV infection Immunosuppression DES exposure in utero Previous treatment for CIN 2, CIN 3, or cancer ACOG Practice Bulletin #
30 Guidelines: Age to Stop Cervical Cancer Screening ACS, ASCCP, ASCP, and ACOG Can stop screening in women older than age 65 with no history of CIN2 within the past 20 years and with evidence of adequate negative screening* USPSTF Can stop at age 65 if adequate recent screening with normal Pap tests and are not at high risk for cervical cancer * defined as 3 consecutive normal Pap tests or 2 consecutive negative cotests within preceding 10 years, with the most recent test occurring within the past 5 years. Saslow D. et al. CA Cancer J Clin. 2012; ACOG Committee on Practice Bulletins. Obstet Gynecol ; USPSTF. Moyer VA on behalf of the USPSTF. Ann Intern Med. 2012
31 Guidelines: Screening Post- Hysterectomy ACS/ASCCP/ASCP, ACOG, USPSTF Guidelines Recommend against routine screening if hysterectomy performed for benign disease and no history of high-grade precancer or greater Saslow D. CA Cancer J Clin. 2012; ACOG Committee on Practice Bulletins. Obstet Gynecol. 2012; Moyer VA on behalf of USPSTF. Ann Intern Med
32 Interval Extension and Well Woman Visit Pap is only one part of the annual well woman exam Unteach women about annual cervical screening Individualized: age, prior screening, HPV status Pap only part of visit, and not every year The annual exam should include Screening, evaluation, counseling, immunizations per age, risk factors Cervical Cytology Screening. ACOG Practice Bulletin No American College of Obstetricians and Gynecologists. Obstet Gynecol 2009; 114:
33 July 1, 2014
34 June 30, 2014
35 HPV Testing
36 Why Test for HPV? Persistent high risk HPV is necessary for the development of cervical cancer An obvious corollary is that the absence of HPV means that the risk of cervical cancer is negligible The negative predictive value for combined HPV Testing and the Pap has been shown to be 99.21% for CIN3. Sherman ME, et al. J Nat Cancer Inst. 2003;95:46-52.
37 HPV Testing for Screening: Stratifies Risk Allows for less frequent testing Identifies women who need increased surveillance Wright TC. Obstet Gynecol Katki HA et al. Lancet Oncol
38 HPV Detection with FDA-Approved Tests Four tests are currently FDA approved and commercially available in the US One is approved for primary, stand-alone screening more
39 HPV Tests Available Tests HPV Types Detected Identifies HPV Type Hybrid Capture 2 High and low risk panels (request high risk only) Cervista HPV HR High risk No (add on test for 16 and 18) cobas HPV Test High risk Yes for 16 and 18 No APTIMA HPV mrna assay High risk No (add on test for 16, 18, and 45) ASCCP. Educate the Educators: HPV and the HPV Vaccines
40 Screening Interval for Combined Pap and HPV Testing in Women 30 and Older: Co-Testing HPV Result Cytology Recommended Management Negative Negative Cotest in 5 years Negative ASC-US Cotest in 3 years Positive ASC-US Colposcopy Negative LSIL Repeat cotesting in 1 year preferred; colposcopy acceptable Positive Pap > LSIL Colposcopy Any Positive HSIL Negative Colposcopy or immediate loop electrosurgical excision Option 1: Cotest in 12 months Option 2: Reflex to genotyping for HPV 16/18. If positive, colposcopy. If negative, cotest in 12 months Massad LS, et al. J Low Genit Tract Dis Saslow D. CA Cancer J Clin 2012.
41 Genotyping to Triage Women 30 with Pap-/HPV+ Results Genotyping Positive for 16 or 18 Negative for 16 and 18 Immediate colposcopy Co-testing in 12 months
42 Management of Repeat Testing After HPV +, Cytology - Results HPV Result Cytology Recommended Management Negative Negative Repeat cotesting in 3 years Positive Negative Perform colposcopy Any Pap > ASC-US Perform colposcopy Massad LS, et al. J Low Genit Tract Dis Saslow D. CA Cancer J Clin 2012.
43 What s to Know, What s New and What s Changed Primary HPV Testing for Cervical Cancer Screening
44
45 FDA approves first human papillomavirus test for primary cervical cancer screening The U.S. Food and Drug Administration today approved the first FDA-approved HPV DNA test for women 25 and older that can be used alone to help a health care professional assess the need for a woman to undergo additional diagnostic testing for cervical cancer. The test also can provide information about the patient s risk for developing cervical cancer in the future.
46 FDA Approved Test for Primary HPV Screening (Stand Alone Testing) Roche cobas HPV Test Provides genotyping for HPV types 16 and 18 concurrently with testing for the presence of 12 other high-risk HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, & 68) Has an internal control for specimen adequacy Currently: this is the only test that is FDA approved for primary HPV testing!
