HIV-infected men and women. Joel Palefsky, M.D. University of California, San Francisco
|
|
- Marylou Griffin
- 5 years ago
- Views:
Transcription
1 Anal cytology and anal cancer in HIV-infected men and women. Joel Palefsky, M.D. University of California, San Francisco April 10, 2010
2 Disclosures Merck and Co: Research grant support, advisory boards
3 Cervical Squamo-columnar Transformation Zone Active transformation zone Original squamocolumnar junction Active squamocolumnar junction Columnar epithelium External os Cervical cleft opening
4
5 From condyloma to cancer Bethesda Classification Cervical Intraepithelial Neoplasia Normal Low-grade squamous intra-epithelial ith l lesion* Flat CIN 1 CIN 2 condyloma High-grade squamous intra-epithelial ith l lesion CIN 3 Invasive cancer Histology of the Squamous Cervical Epithelium basal layer basal membrane Associated HPV Types (Relative Frequency) negative or other HPV types HPV 6, 11, 42, 43, 44 HPV 31, 33, 35, 52, 58 HPV 16 HPV 18, 45, 56 90% 80% 70% 60% 50% 40% 30% 20% 10% The prevalence of high-risk oncogenic HPVs increases with the severity of the lesion * LSIL also includes ASCUS (atypical squamous cells of unknown significance) Modified from Bonnez W. Papillomavirus. In: Richman RD et al eds. Clinical Virology. 2nd ed. Washington, DC: American Society for Microbiology; 2002:
6 The incidence of HPV-related cancers is increasing Age-adjusted Incidence Rate of Primary, malignant Anal cancer by Gender and Year of diagnosis Rate per Age-adjus sted Incidence 100, Male Female Year of Diagnosis Parkin DM et al, CA Cancer J Clin 2005; Chaturvedi A et al, 2008
7 Recent reports of incidence in anal cancer since introduction of ART Piketty C, Selinger-Leneman H, Grabaret S, et al. AIDS. 2008;22: /100,000 person-years among HIV+ MSM since 1999 D Souza G, Wiley D, Li X, et al. J Acquir Immune Defic Syndr. 2008;48(4): /100,000 person-years among HIV+ MSM since 1996 Patel P, Hanson H, Sullivan S, et al. Ann Intern Med. 2008; 10(148): /100,000 person-years among HIV+ MSM since 2000 Engels EA, Biggar, RJ et al. Int J Cancer 2008; 123: /100,000 person-years among HIV+ men and women since 1996
8 Progression of HGAIN to anal cancer
9 Percent with anal HPV infection HIV- HIV+ HIV+ HIV+ CD4> <200
10 Anal HPV infection by age group in sexually active HIV-negative MSM Perc cent HPV HPV HR 0 <
11 HPV infection Low-grade CIN High-grade CIN Cervical cancer Schiffman, MH. J Natl Cancer Inst. 1992; 84:394-98
12 Percent with abnormal anal cytology HIV- HIV+ HIV+ HIV+ CD4> <200
13 Prevalence of anal cytologic abnormalities by age among sexually active HIV-negative MSM Perc cent ASIL HSIL 5 0 <
14 Population-based data Chin-Hong et al Ann Int Med 2008; 149; 300-6
15 Anal and cervical HPV infection in HIV-positive women Anal Cervical HIV- HIV+ CD4 >500 HIV+ CD HIV+ CD4 <200
16 Cervical vs anal HPV types
17 AIN in HIV+ and HIV- women ( N= 655) AIN (16%) was more common among HIV- positive women than HIV- women (4%) p<.001 CIN (16%) was more common than among HIV-positive women than HIV- women (5%) p=.003 Hessol N and Palefsky J AIDS 2009; 23:59-70.
