WK 12 DISCUSSION ON CERVICAL CANCER

The purpose of this post is to answer the following questions in the below case scenario. A brief overview of the Human Papilloma Virus (HPV) will be provided at the beginning of the post.

HPV

HPV is the most common cause of viral infection in the reproductive tract. It is a sexually transmitted infection (STI) but can be transmitted orally. Most HPV infections are self-limiting and do not require treatment. HPV is strongly linked to several cancers, cervical, vaginal, vulvar, penile, anal, and throat cancer amongst others (Meites et al., 2019). An HPV vaccine is available and routinely recommended for later cancer prevention.

An 18-year-old is accompanied by her mother for her first visit to the gynecologist. She has never been sexually active. She has no concerns with her menses. Her mom reports that she brought her in “because she is 18 and when I turned 18, I had to get my first Pap smear.” Her mother requests the patient have a Pap smear and be tested for HPV “just in case.” The patient is up to date on all vaccines “mandatory for school” but has never had the HPV vaccine.

1. What are the recommendations on the HPV vaccine?

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination for both boys and girls from age 11-12 years through 26 years of age, vaccination can begin as early as 9 years of age. Additionally, individuals who have never has the HPV vaccine, ‘catch-up’ is advised through the age of 26 years (Meites et al., 2019).

2. How would you counsel this patient about the HPV vaccine?

Given the above information, the patient has no contraindications for the HPV vaccine. It is important that this patient receive the HPV vaccine today because HPV infection is prevalent and often occurs after the first sexual encounter. Additionally, the earlier the age that the HPV vaccine is administered, the better the outcome as it has shown to produce a stronger protective effect in younger patients (Meites et al., 2019). Moreover, over 30, 000 men and women are diagnosed with HPV related cancers annually in the United States (Moreno, 2019). As such, the benefits of the HPV vaccine cannot be overstated.

3. What are the current ASCCP guidelines for Pap smears and HPV testing?

The American Society for Colposcopy and Cervical Pathology (ASCCP) recommends that the pap test screening begins at the age of 21-29 years and be repeated every 3 years if the initial screen is normal, this test checks for abnormal cell changes in the cervix.  HPV testing is not recommended at this time except in cases of an abnormal pap test (American Cancer Society, n.d).

The ASCCP recommends co-testing (HPV test and Pat test) for females aged 30-65 years of age and repeat every 5 years if the screen is normal. However, if HPV testing is not available or via patient preference, the Pap test can suffice every 3 years. Note however that their preferred screening is the co-testing. In women over 65 years of age who have had normal screens, HPV and pap testing are not recommended as they are deemed low risk (American Cancer Society, n.d).

4. How will you explain the rationale to the patient and the mother?

Given that the patient has never been sexually active, chances of her having HPV are minimal and it is not recommended she get HPV testing today. But as explained above, she should get the HPV vaccine as a preventative measure for HPV and HPV-related cancers. However, the patient should also be educated about safe sex practices for when she does decide to be sexually active. Some of this would be using protection such as condoms and having one sexual partner. The patient should also be taught that sexual contact includes oral sex.

Summary

The HPV vaccine has been successful in the reduction of HPV related cancers such as cervical cancer. In fact, the Center for Disease Control and Prevention (2019) reported that the HPV vaccine has been shown to have dropped HPV infection among teenage girls by approximately 86 % and HPV related cancer in adult women by 40% (CDC, 2019). What’s more, the vaccine has been shown to be safe and has not been found to increase sexual activity in adolescents as has been feared by some parents (CDC, 2019).

References

American Cancer Society. (n.d.). The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer. https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html

Centers for Disease Control and Prevention. (2019, August 15). Vaccinating Boys and Girls. https://www.cdc.gov/hpv/parents/vaccine.html

Meites, E., Szilagyi, P. G., Chesson, H. W., Unger, E. R., Romero, J. R., & Markowitz, L. E. (2019). Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR. Morbidity and Mortality Weekly Report, 68(32), 698–702. https://doi.org/10.15585/mmwr.mm6832a3

Moreno, M. A. (2019, February 1). Human papillomavirus vaccination. JAMA Network | Home of JAMA and the Specialty Journals of the American Medical Association. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2718502