47 Why HPV Primary Screening? Co-testing (Pap and HPV testing) is only marginally better than HPV testing alone!
48 Issues to Consider With Cytology Highly subjective test: substantial inter- and intralaboratory variability and limited reproducibility Misses quite a few cervical cancers Unable to identify those women who are at future risk of developing cervical cancer precursors Unclear how cytology will perform as HPV vaccine uptake rates increase in the US
49 Performance of Cervical Cytology Sensitivity for >CIN2 Author Year Number Method Sensitivity 95% CI Petry ,466 Conv 44% (30-58%) Coste ,080 Conv 65% (50-80%) Taylor ,114 LBC 71% (58-81%) Ronco ,760 LBC 74% (62-84%) Mayrand ,153 Conv 57% (34-78%) 2012 US Preventative Task Force Review
50 Importance of Genotyping for HPV 16 &18 Over two thirds of cervical cancers in the United States are caused by HPV 16 &18 Other individual high-risk HPV genotypes are associated with far fewer cancers Persistent HPV 16 infection confers a very high risk for CIN 3+, as shown in multiple long-term studies Educate the Educators, ASCCP 2016
51 Predictive Value of HPV Genotyping National Cancer Institute-Kaiser Northwest Study 20,817 women with satisfactory cytology at enrollment ( ) Archived samples tested with PCR for HPV Follow-up with cytology, standard workup for abnormal findings Case-control design (women with/without CIN) Women followed for up to 15 y (median = 10.5 y) Educate the Educators, ASCCP 2016
52 Predictive Value of HPV Genotyping 15-y risk of CIN 3+ in Kaiser Northwest cohort Educate the Educator: ASCCP 2016
53 What Study Led to FDA Approval for Primary HPV Testing? ATHENA Addressing the Need for Advanced HPV Diagnostics
54 ATHENA: Addressing the Need for Advanced HPV Diagnostics Prospective, multicenter, US-based study of 47,208 women aged 21 and older Recruited at time of routine screening 2.6% had been vaccinated against HPV Screened by liquid based cytology and HPV test
55 ATHENA Designed to assess the medical utility of pooled high-risk HPV DNA in addition to genotyping for HPV 16 and 18 in 3 populations Women 21 and older with a cytologic finding of ASC-US Women 30 and older with normal cytology Women aged 25 and older in the overall screening population with any cytologic finding
56 Variability of Cervical Cytology Cytology for the ATHENA study Educate the Educator: ASCCP 2016
57 Absolute Risk of CIN in Cytology- Women Women 30 years, Athena Study Wright TC, Stoler MH, Behrens CM, et al. Primary cervical cancer screening with human papillomavirus: End of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol. 2015;136(2): Educate the Educator ASCCP 2016
58 Proportion of CIN3 by Age Group Athena Trial: Why Start Primary Screening at Age 25 Wright TC, Stoler MH, Behrens CM, et al. Primary cervical cancer screening with human papillomavirus: End of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol. 2015;136(2): Educate the Educator ASCCP 2016
59 Primary High Risk Human Papillomavirus Testing for Cervical Cancer Screening Interim Clinical Guidance Huh WK, Ault KA, Chelmow D, Davey D, Goulart FA, Garcia FA, Kinney WK, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Obstet Gynecol 2015:125:
60 Interim Clinical Guidance Published Obstetrics & Gynecology, February 2015 Rationale: A negative hrhpv test provides grater reassurance of low CIN3+ risk than a negative cytology result Because of equivalent or superior effectiveness, primary hrhpv screening can be considered as an alternative to current U.S> cytology-based cervical cancer screening methods. Cytology alone and cotesting remain the screening options specifically recommended in major guidelines Huh WK, Ault KA, Chelmow D, Davey D, Goulart FA, Garcia FA, Kinney WK, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Obstet Gynecol 2015:125:
61 Interim Clinical Guidance Based on limited data: Triage of hrhpv positive women using a combination of genotyping for HPV 16 and 18 And reflex cytology for women positive for the 12 other hrhpv genotypes appears to be a reasonable approach to managing hrhpv-positive women Huh WK, Ault KA, Chelmow D, Davey D, Goulart FA, Garcia FA, Kinney WK, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Obstet Gynecol 2015:125:
62 Women with HPV16 and HPV18 infections are more likely to develop high-grade disease HPV16+ HPV18+ Other high-risk HPV+ High-risk HPV- 20 Cumulative incidence rate of CIN3 (%) Follow-up time (months) % (11.5, 22.9) 13.6% (3.6, 23.7) 3.0% (1.9, 4.2) 0.8% (0.6, 1.1) Khan MJ, et al. J Natl Cancer Inst 2005; 97:
63 2014 FDA Approval for Primary HPV Testing for Cervical Cancer Screening Rationale More sensitive and reproducible than cytology Assesses current and future risk More cost-effective for large-volume screening May be more useful in women vaccinated against HPV Educate the Educator: ASCCP 2016
64 Interim Clinical Guidance Rescreening after a negative primary hrhpv screen should occur NO SOONER than every 3 years Huh WK, Ault KA, Chelmow D, Davey D, Goulart FA, Garcia FA, Kinney WK, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Obstet Gynecol 2015:125:
65 Interim Clinical Guidance Primary hrhpv screening can be considered as an alternative to current U.S. cytology alone or cotesting HPV 16/18 genotyping and reflex cytology for women positive for the other 12 types: achieves a reasonable balance of disease detection with the number of screening tests and colposcopies required to achieve that detection Huh WK, Ault KA, Chelmow D, Davey D, Goulart FA, Garcia FA, Kinney WK, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Obstet Gynecol 2015:125:
66 The HPV primary screening algorithm cobas HPV Test other hrhpv+ HPV Cytology HPV16/18+ NILM ASC-US Routine screening Follow-up in 12 months Colposcopy
67 HPV Primary Screening New ACOG Guidelines Recommends following the SGO/ASCCP guidelines if HPV primary screening is used Additional recommendations: Stop screening women at 65 y who have a history of negative findings. Do not use HPV testing to screen women who have had a hysterectomy. Follow-up with cotesting at 12 months if HPV+ and cytology-negative and HPV 16/18 negative. Use only the FDA approved test. Educate the Educators: ASCCP 2016
68 Countries Implementing HPV Primary Screening Netherlands: Minister of Health approved HPV primary screening beginning in 2016 Australia: National Health Service adopted screening with HV 16/18 genotyping starting at age 25 y at 5-yr intervals up to age United Kingdom: Evaluating in large national pilot study at 6 National Health Service screening sites including London, Liverpool, and Manchester. Italy: A number of regions have adopted primary screening Educate the Educators: ASCCP 2016
69 Case Study Your 42-year old patient with no previous HPV screening was screened by you, using HPV testing alone. The patient is HPV (+) for HPV 16 and the panel of 12 other types How do you interpret this result? What is the next step in her management? Does she need a reflex to a Pap?
