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    Know Your Risk
    for Cervical Cancer?

    A discussion guide on HPV & cervical cancer screening for healthcare providers and their patients.

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  • Cervical Cancer & HPV

    Why is cervical health &
    HPV screening important?

  • Cervical Cancer & HPV

    Cervical cancer & HPV 101

    Cervical cancer is the second most common cancer in women worldwide, and
    HPV (human papillomavirus) is the cause.1

    HPV's role in cervical cancer

    • Cervical cancer is caused by a persistent HPV infection
    • HPV can cause cervical dysplasia or the growth of abnormal cells, which after some period of time can change into cervical cancer
    • Certain genotypes of the HPV virus are associated with cervical cancer

    HPV can happen to anyone.

    • Many estimates have placed the lifetime likelihood of getting genital HPV to be in the range of 75-90%2 — if you test positive for HPV, it is not a reflection on you or your lifestyle, as it is common in intimate
    • relationships. In fact, 80% of all women will have had HPV by the time they are 50 years of age.
    • Anyone can have a positive HPV test result even if you are in a monogamous long-term relationship. The infection can stay dormant for years before it is detected.
    • Most HPV infections have no symptoms, are harmless and are cleared by the body's natural immune system. However, in some cases, infections will persist.
    • Not all women who have HPV will develop cervical cancer.
    • There is good news for women who have an HPV infection and who are at high risk for cervical cancer. Cervical cancer is highly
    • preventable when identified and treated early.

    How do you know if you are at high risk for cervical cancer?

    Certain types of HPV put you at a higher risk to develop cervical cancer than others. You will want to know if you have certain types of HPV because timely detection can prevent cervical cancer from developing.

    You have a very low risk of developing cervical cancer within the next few years if your Pap test is normal and you are HPV negative.3

  • Cervical Cancer & HPV

    The cervix explained

    Cervical cancer starts in the cervix.

    • The cervix is lined with a layer of cells called epithelial cells, which are found throughout the body.
    • It is called cervical pre-cancer when cells seem significantly abnormal (but not cancerous), and it is critical to detect changes at this stage when progression to cervical cancer can be prevented.

    There are two types of cervical cancer.4

    • Squamous cell carcinomas begin in epithelial cells and account for about 80%–90% of all cervical cancers.
    • Adenocarcinomas begin in glandular tissue and account for 10%–20% of all cervical cancers.
    • Uterus
    • Glandular Region
    • Flat Squamous Cells
    • Vagina
    More Info
  • Cervical Cancer & HPV

    Types of HPV

    There are over 100 HPV types (genotypes), but only 14 types are considered high-risk for cervical cancer.
    Types 16 & 18 are the highest risk of all as they are strongly linked to cervical cancer.

    Low-risk HPV Genotypes

    Low-risk HPV genotypes7: HPV 6, 11, 34, 40, 42, 43, 44, 53, 54, 61, 72, 73 & 81
    Low risk of cervical cancer

    High-risk HPV Genotypes

    High-risk HPV genotypes8: HPV 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68
    May cause cervical cancer

    Highest-risk HPV Genotypes

    Highest-risk HPV genotypes9:
    HPV 16 and 18
    Strongly linked to cervical cancer

  • Prevention & Detection

    Take charge of your health for
    cervical cancer prevention.

  • Prevention & Detection

    Three ways to detect and/or prevent cervical cancer

    Pap test or cytology-based screening

    Cervical cells are collected and sent to a lab where they are examined for any abnormalities.

    HPV or molecular DNA testing

    HPV testing can be conducted by using a sample of cervical cells collected during a Pap test (co-testing).* If a Pap test alone is ordered, and the result is abnormal, then your provider may order an HPV test at that time. An HPV test is used to detect the presence of high-risk HPV genotypes that can lead to cervical cancer.