18 The cervical cancer model Anal and cervical cancer are biologically similar The incidence of cervical cancer has declined largely due to screening and treatment of high-grade grade CIN HGAIN is a true anal cancer precursor
19 Progression of HGAIN to cancer Classic Bowen s: 5-10% progression (Rickert RR et al. CA 1977; 27:160-6) 6) 8 of 72 (11%) immunosuppressed patients progressed from HGAIN to cancer over 42 months (Watson et al, ANZ J Surg. Aug 2006;76(8):715-17) ) 22 patients with HGAIN progressed to cancer over an average of 52 months from time of first diagnosis (Berry et al, submitted)
20 Reasons for lack of routine screening Lack of data on the optimal screening strategy Paucity of clinicians trained in high resolution anoscopy, biopsy and treatment of AIN Paucity of data on efficacy of treatment for HGAIN Paucity of cost-effectiveness data No data yet that treatment of HGAIN reduces the incidence id of anal cancer
21 Recommendations of the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the HIV Medicine i Association of the Infectious Diseases Society of America (HIVMA/IDSA).anal cytology screening of HIVseropositive MSM and of women may be useful preventive measures. However, studies of screening and treatment t t programs for AIN 2 or 3 need to be implemented before definitive recommendations for anal cytology screening can be made.
22 Lack of data on the optimal screening strategy Anal cytology has similar performance characteristics ti to cervical cytology
23 Anal cytology and histology correlation Anal histopathology Anal cytology* Normal Atypical AIN 1 AIN 2 or 3 Insufficient Total (%) Normal (32%) ASCUS (3%) LSIL (35%) HSIL (28%) Insufficient (1%) Total (%) 5 (5%) 2 (2%) 26 (26%) 69 (68%) 0 (0%) 102
24 Paucity of clinicians trained in high resolution anoscopy, biopsy and treatment of AIN ASCCP and other courses More and more clinicians being trained U.S., Canada, Australia, U.K., France, Germany and others
25 Paucity of data on efficacy of treatment for HGAIN Early in natural history- increased ease of treating small lesions 85% TCA Singh JC 2009; JAIDS, 52(4): Mid-natural history- local vs. surgical removal Infra-red red coagulation 65% free of disease after median of 413 days Goldstone SE et al, Dis Colon Rectum. 2006; 49: Late in natural a history- monitoring to detect early development of cancer
26 Early detection of anal cancer: superficially invasive squamous cell carcinoma of the anus (SISCCA) 19 patients treated with local excision No patients died of SCCA 5 of 19 (26%) developed recurrent cancer 2 required RAC No patients required a colostomy 17 of 19 (89%) developed recurrent HGD Careful follow-up is essential Berry, Jay and Palefsky,unpublished data
27 Paucity of cost-effectiveness data Anal cytology screening ($/QALY): Anal pap screening +HIV* -HIV** Every year $16,600 $34,800 Every 2 years $13,000 $15,100 *Goldie et al. JAMA. 1999; 281: **Goldie et al. Am J Med. 2000; 108:
28 Until this is sorted out. What to do in the meantime?
29 The anal cancer screening test Digital rectal exam
30 Anal cytology screening for AIN
31 Who should be screened? All HIV+ MSM with good prognosis? All HIV+ men regardless of sexual orientation All HIV- MSM over the age of 40? Women with high-grade grade vulvar lesions or cancer? All HIV+ women?? All men and women with perianal condyloma?m Men and women with ih transplant-associated associated immunosuppression
32 Before setting up screening Ability to perform cytology Ability to perform HRA and anal biopsies Ability to read cytology and biopsies Ability to perform office-based treatment
33 Before setting up screening Surgeons who understand d AIN to whom you can refer patients as needed
34 Until the definitive studies are done All of the evidence combined suggests that we should be treating HGAIN Proven carcinogenic potential, rising rates of anal cancer, proven prevention in the cervix If feasible, screen and treat t Monitor for progression to anal cancer among those who cannot be treated If screening not feasible, annual DRE