70 Case Study You are a colposcopist and bring her in for immediate colposcopy or refer her out for colposcopy. The colposcopy is adequate, as the squamocolumnar junction is seen 360 degrees around. There are no lesions to biopsy and an ECC is performed, which is reported as negative. What will you do next? How will you determine what you do next?
71 Guidelines Are Meant to Increase Benefits and Decrease Harms! Complicated? HELP IS AVAILABLE!
72 The Patient is Out of Primary Screening Guidance and Into Management of Abnormal Screening Test Guidelines! 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) Guidelines Download Algorithms Mobile App: iphone and Android
73 Case Study According to the consensus guidelines for managing abnormal cervical cancer screening tests and cancer precursors. 1. Women 25 to 65: Algorithm: Management of Women with No Lesion or Biopsy-confirmed Cervical Intraepithelial Neoplasia Grade 1 (CIN1) Preceded by Lesser Abnormalities FOLLOWUP WITHOUT TREATMENT Lesser Abnormalities Includes HPV 16+ or 18+ The management is cotesting in 12 months 1. Massad LS, et al updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;121(4):
74 Case Study The patient is cotested in 12 months. The results are NILM/HPV 16+. What will you do next? Massad LS, et al updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;121(4):
75 Case Study The patient will return to colposcopy. At the 12 month follow-up: if the Pap is ASC-US or HPV (+): Colposcopy is indicated. Massad LS, et al updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;121(4):
76 Cervical Cancer Screening Options for 2017 Attributes Cytology Cotesting HPV Primary Interval 3 years 5 years 3 years Age to start 21 years 30 years 25 years Complexity High Highest Low Level of Protection Moderate High High* Referrals to Colposcopy Lowest Higher Higher *Greater than cotesting if done q3 years vs q5 years for cotesting Wright, TC, Omnia, Webinar, 12/15
77 What s to Know, What s New and What s Changed HPV Counseling
78 Counseling Women with HPV Remind your patient that: Most women will have HPV at some point. There is no way of knowing how long HPV has been present. Having HPV is not a sign of infidelity or promiscuity. more
79 Counseling Women with HPV (Continued) Most women who have HPV do not develop abnormal cells or cancer. Women who have HPV in their cells a long time are at greater risk for developing abnormal cells or cancer.
80 Messaging Educate women when they are being screened, about the role of HPV infection in cervical cancer You need an HPV test to determine if you have the virus Your son or daughter may be vaccinated to be protected from being infected by the types in the vaccine
81 Utilize Written Materials Helpful in supporting patient education Patients can use for later reference Many are available in additional languages including Spanish Unbranded materials: Center for Disease Control American Cancer Society American Society for Colposcopy and Cervical Pathology Association of Reproductive Health Professionals
82 Summary The 2012 Guidelines for cervical cancer prevention More benefit with least harm (over screening) Identifies low risk women (HPV and Pap negative) and reassures them about safety of longer screening interval Identifies truly at-risk women with persistent HPV Follow them diligently FDA approval of HPV testing as a primary screen, April 2014 Never has education of patients and clinicians been more important!
83 Summary HPV Testing in Primary Screening Interim Guidance has been published Are you ready? Will you perform stand alone HPV testing as primary screening?
84 Summary Majority of cervical cancer in U.S. occurs in women who have not been screened or infrequently screened Improving access to screening for these women will have a great impact on the prevention of cervical cancer!
85 References
86 References
87 References
88 References
89 References
90 References
9/19/17. Emerging Challenges in Primary Care: Cervical Cancer Screening: Appropriate Use of Pap & HPV Testing. Faculty.