    HPV vaccine

    This vaccine prevents HPV infection associated with the development of cervical cancer. While the vaccine covers the two highest risk genotypes, HPV 16 & 18, experts still recommend you get a regular Pap test and/or HPV test after vaccination.

    * The cobas® HPV Test is approved with cervical cytology to adjunctively screen women 30 years and older.

  • Prevention & Detection

    Decode the Pap test results

    A Pap test is done to check for signs of any abnormal cell changes in your cervix. Before turning into cancer, cells go through a series of changes, and a Pap test often detects those changes long before you actually have cancer.

    Three categories that describe the possible cell abnormalities in a Pap test:
    ASC-US or "atypical squamous cells of undetermined significance"

    What it means:

    Some of your cells are not normal or "typical." This is usually not serious and may be caused by vaginal infection or HPV.9

    LSIL or "low-grade squamous intraepithelial lesion"

    What it means:

    There are changes in the size and appearance of your cells, and these lesions are often associated with the presence of an HPV infection. You and your doctor will determine next steps.9

    HSIL or "high-grade squamous intraepithelial lesion"

    What it means:

    High-grade lesions may lead to cervical cancer. You and your doctor will discuss next steps.9

  • Prevention & Detection

    Keep your annual exam

    An annual wellness exam keeps you healthy.10

    Many women feel that if they don't need a Pap test every year, then they don't need to go to the doctor at all. When your appointment doesn't require a Pap test, you should still go to the doctor for a "well-woman" visit. You can use this additional time with your healthcare provider to discuss other health concerns, such as:

    • The importance of health screening and evaluation
    • Family planning
    • Counseling on menopause and/or osteoporosis prevention
    • Referral for mammography and colorectal screening
    • Gynecologic physical exam (including a pelvic exam)
    • Detection and screening for disease: diabetes, cardiovascular, cancers (skin, colorectal [via colonoscopy], breast [via mammogram], cervical), smoking/substance abuse, osteoporosis, bone density, thyroid
    • Personal issues (sexual, depression, mood disorders, domestic violence)
    • Exercise and nutrition
  • cobas® HPV Test

    How do you know if you have increased risk for cervical cancer?

    The cobas® HPV Test gives you pooled results for the 12 high-risk
    HPV types and individual results for the two highest-risk types 16 & 18,
    providing your doctor with your complete risk information – all in one test.

  • cobas® HPV Test

    Screening with the cobas® HPV Test

    Approximately two-thirds of all cases of cervical cancer are caused by HPV genotypes 16 & 18.11 Women who are HPV 16 positive and/or 18 positive are 35 times more likely to have cervical pre-cancer than those who are HPV negative.12

    Determining if you are positive specifically for HPV types 16 & 18 helps your doctor detect pre-cervical cancer that cytology (Pap) screening alone can miss. The cobas® HPV Test can make the difference in timely detection so your doctor can make immediate treatment decisions.

    Most HPV tests:

    • "pool" the 14 high-risk types (genotypes)
    • give you only a negative or positive result for all high-risk HPV types
    16, 18, 31,
    33, 35, 39, 45,
    51, 52, 56, 58,
    59, 66, 68
    Most HPV tests will report a
    positive result if one genotype
    of HPV is detected.

    The cobas® HPV Test:

    • gives a pooled result for the 12 high-risk types
    • provides individual results for the two highest risk types HPV 16 & HPV 18
    31, 33, 35,
    39, 45, 51, 52,
    56, 58, 59,
    66, 68
    16
    18
    cobas® HPV Test
    (two individual results +
    one pooled result)

    The cobas® HPV Test provides risk information so your doctor can make immediate treatment decisions.

  • Positive HPV Test Results

    What if my
    HPV test is positive?