35 Protocol 020 objectives Primary Safety Efficacy: Combined incidence of HPV 6/11/16/18-related external genital lesions: Main study: HM + MSM External genital warts Penile/perianal/perineal i l/ i l intraepithelial ith l neoplasia (PIN) Penile, perianal, or perineal cancer Sub-study: MSM Anal intraepithelial neoplasia (AIN) Anal Cancer Immunogenicity Geometric mean titers, seroconversion Secondary Efficacy: Incidence of persistent HPV 6/11/16/18 infection*
36 Efficacy against persistent anal infection in MSM Per-protocol population Endpoint HPV 6/11/16/18 HPV 6 HPV 11 n #of Cases GARDASIL (N=299) PY At Risk IR per 100 PY at Risk n # of Cases Placebo (N=299) PY at Risk IR per 100 PY at Risk HPV HPV N = Number of subjects randomized to the respective vaccination group who received at least 1 injection. n = Number of subjects who have at least one follow-up visit after Month 7. Efficacy (%) (95% CI) 94.9 (80.4, 99.4) 92.1 (47.2, 99.8) 100 (-15.5, 100) 93.8 (60.0, 99.9) 100 (51.5, 100)
37 Efficacy against HPV 6/11/16/18- related AIN and anal cancer in MSM Per protocol population Quadrivalent HPV vaccine (N=299) Placebo (N=299) HPV 6/11/16/18 related AIN and anal cancer By lesion type AIN 1 n Cases Rate n Cases Rate Efficacy y( (%) Condyloma acuminata Non-acuminate AIN 2 or worse CI (39.6 to 93.3) (16.3 to 93.4) (8.2 to 100) (-33.5 to 90.8) (8.8 to 95.4) AIN (-16.9 to 97.5) AIN 3 Anal cancer NA ( to 96.4) NA Palefsky J, for the Male Quadrivalent HPV Vaccine Efficacy Trial Team. Quadrivalent HPV vaccine efficacy against anal intraepithelial neoplasia in men having sex with men. Presented at: EUROGIN 2010 Congress; February 17-20, 2010; Monte Carlo, Monaco. Abstract SS 19-2.
38 Summary HIV-positive men and women are at unacceptably high risk of anal cancer Screening and treatment t t of HGAIN should be considered in high-risk populations to reduce the risk of progression to cancer HPV vaccines may also reduce the incidence of anal cancer in the future
Update on Anal HPV. Medical Management of AIDS. December 9, Joel Palefsky Department of Medicine University of California, San Francisco
Update on Anal HPV Medical Management of AIDS December 9, 2017 Joel Palefsky Department of Medicine University of California, San Francisco Disclosures Merck and Co- research and travel support Antiva
More informationBottoms UP HIV and Anal Cancer from Screening to Prevention
Bottoms UP HIV and Anal Cancer from Screening to Prevention Paul MacPherson PhD, MD, FRCPC Associate Professor Division of Infectious Diseases University of Ottawa The New Reality Normal or near-normal
More informationShould Anal Pap Smears Be a Standard of Care in HIV Management?
Should Anal Pap Smears Be a Standard of Care in HIV Management? Gordon Dickinson, M.D., FACP Professor of Medicine and Chief Infectious Diseases, Miller School of Medicine Short Answer: NO But 15-20 HPV
More informationCancer in the LGBTQ Community. Katie Imborek, MD Clinical Assistant Professor University of Iowa Department of Family Medicine
+ Cancer in the LGBTQ Community Katie Imborek, MD Clinical Assistant Professor University of Iowa Department of Family Medicine + Objectives Discuss the possible reasons that LGBTQ people have a disproportionate
More informationIS39 CP6108 [1]
112 9 26 2017 40 2018:28:112-118 (human papillomavirus, HPV) DNA 100 16 18 31 33 35 39 45 51 52 56 58 59 68 6 11 26 40 42 53 54 55 61 62 64 66 67 69 70 71 72 73 81 82 83 84 IS39 CP6108 ( ) [1] 2012 588,000
More informationCytyc Corporation - Case Presentation Archive - June 2003
ThinPrep General Cytology History: Asymptomatic 35 Year Old Male Specimen type: Anal Cytology - This specimen was collected using a Dacron swab under proctoscopic visualization. This case was provided
More informationHow might we implement screening for anal cancer in HIV-positive patients?