Emerging Challenges in Primary Care: 2017 Cervical Cancer Screening: Appropriate Use of Pap & HPV Testing Faculty Nancy R. Berman, MSN, ANP-BC, NCMP, FAANP Adult Nurse Practitioner Certified Menopause
More informationDisclosures. Goal of Cervical Cancer Screening. Update on Cervical Cancer Screening: Appropriate Use of Pap and HPV Testing
Disclosures Update on Cervical Cancer Screening: Appropriate Use of Pap and HPV Testing Consultant and Speaker: Hologic Nancy R. Berman MSN, ANP-BC, NCMP, FAANP Adult Nurse Practitioner/Colposcopist Certified
More informationDisclosures. Objectives (Continued) Objectives. Goal of Cervical Cancer Screening. An Update on HPV and Cervical Cancer Prevention
An Update on HPV and Cervical Cancer Prevention Disclosures Consultant and Speaker: Hologic Advisory Board: LabCorp Nancy R. Berman MSN, ANP-BC, NCMP, FAANP Adult Nurse Practitioner/Colposcopist Certified
More informationAn Update on HPV and Cervical Cancer Prevention
An Update on HPV and Cervical Cancer Prevention Nancy R. Berman MSN, ANP-BC, NCMP, FAANP Adult Nurse Practitioner/Colposcopist Certified Menopause Practitioner (NAMS) Millennium Affiliated Physicians Division
More informationHPV: Everything You Want to Know: Part 1. Natural History, Screening Guidelines, Pap and HPV Co-Testing, and Vaccines
HPV: Everything You Want to Know: Part 1. Natural History, Screening Guidelines, Pap and HPV Co-Testing, and Vaccines Nancy R. Berman MSN, ANP-BC, NCMP, FAANP Adult Nurse Practitioner/Colposcopist Certified
More informationHPV: Everything You Want to Know: Part 2. Primary (Stand alone) HPV Testing, Anal Cancer Screening and Counseling Tips
HPV: Everything You Want to Know: Part 2. Primary (Stand alone) HPV Testing, Anal Cancer Screening and Counseling Tips Nancy R. Berman MSN, ANP-BC, NCMP, FAANP Adult Nurse Practitioner/Colposcopist Certified
More informationASCCP 2013 Guidelines for Managing Abnormal Cervical Cancer Screening Tests
ASCCP 2013 Guidelines for Managing Abnormal Cervical Cancer Screening Tests www.treatmentok.com Barbara S. Apgar, MD, MS Professor of Family Medicine University of Michigan Ann Arbor, Michigan Disclosures
More informationUpdate on HPV Testing. Robert Schlaberg, M.D., Dr. med., M.P.H. Assistant Professor, University of Utah Medical Director, ARUP Laboratories
Update on HPV Testing Robert Schlaberg, M.D., Dr. med., M.P.H. Assistant Professor, University of Utah Medical Director, ARUP Laboratories Disclosures In accordance with ACCME guidelines, any individual
More informationOctober 9, Dear Ms. Chowdhury:
October 9, 2017 Joya Chowdhury, MPH Senior Coordinator, USPSTF Department of Health and Human Services Agency for Healthcare Research and Quality Center for Evidence and Practice Improvement Room 06E65A
More informationI have no financial interests in any product I will discuss today.
Cervical Cancer Prevention: 2012 and Beyond George F. Sawaya, MD Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics University of California,
More informationHPV Genotyping: A New Dimension in Cervical Cancer Screening Tests
HPV Genotyping: A New Dimension in Cervical Cancer Screening Tests Lee P. Shulman MD The Anna Ross Lapham Professor in Obstetrics and Gynecology and Chief, Division of Clinical Genetics Feinberg School
More informationI have no financial interests in any product I will discuss today.
Cervical Cancer Screening Update and Implications for Annual Exams George F. Sawaya, MD Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics
More informationCervical Cancer Screening
Todd R. Jenkins, MD, MSHA Senior Vice Chair Director, Division of Women s Reproductive Healthcare Learning Objectives Describe the etiology, natural history, and usage of the human papillomavirus (HPV)
More informationSESSION J4. What's Next? Managing Abnormal PAPs in 2014
37th Annual Advanced Practice in Primary and Acute Care Conference: October 9-11, 2014 2:45 SESSION J4 What's Next? Managing Abnormal PAPs in 2014 Session Description: Linda Eckert, MD Review current guidelines
More information32 OBG Management May 2015 Vol. 27 No. 5 obgmanagement.com
The Advisory Committee on Immunization Practices recommends routine vaccination against HPV in 11- and 12-year-olds, although the age can range from 9 to 26 years (for those who have not been vaccinated
More information!"#$%&'(#)*$+&,$-&.#,$/#0()1-$ ),1')$2(%&,2#,%$%(0'#$34567$
!"#$%&'(#)*$+&,$-&.#,$/#0()1-$ ),1')$2(%&,2#,%$%(0'#$34567$ Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors American Society for and Cervical Pathology
More informationCervical cancer screening in vaccinated population
Cervical cancer screening in vaccinated population Cytology and molecular testing Prof. Dr. Fuat Demirkıran I.U Cerrahpaşa School of Medicine. Department of OB&GYN Division Of Gynocol Oncol Izmir, November
More informationHe Said, She Said: HPV and the FDA. Audrey P Garrett, MD, MPH June 6, 2014
He Said, She Said: HPV and the FDA Audrey P Garrett, MD, MPH June 6, 2014 Disclosure Speaker for Merck Gardasil Speaker for Hologic Thin Prep and Cervista Cervical Cancer Screening: 21 st century Dr. Papanicolaou
More informationObjectives. I have no financial interests in any product I will discuss today. Cervical Cancer Screening Guidelines: Updates and Controversies
Cervical Cancer Screening Guidelines: Updates and Controversies I have no financial interests in any product I will discuss today. Jody Steinauer, MD, MAS University of California, San Francisco Objectives
More informationSamuel B. Wolf, D.O., F.A.C.O.G. Emerald Coast Obstetrics and Gynecology Panama City Florida
Making sense of the new Pap smear screening guidelines. Samuel B. Wolf, D.O., F.A.C.O.G. Emerald Coast Obstetrics and Gynecology Panama City Florida Case 17 year old G1P0010 with first sexual encounter
More informationCervical Cancer 4/27/2016
Guidelines for Cervical Cancer Screening and Prevention Management of Abnormal Results Kathy A. King, MD Assistant Professor of OB/GYN Medical College of Wisconsin May 6, 2016 Cervical Cancer In US about
More informationMaking Sense of Cervical Cancer Screening
Making Sense of Cervical Cancer Screening New Guidelines published November 2012 Tammie Koehler DO, FACOG The incidence of cervical cancer in the US has decreased more than 50% in the past 30 years because
More informationNo Disclosures. Updated Guidelines for Cervical Cancer Screening and Prevention Management of Abnormal Results. Objectives 5/9/2016
Updated Guidelines for Cervical Cancer Screening and Prevention Management of Abnormal Results Kathy A. King, MD Assistant Professor of OB/GYN Medical Director, PPWI Medical College of Wisconsin May 6,
More informationNews. Laboratory NEW GUIDELINES DEMONSTRATE GREATER ROLE FOR HPV TESTING IN CERVICAL CANCER SCREENING TIMOTHY UPHOFF, PHD, DABMG, MLS (ASCP) CM
Laboratory News Inside This Issue NEW GUIDELINES DEMONSTRATE GREATER ROLE FOR HPV TESTING IN CERVICAL CANCER SCREENING...1 NEW HPV TEST METHODOLOGY PROVIDES BETTER SPECIFICITY FOR CERVICAL CANCER...4 BEYOND
More informationAn Update on Cervical Cancer Screening Recommendations and on the DOH BCC Program
An Update on Cervical Cancer Screening Recommendations and on the DOH BCC Program Susan Baum, MD, MPH NM Nurse Practitioner Council Annual Conference April 20, 2012 I have no commercial relationships related
More informationUpdated ASCCP Consensus Guidelines For Managing Diagnosed Cervical Cancer Precursors Michael A. Gold, M.D.
