HPV and cervical screening Test of cure

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HPV and cervical screeningTest of cure

• Dr Matt Hewitt

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Cervical cancer in Ireland key statistics
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Key points prevention of deaths from cervical
cancer
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CERVIX
SQ squamous epithelium COL Columnar
epithelium
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HPV
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Natural history of HPV infection
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Natural history of CIN
Observe Treat (LLETZ)
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Metaplasia
Cancer
CIN I
CIN II
CIN III
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Use of HPV in screening

• In the management of women with low grade sears
• In the follow up of women who have had treatment
• Future use of HPV in screening

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Low grade smears

• Very common
• Fill the colposcopy clinic with patients
• Majority of low grade CIN will resolve
  spontaneously
• Low grade CIN natural response to HPV infection
• Patient anxiety
• Cost
• How to overcome these problems?
• Use of HPV in low grade disease in colposcopy
• Use of HPV in primary care

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Future screening protocols

• Incorporate HPV in primary care screening
• If Low grade smear and negative HPV avoid colp
  referral
• Advantages
• Cost saving
• Reduced anxiety in colposcopy referral
• Avoid unnecessary treatment

• Disadvantage
• Counselling women about HPV infection

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Options for follow-up after treatment
Cumulative incidence of CIN3
Dillner, J. et al. BMJ 2008
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Follow-up after treatment
Traditional strategy
New strategy
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HPV 16 and 18
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Advantages of introducing the vaccine

• Reduced incidence of cervical cancer (adeno and
  squamous)
• Reduced incidence of genital warts
• Reduce the incidence of genital cancer
• Reduced incidence of some head and neck cancers
• Potential to stop the cervical cancer screening
  programme
• Greater impact in developing countries where
  there is no cervical screening

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Disadvantages of introducing the vaccine

• Cost
• Only covers 70 75 of cervical cancers
• ?Increased promiscuity
• Ethical issues of vaccination of teenage girls
• Delivery to young girls counselling issues
• Decreased uptake of smears in screening programme
• Future role of colposcopy services
• Long term efficacy
• Side effects
• Bad publicity

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IMPACT OF VACCINE AND DURATION OF PROTECTION
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10 year protection no screening
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MORTALITY FROM CERVICAL CANCER DEATHS (PER
100,000 PER YEAR)
Screening no vaccination
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10 year protection screening
Lifelong no screening
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Lifelong protection screening
0
0
10
20
30
40
50
TIME SINCE START OF VACCINATION PROGRAM
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Thank You