Objective How might we implement screening for anal cancer in HIV-positive patients? Identify the elements required to set up an anal cancer screening and prevention program J. Michael Berry, MD Associate
More informationHPV-related papillomatous-condylomatous lesions in female anogenital area
HPV-related papillomatous-condylomatous lesions in female anogenital area Theo Panoskaltsis MD, FRCOG, CCST (UK) Epidemiology Anal cancer is increasing in both men and women Groups at risk: - HIV (+)
More informationTreatment of High-Grade Anal Dysplasia. Ross D. Cranston MB ChB MD FRCP Fundació Lluita contra la Sida
Treatment of High-Grade Anal Dysplasia Ross D. Cranston MB ChB MD FRCP Fundació Lluita contra la Sida Context What is the problem? What are we doing about it? What are the ongoing issues? Incidence rate
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 informationTrends in Malignancies Among HIV-Infected Patients. Roger Bedimo, MD, MS VA North Texas Health Care System UT Southwestern Medical Center
Trends in Malignancies Among HIV-Infected Patients Roger Bedimo, MD, MS VA North Texas Health Care System UT Southwestern Medical Center Denver, April 2011 Learning Objectives At the conclusion of this
More informationMEDICAL POLICY EFFECTIVE DATE: 12/20/12 REVISED DATE: 11/21/13, 10/16/14 SUBJECT: HIGH RESOLUTION ANOSCOPY
MEDICAL POLICY PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied.
More informationHPV Epidemiology and Natural History
HPV Epidemiology and Natural History Rachel Winer, PhD, MPH Associate Professor Department of Epidemiology University of Washington School of Public Health rlw@uw.edu Human Papillomavirus (HPV) DNA virus
More informationMEDICAL POLICY SUBJECT: HIGH RESOLUTION ANOSCOPY
MEDICAL POLICY SUBJECT: HIGH RESOLUTION ANOSCOPY PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product (including
More informationHCT Medical Policy. High-Resolution Anoscopy for Evaluation of Anal Lesions Policy # HCT109 Current Effective Date: 10/30/2014.
HCT Medical Policy High-Resolution Anoscopy for Evaluation of Anal Lesions Policy # HCT109 Current Effective Date: 10/30/2014 Medical Policies are developed by HealthyCT to assist in administering plan
More informationAnal Cancer and HPV Related Tumor Prevention
Anal Cancer and HPV Related Tumor Prevention Timothy J. Wilkin, MD, MPH Associate Professor of Medicine Weill Cornell Medicine New York, New York Learning Objectives After attending this presentation,
More informationMEDICAL POLICY SUBJECT: HIGH RESOLUTION ANOSCOPY EFFECTIVE DATE: 12/20/12 REVISED DATE: 11/21/13, 10/16/14, 09/17/15, 9/15/16 ARCHIVED DATE: 09/21/17
MEDICAL POLICY SUBJECT: HIGH RESOLUTION ANOSCOPY PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including
More informationDisclosures 4/27/11! New Developments in HPV Infection 11 for Merck Advisory Board!
