Lecture 10
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hpv 16 and 18 account for how many % of cases
70%
true or false: once you get hpv, you will get cancer for sure
nah usually it is persistent infections that cause cancer
true or false: most hpv infections spontaneously regress
true
true or false: grade 3 hpv infection is cancer
nah it is still pre-cancer but still very close to cancer
what is a colposcopy
-done after a weird pap test -insert a vaginal speculum and then you insert a beam of light to see the cervix
what does a high grade hov infection looks like
-it looks super red and looks swollen
what is mostly used to see the state of the basal membrane in cervix
histology to see the fucked up cells
CIN grade 1: regression, persistence, progression to CIN 3 and progression towards cancer
-regression: 57% -Persistence: 32% -progression to cin3: 11% -Progression towards invasive cancer: 1%
CIN grade 2: regression, persistence, progression to CIN 3 and progression towards cancer
-regression: 43% -Persistence: 35% -progression to cin3: 22% -Progression towards invasive cancer: 5%
CIN grade 3: regression, persistence, progression to CIN 3 and progression towards cancer
-regression: 32% -Persistence: <56% -progression to cin3: we dunno % -Progression towards invasive cancer: >12%
treatment of cervical pre-cancer: less invasive
-loop electrocautery: excisitional procedure; basically you take off what is the weird cells -cold knife conization: you make a weird cone and you take off what is fucked up: more invasive
treatment of cervical pre-cancer: more invasive
-radical hysterectomy -intensity modulated radiotherapy; basically targetted
what is the 4th common female malignancy wolrdwide
cervical cancer
how many deaths and new cases of cervical cancer a year
-570 000 cases per year -311 000 deaths anually
where do cervical cancer deaths happen
mostly in poor countried 90%
what is the goal for elimination as a public health problem: cervical cancer
4 per 100 000 women-years for elimination as a public health problem;
cervical cancer: 90-70-90 targets by 2030:
• 90% of girls fully vaccinated with HPV vaccine by age 15 years. • 70% of women are screened with a high- performance test by 35 years of age and again by 45 years of age • 90% of women identified with cervical disease receive treatment (90% of women with precancer treated, and 90% of women with invasive cancer managed).
Screening reduced cervical cancer incidence by
80%
true or false: pap smear has low sensitivity
yeah, a lot of false negatives
US spends more than $… on cervical cancer screening annually.
7 billion
hpv: Three screening options
• HPV with cytology (cotesting) • HPV testing with genotyping and reflex cytology (primary HPV testing) • Cytology alone
Primary hrHPV Testing: advantages
• Improved sensitivity for CIN3+ over cytology alone (↑detection by 50%) • Potential for self-collection • Improve access: you can do it at home
Primary hrHPV Testing: disadvantages
• Lack of specificity (↑colposcopy referral by ~50%) • Requires change in infrastructure • Requires healthcare provider and patient education
What happens after a positive HPV test result?
cytology and genotype to see which type of hpv