Updated ASCCP Consensus Guidelines For Managing Diagnosed Cervical Cancer Precursors Michael A. Gold, M.D. 27 May, 2014 London, England Faculty Disclosure X No, nothing to disclose Yes, please specify
More informationCervical Cancer Screening for the Primary Care Physician for Average Risk Individuals Clinical Practice Guidelines. June 2013
Cervical Cancer Screening for the Primary Care Physician for Average Risk Individuals Clinical Practice Guidelines General Principles: Since its introduction in 1943, Papanicolaou (Pap) smear is widely
More informationI have no financial interests in any product I will discuss today.
How Should We Approach Cervical Cancer Screening and Routine Pelvic Examinations in 2019? Michael Policar, MD, MPH Professor Emeritus Department of Obstetrics, Gynecology and Reproductive Sciences University
More informationThe society for lower genital tract disorders since 1964.
The society for lower genital tract disorders since 1964. Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors American Society for and Cervical Pathology
More information1/12/2016. I do not engage in any lucrative deals that require disclosure.
I do not engage in any lucrative deals that require disclosure. Sabrina Hofmeister, DO Assistant Professor Columbia St. Mary s Family Medicine Residency Program MCW Department of Family and Community Medicine
More informationHUMAN PAPILLOMAVIRUS TESTING
CLINICAL GUIDELINES For use with the UnitedHealthcare Laboratory Benefit Management Program, administered by BeaconLBS HUMAN PAPILLOMAVIRUS TESTING Policy Number: PDS - 016 Effective Date: October 1, 2018
More informationUpdate on Cervical Cancer Screening. Rahmouna Farez M.D. Assistant Professor, Medical College of Wisconsin 5/2/2014
Update on Cervical Cancer Screening Rahmouna Farez M.D. Assistant Professor, Medical College of Wisconsin 5/2/2014 Objectives Review the natural history of HPV as it relates to cervical cancer screening
More informationUpdate on Cervical Cancer Screening
Update on Cervical Cancer Screening Rahmouna Farez M.D. Assistant Professor, Medical College of Wisconsin 5/2/2014 Objectives Review the natural history of HPV as it relates to cervical cancer screening
More informationThe devil is in the details
The cobas KNOW THE RISK For cervical cancer prevention The devil is in the details Leading with the cobas as your primary screening method uncovers disease missed by cytology, and can protect women from
More informationDisclosures & images
Cervical Cancer Screening: New Approaches Levi S. Downs, Jr., MD Disclosures & images During the previous 12 months, I have been a consultant for and received honoraria from Merck. Images are attributed
More informationHPV Primary Screening in the United States
IFCPC 15th World Congress May 2014, London, UK. HPV Primary Screening in the United States E.J. Mayeaux, Jr., M.D. Professor and Chairman Department of Family and Preventive Medicine Professor of Obstetrics
More informationHPV Primary Screening Update. Prof. Vu Ba Quyet Director of NO&G hospital
HPV Primary Screening Update Prof. Vu Ba Quyet Director of NO&G hospital 1 Who can we not worry about? 2 Key questions Who should be screened? Starting age? Ending age? How often? How to manage results?
More informationCervical Cancer Prevention in the 21 st Century Changing Paradigms
Cervical Cancer Prevention in the 21 st Century Changing Paradigms Teresa M. Darragh, MD UCSF Departments of Pathology and Obstetrics, Gynecology & Reproductive Sciences Faculty Disclosures: Teresa M.
More informationI have no financial interests in any product I will discuss today.
Cervical Cancer Screening Update and Implications for Annual Exams George F. Sawaya, MD Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics
More informationRisk : How does it define cervical cancer screening?
Risk : How does it define cervical cancer screening? Alan G. Waxman, MD, MPH Dept. of Obstetrics and Gynecology University of New Mexico The University of New Mexico Disclosures I have no commercial interests
More informationCervical Cancer Screening. David Quinlan December 2013
Cervical Cancer Screening David Quinlan December 2013 Cervix Cervical Cancer Screening Modest variation provincially WHO and UK begin at 25 stop at 60 Finland begin at 30 stop at 60 Rationale for
More informationEvidence-based treatment of a positive HPV DNA test. Th. Agorastos Prof. of Obstetrics & Gynaecology Aristotle University Thessaloniki/GR
Evidence-based treatment of a positive HPV DNA test Th. Agorastos Prof. of Obstetrics & Gynaecology Aristotle University Thessaloniki/GR HPV DNA testing Indications 1. Triage after cytology with ASCUS/LSIL
More informationHuman Papillomavirus
Human Papillomavirus Dawn Palaszewski, MD Assistant Professor of Obstetrics and Gynecology University of February 18, 2018 9:40 am Dawn Palaszewski, MD Assistant Professor Department of Obstetrics and
More informationCervical Cancer Screening
Cervical Cancer Screening MEGAN CHENEY, MD MPH MEDICAL DIRECTOR, THE WOMEN S CENTER ASSISTANT DIRECTOR, BGSMC OBGYN RESIDENCY PROGRAM SECTION CHIEF, THE WOMEN S HEALTH INSTITUTE Objectives Understand proper
More informationObjectives. Background. Background. Background. Background 9/26/16. Update on Cervical and HPV Screening Guidelines: To pap or not to pap?
