HPV Information for Nurses

1
HPV Information forNurses

• Judith Gedrose
• jgedrose_at_mt.gov
• 406 444 4560

2
HPV

• Relationship between cervical cancer and sexual
  activity suspected studied for 100 years
• 40 types infect mucosal epithelium
• Oncogenictypes 16,18 and thirteen others
• 16 18 involved in 70 of cervical cancers
• 99 of cervical cancer cases have HPV detectable
• HPV is necessary for development of CA
• Not sufficient to cause cancer by themselves

3
Conditions Associated with HPV

• Cervical Invasive Neoplasia (CIN)
• Cervical cancer
• Genital warts
• Recurrent respiratory papillomatosis (RRP)
• Anal cancer
• Vulvular cancer
• Penile cancer
• Head and neck cancers

4
Pathogenesis

• Most HPV infections resolve spontaneously
• Progression to cervical intraepithelial neoplasia
  type 1 2 are cancer precursors
• Digene Hybrid Capture2 (hc2) is only DNA test
  approved ( only way to detect HPV)
• Mostly sexual transmission (intimate contact)
  can be transmitted to neonate during birth
  process
• 9700 new cases of cervical CA in U.S./yr cost of
  4 billion per year to manage HPV sequelae

5
Burden Of Cervical Cancer In Montana

• Montana Cervical Cancer
• 8 cases per 100,000 women at risk diagnosed
  each year
• Fewer than 2 deaths per 100,000 women
  Consistent with the national
• Carol Ballew, PhD, the epidemiologist for the
  Cancer Control Section at the Montana Department
  of Public Health and Human Services in
  presentation to Cervical Cancer Task Force

6
Epidemiology Of Cervical Cancer

• 95 of women who are diagnosed with cervical
  cancer have evidence of a prior infection with
  HPV
• HPV incorporates into DNA of cervical cells and
  becomes permanent
• Cell cant maintain normal function
• Infection with HPV not synonymous with
  incorporation not all strains associated with
  increased risk of cervical cancer
• Most women spontaneously clear infection
• Some go on to CIN, cervical cancer, genital warts
  
• Not known how many women who have HPV DNA
  incorporation go onto cervical cancer
• 70 of cervical cancer cases have HPV strains 16
  18 associated
• 90 of genital warts and laryngeal papilloma
  infection have an association with HPV strains 6
  11
• Carol Ballew, PhD, the epidemiologist for the
  Cancer Control Section at the Montana Department
  of Public Health and Human Services in
  presentation to Cervical Cancer Task Force

7
Cost-effectiveness Of Vaccination By Age Groups
Goldie/Kim Model

• The cost per QALY (quality-adjusted life year) is
  the incremental cost-effectiveness . These costs
  include continued pap smear cervical cancer
  screening, which must be done, after vaccination
  for HPV.
• 
  
• Ages vaccinated Cost per
  QALY (CIN, cervical cancer, warts, RRP)
• 11-12 40,000
• 11-18 90,000
• 11-21
  100,000
• 11-26
  125,000
• RRP recurrent respiratory papillomatosis
• Chesson H.(2008). Cost-effectiveness of HPV
  vaccination in the U.S. Centers for Disease
  Control, ACIP Presentation Slides February 2008
  Meeting.

8
Cost-effectiveness Of Vaccination By Age

• Ages vaccinated Cost per QALY gained
• No vaccination -
• 12 8,600
• 12-18 10,900
• 12-21 31,800
• 12-24 60,900
• 12-26 92,300
• 12-29 141,700
• 12-34 226,100
• Chesson H.(2008). Cost-effectiveness of HPV
  vaccination in the U.S. Centers for Disease
  Control, ACIP Presentation Slides February 2008
  Meeting. ACIP Presentation Slides February 2008
  Meeting (CDC website)

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HPV Vaccination Of 12-year-old Girls

• Cost-effective by usual standards
• 3,000 to 24,000 per QALY gained
• More cost-effective when including protection
  against HPV 6/11
• Indirect effects (herd immunity)
• Consistent results across range of different
  models
• Chesson H.(2008). Cost-effectiveness of HPV
  vaccination in the U.S. Centers for Disease
  Control, ACIP Presentation Slides February 2008
  Meeting.
• Quality-adjusted life year