New Developments in HPV Infection 11 for 2011 Peter V. Chin-Hong, MD, MAS Division of Infectious Diseases University of California at San Francisco April 28, 2011 AIDS Research Institute http://ari.ucsf.edu
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 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 informationHPV Infection and associated disease among HIV positive individuals. Admire Chikandiwa. Wits RHI
HPV Infection and associated disease among HIV positive individuals Admire Chikandiwa Wits RHI Outline of presentation Introduction Burden of HPV associated diseases The role of HIV and its interaction
More informationPRODUCT INFORMATION GARDASIL 9. [Human Papillomavirus 9-valent (Types 6, 11, 16, 18, 31, 33, 45, 52, 58) vaccine, Recombinant]
PRODUCT INFORMATION GARDASIL 9 [Human Papillomavirus 9-valent (Types 6, 11, 16, 18, 31, 33, 45, 52, 58) vaccine, Recombinant] DESCRIPTION GARDASIL 9 *, Human Papillomavirus 9-valent Vaccine, Recombinant,
More informationACTHIV 2018: A State-of-the-Science Conference for Frontline Health Professionals
ACTHIV 2018: A State-of-the-Science Conference for Frontline Health Professionals ACTHIV 2018: A State-of-the-Science Conference for Frontline Health Professionals Cancer screenings for the HPV Clinician:
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 informationCervical Dysplasia and HPV
Cervical Dysplasia and HPV J. Anthony Rakowski D.O., F.A.C.O.O.G. MSU SCS Board Review Coarse HPV Double stranded DNA virus The HPV infect epithelial cells of the skin and mucous membranes Highest risk
More informationHigh Prevalence of High Grade Anal Intraepithelial Neoplasia in HIV-infected Women Screened for Anal Cancer ACCEPTED
JAIDS Journal of Acquired Immune Deficiency Syndromes Publish Ahead of Print DOI: 10.1097/QAI.0b013e318251afd9 High Prevalence of High Grade Anal Intraepithelial Neoplasia in HIV-infected Women Screened
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 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 informationJean Anderson, MD Catherine Sewell, MD, MPH
Jean Anderson, MD Catherine Sewell, MD, MPH To review diagnosis and management of HPV disease in the setting of HIV infection and address controversies HIV-infected women have: higher prevalence and incidence
More informationTowards the elimination of HPV
Towards the elimination of HPV Richard Hillman June 11th 2018 Potential conflicts of interest Potential Conflicts of Interest Declaration CSL research + travel + support for student MSD International Scientific
More informationHPV From the Bottom Up
HPV From the Bottom Up Evolving Strategies for the Treatment & Prevention of Anal Disease Rebecca A. Levine, MD Assistant Professor of Surgery Colon & Rectal Surgery Montefiore Medical Center Einstein
More informationGuidance Document on HPV Vaccination in Public HIV and STI Clinics
Guidance Document on HPV Vaccination in Public HIV and STI Clinics Version 2.0 26 th October 2018 Contents 1. Introduction and Background... 2 1.1 Introduction... 2 1.2 Background... 2 2. Safety and efficacy
More informationHPV infection and intraepithelial lesions from the anal region: how to diagnose?
HPV infection and intraepithelial lesions from the anal region: how to diagnose? Review Article ABSTRACT In the last years, the prevalence of HPV infection in the anal region has increased, especially
More informationCervical Screening for Dysplasia and Cancer in Patients with HIV
Cervical Screening for Dysplasia and Cancer in Patients with HIV Adult Clinical Guideline from the New York State Department of Health AIDS Institute w w w.hivg uidelines.org Purpose of the Guideline Increase
More informationO RIGINAL P APER. Extending Quadrivalent Human Papilloma Virus (HPV) Vaccination To Males What Is The Current Evidence?
O RIGINAL P APER Extending Quadrivalent Human Papilloma Virus (HPV) Vaccination To Males What Is The Current Evidence? T H E S I N G A P O R E F A M I L Y P H Y S I C I A N V O L 4 1(3) J U L - S E P 2
More informationColposcopy. Attila L Major, MD, PhD
Colposcopy Attila L Major, MD, PhD Histology Colposcopy Cytology It has been estimated that annual Pap smear testing reduces a woman s chance of dying of cervical cancer from 4 in 1000 to about 5 in 10,000
More informationAnal cancer is generally uncommon,1 but
CMAJ Review CME Anal cancer and intraepithelial neoplasia: epidemiology, and prevention of a sexually transmitted disease Richard J. Medford MD, Irving E. Salit MD See also CMAJ Open research article at
More informationHigh Resolution Anoscopy Overview. Naomi Jay, RN, NP, PhD University of California San Francisco
High Resolution Anoscopy Overview Naomi Jay, RN, NP, PhD University of California San Francisco Email: naomi.jay@ycsf.edy Disclosures No Disclosures Definition of HRA Examination of the anus, anal canal
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 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 informationHuman Papillomavirus (HPV) in Patients with HIV.