  • Positive HPV Test Results

    Understanding your HPV test results

    If you have an HPV positive test result, you and your doctor will discuss one of three possible scenarios:13

    Pap abnormal and HPV positive
    (any one of the high-risk types in a pooled test)

    • Your doctor may discuss colposcopy as the next step for prevention

    Pap normal and HPV positive
    (all high-risk types)

    • This is possible, as it's hard to know if your Pap test result
      is truly normal, or if the test may have missed cervical abnormalities
    • You have different options, which you can discuss with your doctor, based on the guidelines your doctor follows
    • You can wait a year and then come back for a repeat Pap test and HPV test OR
    • You can find out now. An HPV genotyping test can help
      you find out if you have the HPV types that put you at highest risk for cervical cancer

    HPV 16 or HPV 16/18 status

    • If you are HPV 16 positive or 16/18 positive, your doctor may discuss colposcopy as the next step for prevention
    • If you are HPV positive but do not have the highest risk genotypes 16 or 18, your doctor may advise you to return
      for a follow-up Pap test and HPV test. Depending upon your age and national screening guidelines, your doctor may recommend a follow-up Pap test and HPV test.

    Find out your cervical cancer risk today.

  • Positive HPV Test Results

    Colposcopy 101: A closer look

    This simple 10-15 minute procedure is typically performed in a gynecologist's office and may help identify problems that could be missed by the naked eye.

    When do you need it?:

    You and your doctor may discuss colposcopy if significant cervical abnormality is suspected, i.e., if you have a Pap test result that indicates cervical dysplasia or your HPV testing shows that you are positive for HPV genotypes 16 and/or 18.

    Procedure:

    Your gynecologist will use a colposcope, which is a lighted magnifying device. The coloposcope allows your doctor to get a better view of your cervix at a cellular level;
    it helps your doctor to see problems that

    might be missed by the naked eye.

    During the exam, a tissue sample or cervical biopsy may be taken and sent to the lab for analysis to determine if there is any cervical pre-cancer or existing cancer— you may experience cramping or pinching during a biopsy. Afterwards, you may feel some soreness and may have some vaginal bleeding or discharge.

    Risks and benefits of colposcopy:

    • A cervical biopsy can cause infection (rarely) or bleeding (which is usually easily controlled).
    • The benefits far outweigh the risks, as a colposcopy can tell whether you need further intervention to prevent cervical cancer.

    If you and your doctor discuss a colposcopy, it does not mean you have cervical cancer—it is an important step toward prevention.

  • Additional Resources

    How can I get more
    information on HPV?

  • Additional Resources

    HPV Frequently Asked Questions

    • If I have HPV, does that mean my partner has been unfaithful?
      Close
      ANSWER:

      No. Even if you have been in a monogamous, long-term relationship, you could still test positive, as the infection can stay dormant (latent) for years and years before it is detected. In fact, 85% of HPV detections occur during periods of monogamy or abstinence.14 Remember, a positive HPV test result can happen to anyone. It is not a reflection on you, your partner or your lifestyle.

    • If I have an HPV infection, will I have it forever?
      Close
      ANSWER:

      The Centers for Disease Control and Prevention (CDC) estimates that over 90% of HPV infections are naturally cleared by the body within two years.15 However, it is not fully understood whether the virus is 100% gone or merely suppressed to a low, undetectable level. But the virus can reactivate years later. Your doctor may order an HPV test if your Pap test results are inconclusive or if HPV DNA testing is part of the guidelines followed by your doctor.

    • Can HPV cause any other kind of cancer?
      Close
      ANSWER:

      Cervical cancer is the most prevalent cancer associated with HPV. However, according to the American Cancer Society, high-risk types of HPV have been associated with less common cancers of the vulva, vagina and anus. It can also cause cancers in other areas of the body, such as the oral cavity and the throat.16 However, most HPV tests, like the cobas® HPV Test, are only approved for the detection of HPV in cells collected from the cervix.

    • Does using a condom prevent HPV?
      Close
      ANSWER:

      Though condoms can help, they do not prevent HPV, as the virus may be on skin not covered by a condom. The virus is spread through direct skin-to-skin contact and could even occur before a condom is put on.

