Title in Initial Caps: 40point Arial

1
(No Transcript)
2
Managing HPV A New Era in Patient Care

• Presented By
• Association of Reproductive Health Professionals
  www.arhp.org
• Planned Parenthood Federation of America
• www.ppfa.org

3
Expert Medical Advisory Committee

• Nancy R. Berman, MSN, APRN, BC
• Barbara Clark, MPAS, PA-C
• Don Downing, RPh
• Francisco Garcia, MD, MPH
• Sherri Sheinfeld Gorin, PhD
• Richard Guido, MD
• Julie Hibben, LMSW, CPSI

Required Slide
more
4
Expert Medical Advisory Committee (Continued)

• Mary M. Rubin, RNC, PhD, CRNP
• Marie Savard, MD
• Anafidelia Tavares, MD, MPH
• Maria Trent, MD, MPH
• Jeffrey Waldman, MD
• Thomas C. Wright, Jr, MD

5
Module 6 Anal Cancer Screening
6
Learning Objectives

• Discuss HPV-associated anal lesions
• Identify 3 risk factors for development of
  HPV-associated anal lesions
• Discuss the status of current recommendations for
  anal cancer screening

7
HPV-Associated Anal Lesions

• Anal cancer is associated high-risk types of HPV
  (16 and 18 are identified in about 80)
• 4,650 estimated cases in the United States (2007)
• Estimated annual mortality 260 men and 430 women

more
Daling JR. Cancer. 2004 Frisch M. Am J Epidem.
2003.
8
HPV-Associated Anal Lesions (Continued)

• Risk factors
• 15 or more lifetime sexual partners
• Receptive anal intercourse
• Current smoking
• In women, history of CIN
• HIV infection

more
Daling JR. Cancer. 2004 Frisch M. Am J Epidem.
2003.
9
HPV-Associated Anal Lesions (Continued)

• High-grade precursor lesions called anal
  intraepithelial neoplasia (AIN)
• High prevalence of anal HPV infections and AIN in
  selected populations including MSM and
  HIV-infected individuals
• In one study 95 of 357 gay males had anal HPV
  and 50 had high-grade AIN

Palefsky JM. AIDS. 2005.
10
Anal Lesions in HIV-Infected People MSM
N67
Picketty C. Ann Inter Med. 2003.
11
Anal Lesions in HIV-Infected People IV Drug
Users
N50
Picketty C. Ann Inter Med. 2003.
12
Screening for AIN and Anal Cancer

• Role of routine screening for AIN and anal cancer
  is controversial
• Advocates for screening note
• Cytology is as effective for detecting anal
  disease as for cervical disease
• Cost-effective studies suggest anal screening is
  an attractive option

more
CDC. MMWR (RR-8). 2002.
13
Screening for AIN and Anal Cancer (Continued)

• Opponents note
• Treatments for AIN often fail and there is no
  data that treatment prevents cancer

CDC. MMWR (RR-8). 2002.
14
2007 Anal Cytology Screening Recommendations

• Routine anal cytology screening is NOT
  recommended by CDC, USPSTF, ACS, or ISDA
• National Guidelines Clearinghouse has no
  guidelines for anal cytology screening
• However New York State Department of Health now
  recommends anal cytology for HIV-infected
  individuals who 1) are MSM, 2) have had genital
  warts or 3) have had CIN

New York State Dept of Health. www.hivguidelines.o
rg.
15
Expert Medical Advisory Committee
InsertPhotoHere
Nancy R. Berman, MSN, APRN, BC Northwest
Internal Medicine Associates Southfield, MI
InsertPhotoHere
Barbara Clark, MPAS, PA-C Knox OB/GYN,
Ltd. Galesburg, IL
Don Downing, RPh Clinical Associate Professor,
Department of Pharmacy Institute for Innovative
Pharmacy Practice University of Washington School
of Pharmacy Seattle, WA
InsertPhotoHere
more
16
Expert Medical Advisory Committee (Continued)
Francisco Garcia, MD, MPH (Chair) Associate
Professor Director, Division of Gynecology
University of Arizona Tuscon, AZ
InsertPhotoHere
InsertPhotoHere
Sherri Sheinfeld Gorin, PhD Associate Professor
of Health and Social Behavior Columbia
University New York, NY
Richard Guido, MD Associate Professor of
Obstetrics/Gynecology Reproductive
Services University of Pittsburgh Pittsburgh, PA
InsertPhotoHere
more
17
Expert Medical Advisory Committee (Continued)
Julie Hibben, LMSW, CPSI Director of Education
Community Outreach Planned Parenthood of Greater
Iowa Des Moines, IA
InsertPhotoHere
Marie Savard, MD Author and Private Practice
Internal Medicine and Womens Health Wynnewood,
PA
InsertPhotoHere
Mary M. Rubin, RNC, PhD, CRNP Associate Clinical
Professor School of Nursing Gyn Oncology Clinical
Research Coordinator University of California San
Francisco San Francisco, CA
InsertPhotoHere
more
18
Expert Medical Advisory Committee (Continued)
InsertPhotoHere
Anafidelia Tavares, MD, MPH Director, The ISIS
Project The Balm in Gilead, Inc New York, NY
InsertPhotoHere
Maria Trent, MD, MPH Assistant Professor,
General Pediatrics and Adolescent Medicine Johns
Hopkins University Hospital Baltimore, MD
InsertPhotoHere
Jeff Waldman, MD Senior Director, Clinical
Services and Medical Education Planned Parenthood
Federation of America New York, NY
more
19
Expert Medical Advisory Committee (Continued)
InsertPhotoHere
Thomas C. Wright, Jr, MD Pathology Columbia
University New York, NY
20
(No Transcript)