Human Papillomavirus (HPV) in Patients with HIV www.hivguidelines.org Purpose of the Guideline Increase the numbers of NYS residents with HIV who are screened for HPV-related dysplasia and managed effectively.
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 informationAnal Dysplasia Screening
Ontario Health Technology Assessment Series 2007; Vol. 7, No. 4 Anal Dysplasia Screening An Evidence-Based Analysis June 2007 Medical Advisory Secretariat Ministry of Health and Long-Term Care Suggested
More informationThe promise of HPV vaccines for Cervical (and other genital cancer) prevention
The promise of HPV vaccines for Cervical (and other genital cancer) prevention CONTROVERSIES IN OBSTETRICS GYNECOLOGY & INFERTILITY Barcelona March 27 F. Xavier Bosch Catalan Institute of Oncology CURRENT
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 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 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 informationLABORATORY - PELVIC EXAM STUDIES COLPOSCOPY RESULTS FORM L14
LABORATORY - PELVIC EXAM STUDIES COLPOSCOPY RESULTS FORM L4 ID LABEL HERE ---> - - - VISIT #: FORM COMPLETED BY: VERSION DATE: 09/5/95 ANY MISSING OR INCOMPLETE TEST RESULTS MUST BE EXPLAINED ON THIS FORM.
More informationStudy Number: Title: Rationale: Phase: Study Period Study Design: Centres: Indication Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationMalignancies in HIV. Prof. S. DE WIT Saint-Pierre University Hospital Brussels, Belgium
EACS HIV Summer School 5-9 September 2016 Aix-en-Provence, France Malignancies in HIV Prof. S. DE WIT Saint-Pierre University Hospital Brussels, Belgium HIV and cancer AIDS-defining malignancies: Kaposi
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 informationHistopathology: Cervical HPV and neoplasia
Histopathology: Cervical HPV and neoplasia These presentations are to help you identify basic histopathological features. They do not contain the additional factual information that you need to learn about
More informationINTRODUCTION HUMAN PAPILLOMAVIRUS
INTRODUCTION HUMAN PAPILLOMAVIRUS Professor Anna-Lise Williamson Institute of Infectious Disease and Molecular Medicine, University of Cape Town National Health Laboratory Service, Groote Schuur Hospital
More informationWhat is a Pap Smear and What do the results mean? Maria E Daheri RN Cervical Nurse Case Harris Health System
What is a Pap Smear and What do the results mean? Maria E Daheri RN Cervical Nurse Case Manager @ Harris Health System What is a Pap Smear and when is it recommended? Pap smear The Pap smear is a screening
More informationUnderstanding Your Pap Test Results
Understanding Your Pap Test Results Most laboratories in the United States use a standard set of terms called the Bethesda System to report pap test results. Normal: Pap samples that have no cell abnormalities
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 informationHPV FREE IDAHO. Fundamentals of HPV Bill Atkinson, MD MPH
HPV FREE IDAHO Fundamentals of HPV Bill Atkinson, MD MPH You are the Key to HPV Cancer Prevention William Atkinson, MD, MPH Associate Director for Immunization Education Immunization Action Coalition February
More informationThe Anal Canal: an Important Transition Zone for Rectal Microbicide Development
The Anal Canal: an Important Transition Zone for Rectal Microbicide Development Ross D. Cranston MD FRCP Assistant Professor University of Pittsburgh Plan Anal canal Comparison with the rectum Common anal
More informationWOMEN S INTERAGENCY HIV STUDY LABORATORY - PELVIC EXAM STUDIES COLPOSCOPY RESULTS FORM L14
WOMEN S INTERAGENCY HIV STUDY LABORATORY - PELVIC EXAM STUDIES COLPOSCOPY RESULTS FORM L4 ID LABEL HERE ---> - - - VISIT #: FORM COMPLETED BY: VERSION DATE: 0 / 0 / 6 ANY MISSING OR INCOMPLETE TEST RESULTS
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 informationThe incidence of anal human papillomavirus. Anal Cancer and Screening Guidelines for Human Papillomavirus in Men
Anal Cancer and Screening Guidelines for Human Papillomavirus in Men Richard A. Ortoski, DO Christine S. Kell, PhD The association between human papillomavirus (HPV) and anal cancer and the similarities
More informationAnal Cytology as a Screening Tool for Early Detection of Anal Dysplasia in HIV-infected Women
Anal Cytology as a Screening Tool for Early Detection of Anal Dysplasia in HIV-infected Women ANDREA GINGELMAIER, TOBIAS WEISSENBACHER, BERND KOST, RALPH KAESTNER, MILENA SOVRIC, IOANNIS MYLONAS, KLAUS
More informationLABORATORY - PELVIC EXAM STUDIES COLPOSCOPY RESULTS FORM L14
LABORATORY - PELVIC EXAM STUDIES COLPOSCOPY RESULTS FORM L4 ID LABEL HERE ---> - - - VISIT #: FORM COMPLETED BY: VERSION DATE: 0/0/0 ANY MISSING OR INCOMPLETE TEST RESULTS MUST BE EXPLAINED ON THIS FORM.