    • Do I need to ask my doctor for an HPV test or will it be automatically given?
      Close
      ANSWER:

      Your doctor may order an HPV test if you are 21 or older and your Pap test results are inconclusive, or if you are 30-65 in conjunction with your Pap test.

  • Additional Resources

    Want to Learn More?

    Download this patient resource guide that provides discussion topics for your wellness exam and online resources about HPV and cervical cancer.

    Download Guide
  • Additional Resources

    References

    1. Herzog TJ, Monk BJ. Reducing the burden of glandular carcinomas of the uterine cervix. Am J Obstet Gynecol. 2007;197(6):566-571.
    2. http://www.asccp.org/PracticeManagement/HPV/NaturalHistoryofHPV/tabid/5962/Default.aspx. Accessed January 11, 2013
    3. CDC National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control. Cervical cancer screening with the HPV test and the Pap test in women ages 30 and older: when to get tested and how to make sense of your test results. 2012:8.
    4. American Cancer Society. Cervical cancer: what is cervical cancer? American Cancer Society Web site. http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-what-is-cervical-cancer. Updated March 14, 2012. Accessed December 2, 2012.
    5. Adapted from: Woodman CB, Collins SI, Young LS. The natural history of cervical HPV infection: unresolved issues. Nat Rev Cancer. 2007;7(1):11-22. doi:10.1038/nrc2050.
    6. Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases (STDs): making sense of your Pap and HPV test results. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/std/hpv/pap/default.htm. Accessed December 2, 2012.
    7. Molano M, van den Brule A, Plummer M, et al. Determinants of clearance of human papillomavirus infections in Colombian women with normal cytology: a population-based, 5-year follow-up study. Am J Epidemiol. 2003;158(5):486-494. doi:10.1093/aje/kwg171.
    8. Rijkaart DC, Berkhof J, Rozendaal L, et al. Human papillomavirus testing for the detection of high-grade cervical intraepithelial neoplasia and cancer: final results of the POBASCAM randomised controlled trial. Lancet Oncol. 2012;13(1):78-88.
    1. CDC National Cancer Institute. Fact sheet: Pap and HPV testing. National Cancer Institute at the National Institutes of Health Web site. http://www.cancer.gov/cancertopics/factsheet/detection/Pap-HPV-testing. Reviewed May 23, 2012. Accessed December 2, 2012.
    2. The American College of Obstetricians and Gynecologists (ACOG). Committee opinion no. 534: well-woman visit. Obstet Gynecol. 2012;120(2):421-424. doi:10.1097/AOG.0b013e3182680517.
    3. CDC National Cancer Institute. Fact sheet: HPV and cancer. National Cancer Institute at the National Institutes of Health Web site. http://www.cancer.gov/cancertopics/factsheet/Risk/HPV. Reviewed March 15, 2012. Accessed December 2, 2102.
    4. Wright TC Jr, Stoler MH, Sharma A, et al. Evaluation of HPV-16 and HPV-18 genotyping for the triage of women with high-risk HPV+ cytology-negative results. Am J Clin Pathol. 2011;136:578-586. doi: 10.1309/AJCPTUS5EXAS6DKZ.
    5. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol. 2012;137(4):516-542.
    6. Rositch AF, Burke AE, Viscidi RP, Silver MI, Chang K, Gravitt PE. Contributions of recent and past sexual partnerships on incident human papillomavirus detection: acquisition and reactivation in older women. Cancer Res. Published OnlineFirst September 27, 2012. doi:10.1158/0008-5472.CAN-12-2635.
    7. Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases (STDs): genital HPV infection - fact sheet. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/std/hpv/stdfact-hpv.htm. Reviewed August 8, 2012. Updated August 9, 2012. Accessed December 2, 2012.
    8. American Cancer Society. Cervical cancer: what is cervical cancer? American Cancer Society Web site. http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-what-is-cervical-cancer. Revised March 14, 2012. Accessed December 2, 2012.