Update on Cervical and HPV Screening Guidelines: To pap or not to pap? Marina Delazari Miller MD Clinical Assistant Professor Department of Obstetrics & Gynecology University of Iowa Hospitals and Clinics
More informationThe data from the ATHENA study and others bring this expectation and the appropriateness of the guidelines for women aged into question.
New data support HPV testing beginning at age 25 By Hope Cottrill, M.D. Recent findings from the ATHENA (Addressing the Need for Advanced HPV Diagnostics) study of cervical cancer screening revealed surprising
More information9/18/2008. Cervical Cancer Prevention for Adolescent Populations Garcia. Faculty disclosure. Objectives. HPV Positivity by Age (UK)
Faculty disclosure Cervical Cancer Prevention for Francisco, MD, MPH Associate Professor Obstetrics & Gynecology Mexican American Studies Public Health Francisco, MD, MPH has no financial affiliations
More informationGoals. In the News. Primary HPV Screening 3/9/2015. Your PAP and HPV Update Primary HPV Testing- Screening Intervals- HPV Vaccine Updates-
Your PAP and HPV Update 2015 Connie Mao, MD University of Washington Goals Primary HPV Testing- Is it time to stop doing pap smears? Screening Intervals- Should patients have a choice? HPV Vaccine Updates-
More informationP16 et Ki67 Biomarkers: new tool for risk management and low grade intraepithelial lesions (LGSIL): be ready for the future.
P16 et Ki67 Biomarkers: new tool for risk management and low grade intraepithelial lesions (LGSIL): be ready for the future. Mark H Stoler, MD University of Virginia Health System, Charlottesville, VA,
More informationFaculty Pap Smear Guidelines: Family Planning Update 2008 Part Two
Faculty Pap Smear Guidelines: Family Planning Update 2008 Part Two Seshu P. Sarma, MD, FAAP Emory University Regional Training Center Atlanta, Georgia Produced by the Alabama Department of Public Health
More informationCancer Treatment Centers of America: Supercharge Your Knowledge: A Focus on Breast, Cervical and Prostate Screening Guidelines and Controversies
8 ACOFP 55th Annual Convention & Scientific Seminars Cancer Treatment Centers of America: Supercharge Your Knowledge: A Focus on Breast, Cervical and Prostate Screening Guidelines and Controversies Anthony
More informationMolecular Triage: Partial and Extended Genotyping and More!
Molecular Triage: Partial and Extended Genotyping and More! Thomas C. Wright, Jr. MD Professor Emeritus Columbia University, New York Pathologist, Enzo Clinical Laboratories, Farmingdale, NY Disclosures
More informationCervical cancer prevention: Advances in primary screening and triage system
Cervical cancer prevention: Advances in primary screening and triage system Dr Farid Hadi Regional Medical and Scientific Affairs Roche Diagnostics Asia-Pacific, Singapore Cervical cancer is highly preventable
More informationEradicating Mortality from Cervical Cancer
Eradicating Mortality from Cervical Cancer Michelle Berlin, MD, MPH Vice Chair, Obstetrics & Gynecology Associate Director, Center for Women s Health June 2, 2009 Overview Prevention Human Papilloma Virus
More informationCervical Cancer Screening Guidelines Update
Frontier AIDS Education and Training Center Cervical Cancer Screening Guidelines Update Hillary Liss, MD Harborview Medical Center, Madison and Adult Medicine Clinics Frontier AETC, Medical Program Director
More informationAppropriate Use of Cytology and HPV Testing in the New Cervical Cancer Screening Guidelines
Appropriate Use of Cytology and HPV Testing in the New Cervical Cancer Screening Guidelines Tim Kremer, MD Ralph Anderson, MD 1 Objectives Describe the natural history of HPV particularly as it relates
More informationClinical outcomes after conservative management of CIN1/2, CIN2, and CIN2/3 in women ages years
Clinical outcomes after conservative management of CIN1/2, CIN2, and CIN2/3 in women ages 21-39 years Michelle I. Silver, PhD, ScM Cancer Prevention Fellow National Cancer Institute Division of Cancer
More informationThe new Cervical Screening Test for Australian women: Louise Farrell
The new Cervical Screening Test for Australian women: Louise Farrell Outline and explain the changes to the National Cervical Screening Program due to commence in Dec 2017 LEARNING OBJECTIVES FOR TODAY
More informationPap Smears Pelvic Examinations Well Woman Examinations. When should you have them performed???
Pap Smears Pelvic Examinations Well Woman Examinations. When should you have them performed??? Arlene Evans-DeBeverly, PA-C Copyright 2012 There are always ongoing changes in gynecology, including the
More informationOver-diagnoses in Cytopathology: Is histology the gold standard?