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 informationIl percorso sulla diagnosi del carcinoma anale. Cristina Mussini
Il percorso sulla diagsi del carcima anale Cristina Mussini Standardized Incidence Ratio (SIR) of AIDS-defining cancers in 99.309 pts with HIV/AIDS from French registry-linkage study in different cart
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 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 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 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 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 informationHPV VACCINE AND AIN Palefsky NEJM 2011 n=602 MSM 16-26y qhpv = vaccine against HPV 6, 11, 16 and 18 vs placebo They analyzed ITT and per protocol.
ANAL CANCER Updated Mar 2017 by Doreen Ezeife, PGY-5 resident University of Calgary Reviewed by Dr. Lee-Ying (Staff Medical Oncologist, University of Calgary), Dr. Kzyzanowska (Staff Medical Oncologist,
More informationBattle against Human Papilloma Virus (HPV): Expanded Vaccine Recommendations
Battle against Human Papilloma Virus (HPV): Expanded Vaccine Recommendations Sean W. Clark, Pharm.D. PGY-2 Ambulatory Care Resident Duquesne University and The Center for Pharmacy Care I have no relevant
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 informationCarolyn Johnston, MD Clinical Professor University of Michigan and St. Joseph Mercy Hospital Gynecologic Oncology Sept 2014
Carolyn Johnston, MD Clinical Professor University of Michigan and St. Joseph Mercy Hospital Gynecologic Oncology Sept 2014 HPV is the most common sexually transmitted infection in the USA Small DNA virus
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 informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 6, Issue 5 2016 Article 1 High Resolution Anoscopy In A High Risk Population: A Retrospective Review Of 61 Patients Erich M. Wessel Mazin Al-Kasspooles Peter
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 informationAnal cancer prevention strategies including screening for HPV-related diseases in HIV-positive patients
Anal cancer prevention strategies including screening for HPV-related diseases in HIV-positive patients Charles JN Lacey, Centre for Immunology and Infection, University of York, York, United Kingdom One
More informationHPV Vaccine Ina Park, MD, MS
HPV Vaccine Ina Park, MD, MS California Department of Public Health STD Control Branch Alameda County Immunization Update 2014 Over 170 types of HPV classified Updated incidence/prevalence estimates (CDC):
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 informationHPV AND CERVICAL CANCER
HPV AND CERVICAL CANCER DR SANDJONG TIECHOU ISAAC DELON Postgraduate Training in Reproductive Health Research Faculty of Medicine, University of Yaoundé 2007 INTRODUCTION CERVICAL CANCER IS THE SECOND
More informationProtocol. This trial protocol has been provided by the authors to give readers additional information about their work.
Protocol This trial protocol has been provided by the authors to give readers additional information about their work. Protocol for: Palefsky JM, Giuliano AR, Goldstone S, et al. HPV vaccine against anal
More informationAging and Cancer in HIV
Aging and Cancer in HIV Ronald Mitsuyasu, MD Professor of Medicine Director, UCLA Center for Clinical AIDS Research and Education Group Chairman, AIDS Malignancy Consortium (AMC) Age distribution of HIV-infected
More informationHigh Rates of Anal High-Grade Squamous Intraepithelial Lesions in HIV-Infected Women Who Do Not Meet Screening Guidelines
Clinical Infectious Diseases MAJOR ARTICLE High Rates of Anal High-Grade Squamous Intraepithelial Lesions in HIV-Infected Women Who Do Not Meet Screening Guidelines Michael Gaisa, 1 Fanny Ita-Nagy, 1 Keith
More informationHPV-Associated Disease and Prevention
HPV-Associated Disease and Prevention Odessa Regional Medical Center May 28, 2015 Erich M. Sturgis, MD, MPH Professor Department of Head & Neck Surgery Department of Epidemiology Christopher & Susan Damico
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,500 108,000 1.7 M Open access books available International authors and editors Downloads Our
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 informationOpinion: Cervical cancer a vaccine preventable disease
Opinion: Cervical cancer a vaccine preventable disease Leon Snyman Principal specialist at the Department of Obstetrics and Gynaecology, Gynaecological Oncology unit, University of Pretoria and Kalafong
More informationCytology/Biopsy/Leep Gynecologic Correlation: Practical Considerations and Approaches.
Cytology/Biopsy/Leep Gynecologic Correlation: Practical Considerations and Approaches. Fadi W. Abdul-Karim MD MEd. Professor of Pathology. Vice chair for education. Robert Tomsich Pathology and Lab Med
More informationGuidelines for Preventative Health Care in LGBT Populations
+ Guidelines for Preventative Health Care in LGBT Populations Katie Imborek, MD Department of Family Medicine Co-Director UI LGBTQ Clinic April 2 nd, 2014 + Objectives n Understand CDC screening guidelines
More informationThe successful case of HPV prophylactic vaccines
7th LA Congress of Clinical Research São Paulo, November 12, 2010 Brazilian Experience on Translational Medicine: The successful case of HPV prophylactic vaccines Luisa Lina Villa, Ph.D. Ludwig Institute
More informationHPV & RELATED DISEASES
GAY MEN, HPV & ANAL CANCER THEBOTTOMLINE.ORG.AU HPV & RELATED DISEASES WHAT IS HPV? The Human Papilloma Virus (HPV) is not one virus, but a family of about 200 different ones that cause common warts, genital
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 informationCervical Cancer : Pap smear
Taking a PAP SMEAR Cervical Cancer : Pap smear George N Papanicolaou introduced cervical cytology in clinical practice in 1940 In 1945, PAP smear was endorsed by American cancer society as an effective
More informationImmunogenicity, efficacy and safety of quadrivalent HPV. vaccine in men: a systematic review & meta-analysis
Immunogenicity, efficacy and safety of quadrivalent HPV vaccine in men: a systematic review & meta-analysis Keywords: Human papillomavirus, quadrivalent vaccine, men, systemic review, meta-analysis Word
More informationPromoting Cervical Screening Information for Health Professionals. Cervical Cancer
Promoting Cervical Screening Information for Health Professionals Cervical Cancer PapScreen Victoria Cancer Council Victoria 1 Rathdowne St Carlton VIC 3053 Telephone: (03) 635 5147 Fax: (03) 9635 5360
More informationCervical Screening Recommendation for non HIV-infected Immunosuppressed Women
Cervical Screening Recommendation for non HIV-infected Immunosuppressed Women Chair: Anna-Barbara Moscicki Team (in alphabetic order): Lisa Flowers, Michael Gold, Megan Huchko, Margaret Long, Kathy MacLaughlin,
More informationAnale intraepitheliale Neoplasien (AIN) Workshop 2018
Anale intraepitheliale Neoplasien (AIN) Workshop 2018 Diagnostics, Follow-Up and Vaccination Gastroenterologie Kantonsspital St. Gallen Diagnostics Region of Interest The Tools High Resolution Anoscopy
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 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 information