Over-diagnoses in Cytopathology: Is histology the gold standard? Teresa M. Darragh, MD UCSF Departments of Pathology and Obstetrics, Gynecology & Reproductive Sciences Faculty Disclosures: Teresa M. Darragh,
More informationPerfecting the Prevention of Cervical cancer. I have no financial interests in any product I will discuss today. Preview
Perfecting the Prevention of Cervical cancer Rebecca Jackson, MD Associate Professor Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics I have no financial interests in any
More informationScreening for Cervical Cancer: Demystifying the Guidelines DR. NEERJA SHARMA
Screening for Cervical Cancer: Demystifying the Guidelines DR. NEERJA SHARMA Cancer Care Ontario Cervical Cancer Screening Goals Increase patient participation in cervical screening Increase primary care
More informationHuman Papillomavirus (HPV) and Cervical Cancer Prevention
Human Papillomavirus (HPV) and Cervical Cancer Prevention MOA Autumn Convention November 3, 2017 David J Boes, DO, FACOOG (Dist.) Associate Professor, MSU-COM 1 Disclosures None relative to this presentation
More informationNatural History of HPV Infections 15/06/2015. Squamous cell carcinoma Adenocarcinoma
14,670 5796 United States/ Canada 17,165 8124 Central America 48,328 21,402 South America 59,929 29,814 Europe 78,896 61,670 Africa 157,759 86,708 Southcentral Asia 61,132 31,314 Eastern Asia 42,538 22,594
More informationClinical Policy Title: Fluorescence in situ hybridization for cervical cancer screening
Clinical Policy Title: Fluorescence in situ hybridization for cervical cancer screening Clinical Policy Number: 01.01.02 Effective Date: April 1, 2015 Initial Review Date: January 21, 2015 Most Recent
More informationCervical Cancer Screening Update. Melissa Hartman, DO Women s Health
Cervical Cancer Screening Update Melissa Hartman, DO Women s Health Previous Cervical Cancer Screening Organization Recommendation ACS (2011) ACP (2008) NCI (2003) Age 21 or 3 years after first intercourse
More informationHPV Molecular Diagnostics and Cervical Cytology. Philip E. Castle, PhD, MPH American Society for Clinical Pathology (ASCP) March 15, 2012
HPV Molecular Diagnostics and Cervical Cytology Philip E. Castle, PhD, MPH American Society for Clinical Pathology (ASCP) March 15, 2012 Disclosures & Disclaimers I serve on a Merck Data and Safety Monitoring
More informationRecommendation Summary U S. Prevention Statement Task Force for HPV (USPSTF)
Recommendation Summary U S. Prevention Statement Task Force for HPV (USPSTF) Population Recommendation Grade (What's This?) Women ages 21 to 65 years The USPSTF recommends screening for cervical cancer
More informationScreening for Cervical Cancer. Grand Rounds 1/16/13 Meggan Linck
Screening for Cervical Cancer Grand Rounds 1/16/13 Meggan Linck Cervical Cancer Worldwide 2 nd most common and 5 th deadliest U.S. 8 th most common 80% occur in developing world Median age at diagnosis
More informationCervical Testing and Results Management. An Evidenced-Based Approach April 22nd, Debora Bear, MSN, MPH
Cervical Testing and Results Management An Evidenced-Based Approach April 22nd, 2010 Debora Bear, MSN, MPH Assistant Medical Director for Planned Parenthood of New Mexico, Inc. Burden of cervical cancer
More informationFocus. International #52. HPV infection in High-risk HPV and cervical cancer. HPV: Clinical aspects. Natural history of HPV infection
HPV infection in 2014 Papillomaviruses (HPV) are non-cultivable viruses with circular DNA. They can establish productive infections in the skin (warts) and in mucous membranes (genitals, larynx, etc.).
More informationDysplasia: layer of the cervical CIN. Intraepithelial Neoplasia. p16 immunostaining. 1, Cervical. Higher-risk, requires CIN.
CLINICAL PRACTICE GUIDELINE Guideline Number: DHMP_DHMC_PG1015 Guideline Subject: Routine Cervical Cancer Screening Effective Date: 9/2018 Revision Date: 9/2019 Pages: 2 of 2 Quality Management Committee
More informationWoo Dae Kang, Ho Sun Choi, Seok Mo Kim
Is vaccination with quadrivalent HPV vaccine after Loop Electrosurgical Excision Procedure effective in preventing recurrence in patients with High-grade Cervical Intraepithelial Neoplasia (CIN2-3)? Chonnam
More informationCervical Cancer Screening - Improving PAP Rates. Objectives
Cervical Cancer Screening - Improving PAP Rates Dineo Khabele, MD, FACOG, FACS Assistant Professor Division of Gynecologic Oncology Vanderbilt University Medical Center Objectives 1. Review the current
More informationHuman Papillomavirus. Kathryn Thiessen, ARNP, ACRN The Kansas AIDS Education and Training Center The University of Kansas School of Medicine Wichita
Human Papillomavirus Kathryn Thiessen, ARNP, ACRN The Kansas AIDS Education and Training Center The University of Kansas School of Medicine Wichita What is Genital HPV Infection Human papillomavirus is
More informationDisclosures. Learning objectives. George F. Sawaya, MD. I have nothing to disclose.
Well Woman Visits in 2018: How Should We Approach Cervical Cancer Screening and Routine Pelvic Examinations? George F. Sawaya, MD Disclosures I have nothing to disclose. Professor, Obstetrics, Gynecology
More informationHPV the silent killer, Prevention and diagnosis
HPV the silent killer, Prevention and diagnosis HPV Human Papilloma Virus is a name given for a silent virus transmitted sexually most of the time, a virus that spreads in the name of love, passion, and
More informationDisclosures Teresa M Darragh, MD
Below the Belt: Screening for HPV-associated Cancers Teresa M. Darragh, MD UCSF Departments of Pathology and Obstetrics, Gynecology & Reproductive Sciences Disclosures Teresa M Darragh, MD Hologic: Research
More information1 Cervical Cancer Prevention and Screening: Update 2010 Michael S. Policar, MD, MPH Clinical Professor of Ob, Gyn, and RS UCSF School of Medicine policarm@obgyn.ucsf.edu No commercial disclosures for this
More informationHPV Testing & Cervical Cancer Screening:
HPV Testing & Cervical Cancer Screening: Are they linked? By William Chapman, MD, FRCPC Screening for precursor lesions of cervical cancer by the Papanicolaou (Pap) smear has been one of the greatest success
More informationSCCPS Scientific Committee Position Paper on HPV Vaccination
SCCPS Scientific Committee Position Paper on HPV Vaccination Adapted from Joint Statement (March 2011) of the: Obstetrical & Gynaecological Society of Singapore (OGSS) Society for Colposcopy and Cervical
More informationHuman Papillomaviruses: Biology and Laboratory Testing
For our patients and our population Human Papillomaviruses: Biology and Laboratory Testing Geoffrey Higgins Microbiology and Infectious Diseases For our patients and our population HPV Associated Cancers
More informationPaps & Pelvics: Where Do We Stand?
Women s Health Congress Washington DC, April 5, 2014 Paps & Pelvics: Where Do We Stand? There are no relevant financial relationships with any commercial interests to disclose Michael Policar, MD, MPH
More informationColposcopy in the United States: Changes for the 21st Century?
Colposcopy Issues in the HPV Era Colposcopy in the United States: Changes for the 21st Century? Teresa M. Darragh, MD UCSF Departments of Pathology and Obstetrics, Gynecology & Reproductive Sciences Faculty
More informationHPV-Negative Results in Women Developing Cervical Cancer: Implications for Cervical Screening Options
HPV-Negative Results in Women Developing Cervical Cancer: Implications for Cervical Screening Options R. Marshall Austin MD,PhD Magee-Womens Hospital of University of Pittsburgh Medical Center (UPMC) (raustin@magee.edu)
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: cervical_cancer_screening 01/01/2019 n/a 01/01/2020 01/01/2019 Policy Effective April 1, 2019 Description
More informationFocus. A case. I have no conflicts of interest. HPV Vaccination: Science and Practice. Collaborative effort with Karen Smith-McCune, MD, PhD 2/19/2010
HPV Vaccination: Science and Practice George F. Sawaya, MD Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics Director, Colposcopy Clinic,
More informationTrends in HPV-Associated Cancers United States,
National Center for Chronic Disease Prevention and Health Promotion Trends in HPV-Associated Cancers United States, 1999 2014 Elizabeth A. Van Dyne, MD, MPH Division of Cancer Prevention and Control Epidemiology
More informationHPV and Cervical Cancer, Screening and Prevention. John Ragsdale, MD July 12, 2018 CME Lecture Series
HPV and Cervical Cancer, Screening and Prevention John Ragsdale, MD July 12, 2018 CME Lecture Series We have come a long Way Prevalence HPV in Young Adults in U.S HPV genotypes 55-60% of All cancers 20%
More informationEvolving Cervical Cancer Screening Options in Clinical Practice
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/medical-industry-feature/evolving-cervical-cancer-screening-optionsclinical-practice/8214/
More informationCase Based Problems. Recommended Guidelines. Workshop: Case Management of Abnormal Pap Smears and Colposcopies. Disclosure
Disclosure Workshop: Case Management of Abnormal Pap Smears and Colposcopies Rebecca Jackson, MD Associate Professor Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics This
More informationHuman Papillomaviruses and Cancer: Questions and Answers. Key Points. 1. What are human papillomaviruses, and how are they transmitted?
CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Human Papillomaviruses
More informationPathology of the Cervix
Pathology of the Cervix Thomas C. Wright Pathology of the Cervix Topics to Consider Burden of cervical cancer 1 Invasive Cervical Cancer Cervical cancer in world Second cause of cancer death in women Leading
More informationOriginal Policy Date
MP 2.04.03 Cervicography Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return to Medical Policy Index Disclaimer
More informationo 2-yearly (Pap test) o 18 to 69 years 1 o Registry reminder
Invasive cervical cancer cases per 100,000 Main changes from Dec 2017 The Renewed National Cervical Screening Program The Big Picture Brisbane 22 nd April 2017 Ian Hammond National Cervical Screening Program:
More informationDetect Cervical Cancer ReachMD Page 1 of 7
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationAtypical squamous cells. The case for HPV testing
OBG MANAGEMENT FOCUS ON CERVICAL DISEASE BY J. THOMAS COX, MD ASC-US is most often due to transient changes or HPV. HPV-positive ASC-US is 12.5 to 23 times more likely to be associated with CIN 2,3 on
More informationAn update on the Human Papillomavirus Vaccines. I have no financial conflicts of interest. Case 1. Objectives 10/26/2016
An update on the Human Papillomavirus Vaccines Karen Smith-McCune Professor, UCSF Department of Obstetrics, Gynecology and Reproductive Sciences John Kerner Endowed Chair I have no financial conflicts
More informationClinical Relevance of HPV Genotyping. A New Dimension In Human Papillomavirus Testing. w w w. a u t o g e n o m i c s. c o m
Clinical Relevance of HPV Genotyping A New Dimension In Human Papillomavirus Testing Human Papillomavirus: Incidence HPV prevalence was 26.8% for women in US aged 14 59 yrs 1 20 million Americans are currently
More informationThe Biology of HPV Infection and Cervical Cancer
The Biology of HPV Infection and Cervical Cancer Kaitlin Sundling, M.D., Ph.D. Clinical Instructor Faculty Director, Cytotechnology Program Wisconsin State Laboratory of Hygiene and University of Wisconsin
More information